ETHTE #: 13 -5 -32487
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
Name: Fortino & Maria Cruz Phone #: 919 - 842 -9804
Address: PO Box 1238 Broadway NC 27505
Name of Mobile Home Park or S /D:
Name of Owner (if different):
Address of Owner (if different):
Property Location (State Road name and #): 1215 Rosser Pittman Rd
Purpose of Inspection: Man Home Repalcement (28'x76')
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
1� 1' WAR 10
AUTHORIZATION OF EXISTING SYSTEM
Signature of Environment ` Halth Specialist I