ETHTE #: 15-5-35989
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
I ;t
Name: Bryan & Linda Cummins Phone #: 514-3095
Address: 16 Marvin Ferguson Dr Lillington NC 27546
Name of Mobile Home Park or S/D: Mamire Bell Ridge lot 56
Name of Owner (if different):
Address of Owner (if different):
Property Location (State Road name and #): Old US 421
Purpose of Inspection: Pool (14'x28')
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
111JOIJ 0 UI MI W41 14 �,Oki1
AUTHORIZATION OF EXISTING SYSTEM
io ,
Signature of Environmental lth Specialist ate