ETHTE #: 13 -5 -31544
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
I
Name: James Jackson Phone #: 919- 820 -5366
Address: 436 Oak Valley Farm Rd Coats NC 27521
Name of Mobile Home Park or S /D:
Name of Owner (if different): David Camping
Address of Owner (if different): 215 Collins Rd Lillington NC 27546
Property Location (State Road name and ft Collins Rd
Purpose of Inspection: Detached Garage (28'x32')
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
'
111 MA NO '. 0
AUTHORIZATION OF EXISTING SYSTEM
Signature of Environm n ealth Specialist
RIM
Date