ETHTE #: 13 -5 -31257
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
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Name: CRC Phone #: 910 - 624 -5353
Address: 3756 SYeamord Dairy Rd. Fayettevill, NC 28303
Name of Mobile Home Park or S /D: Cooper Farms lot 3
Name of Owner (if different): Ramon Duverge
Address of Owner (if different): 66 Harding Ln. Cameron, NC 28326
Property Location (State Road name and #): Marks
Purpose of Inspection: Bonus room with closet
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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1 f 1 /. t �, 1
AUTHORIZATION OF EXISTING SYSTEM
S� 3
of Environmental Health Specialist Date