ETHTE #: 14 -5 -34250
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
Name: Monica Donathan Phone #: 818 -1874
Address: 7885 Broadway, Rd Broadway NC 27505
Name of Mobile Home Park or S /D: Calvin Hardee lot 2
Name of Owner (if different):
Address of Owner (if different):
Property Location (State Road name and #): Broadway Rd
Purpose of Inspection: DWMH Replacement
The aforementioned site has been evaluated by the Harnett County Health Department
Environmental Health Section. At the time of inspection, there appeared to be a septic
system serving this site. If the system should malfunction, the owner is responsible for any
necessary repairs.
THIS INSPECTION IS VOID IF:
1. the intended use of the septic system should change, and /or
2. the system should fail or malfunction, and /or
3. the owner or tenant of the property change, and /or
4. after six months
11 1 1 R MA �;., �,
AUTHORIZATION OF EXISTING SYSTEM
a
Signature of Enviromn lth Specialist