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ETHTE #: 15-5-36397 HARNETT COUNTY HEALTH DEPARTMENT ENVIRONMENTAL HEALTH 307 CORNELIUS HARNETT BOULEVARD LILLINGTON, NC 27546 Name: Chris Stevens Phone #: 919-795-5042 Address: 1702 Wade Stephenson Rd. Holly Springs, N.C. 27540 Name of Mobile Home Park or S/D: Name of Owner (if different): Mitchell & Virgina Jackson Address of Owner (if different): 1755 Wade Stephenson Rd Holly Springs, NC 27540 Property Location (State Road name and #): Wade Stephenson Purpose of Inspection: Det. Garage 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 I: 1 ,. 1 11 AUTHORIZATION OF EXISTING SYSTEM e 149 of Environmental Health Specialist 2(;,JZ-,-e�� Date