ETHTE #: 14 -5 -34389
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
Name: Ronald Lee Holmes Phone #: 910- 691 -1750
Address: 1179 Anderson Creek School Rd Spring Lake, NC 28390
Name of Mobile Home Park or S /D:
Name of Owner (if different):
Address of Owner (if different):
Property Location (State Road name and #): Anderson Creek School
Purpose of Inspection: bedroom addtion (3br total)
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
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AUTHORIZATION OF EXISTING SYSTEM
Z2 - '&/0
Signature of Environmental Health Specialist
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