ETHTE #: 13 -5 -30930
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
Name: Burgoyne, Felix Phone #: 228 -596 -6606
Address: 100 Waters Wa. L�gton NC 27546
Name of Mobile Home Park or S /D: Taylors Trail lot 205
Name of Owner (if different):
Address of Owner (if different):
Property Location (State Road name and #): Nursery Rd
Purpose of Inspection: Garage (24'x40')
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
110ZIZEOI 0 WR W W03 AN 11A i'MINERN HN [MEN,
AUTHORIZATION OF EXISTING SYSTEM
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Signature of Environmental th Specialist ®'Date