ETHTE #: 12 -5 -29585
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
Name: Claudia Gracia & Jesus Ibanez Phone #: 910- 494 -1871
Address: 161 Cynthia Lane Spring Lake, NC 28390
Name of Mobile Home Park or S /D: Pine Ridge Estates lot 20
Name of Owner (if different):
Address of Owner (if different):
Property Location (State Road name and #):
Purpose of Inspection: replace home
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
of
1 ' � I a
114 LVA mull ta AN 11A N-911M of W I N 010
0
AUTHORIZATION OF EXISTING SYSTEM
tal Health Specialist
Date