ETHTE 12-5-28299
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
Name: Todd Brookhart Phone 919-499-2863
Address: 2895 Tingen Rd Broadway NC 27505
Name of Mobile Home Park or S/D: TA Brookhart lot 11
Name of Owner (if different):
Address of Owner (if different):
Property Location (State Road name and 1130 Tingen Rd
Purpose of Inspection: SFD 33'x56'
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 IIF:
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
BUILDING MUST 5' FROM ANY PART E SEPTIC SYSTEM
NOT DRIVE OR PARK N SEPTIC SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
Signature of Environmental e th Specialist
Z'
Date