ETHTE #: 15-5-36116
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
Name: Monte K Olthoff Phone #: 514-9155
Address: 145 Lucky Ln Bunnlevel NC 28323
Name of Mobile Home Park or S/D: Edgar Southand lot 2
Name of Owner (if different):
Address of Owner (if different):
Property Location (State Road name and #): Lucky Ln
Purpose of Inspection: Man Home (14'x76')
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 � 1N LVA W01,14 WA IN M.
AUTHORIZATION OF EXISTING SYSTEM
Signature of nvironmenta lth Specialist