ETHTE #: 13 -5 -31968
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
Name: Gre oria Espinoza Vivas Phone #: 919- 353 -1776
Address: 10152 Old US421 Broadway NC 27505
Name of Mobile Home Park or S /D:
Name of Owner (if different):
Address of Owner (if different):
Property Location (State Road name and #): Old US421
Purpose of Inspection: Man HOme (28'x60')
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
1 ft a 1
1LIJ042 8 11 IN i ta All II 1 '
TION OF EXISTING SYSTEM
Signature of Environmental Health SpeX i D