ETHTE #: 14-5-35010
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
Name: Jeffrey Dillon Phone #: 910-818-2758
Address: 60 Village Way Lillington, NC 27546
Name of Mobile Home Park or S/D: Tirzah Village lot 41 A
Name of Owner (if different):
Address of Owner (if different):
Property Location (State Road name and #): 421
Purpose of Inspection:ag rage
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
11�1 MIMI, , 0
11 PUMA A MINE]
AUTHORIZATION OF EXISTING SYSTEM
of Environmental Health Specialist Date