ETHTE #: 14 -5 -34412
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
Name: Reyna & Carlos Hernandez Phone #: 919- 721 -9284
Address: 200 N 2nd Street Sanford NC 27330
Name of Mobile Home Park or S /D: K -Bar Hills lot 3
Name of Owner (if different): Lilia Rios
Address of Owner (if different): 326 Queens Rd. Sanford, NC 27330
Property Location (State Road name and #): Milton Welch
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
W- I,
AUTHORIZATION OF EXISTING SYSTEM
W
Signature of Environmental Health Specialist