ETHTE #: 15-5-36070
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
Name: In Soen Phone #: 314-210-8032
Address: 5218 Westpine Ct. Raleigh, NC 27606
Name of Mobile Home Park or S/D: River Pines lot 1
Name of Owner (if different):
Address of Owner (if different):
Property Location (State Road name and #): South River
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
MW gliizwlkz[oolwm 1,' `
AUTHORIZATION OF EXISTING SYSTEM
-z' /�
Signa re of En_vironmen
ealth Specialist
� z�-(0Cl_
Date