ETHTE #: 13 -5 -32524
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
Name: Gregory A. Stube Phone #: 919 - 353 -0915
Address: 4010 Hillman Grove Rd. Cameron NC 28326
Name of Mobile Home Park or S /D:
Name of Owner (if different):
Address of Owner (if different):
Property Location (State Road name and #): Hillmon Grove
Purpose of Inspection: Storage Building
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 �
11 H 11 -'A WW IN N-111210
AUTHORIZATION OF EXISTING SYSTEM
AM
of ffnvironrhental Health Specialist Date