ETHTE #: 13 -5 -30945
HARNETT COUNTY HEALTH. DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
Name: Russell Arnold Phone #: 919- 770 -0176
Address: PO Box 219 Broadway NC 27505
Name of Mobile Home Park or S /D: Riverbend lot 19
Name of Owner (if different):
Address of Owner (if different): 566 Lower River Rd Broadway NC 27505
Property Location (State Road name and #): Lower River Rd
Purpose of Inspection: Front & Back Porch
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
Signature of En
AUTHORIZATION OF EXISTING SYSTEM
_ )5
11th Specialist
ON