ETHTE #: 15-5-35
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
Name: Erick Gaspar Phone #: 824-3250
Address: 100 JM Kelly Rd Broadway NC 27505
Name of Mobile Home Park or S/D: Troy Willett lot 8
Name of Owner (if different): Joyce & James Phillips
Address of Owner (if different): 148 Big Rock Ln Broadway NC 27330
Property Location (State Road name and #): 1379 Knight Rd
Purpose of Inspection: Man Home (14'x65')
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
11OWLI I d U iM, %"A 1
AUTHORIZATION OF EXISTING SYSTEM
Signature of Environm6 Health Specialist