ET RHTE 09-5-21914R
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
Name: Palm Harbor Homes Phone 919-662-9999
Address: 5429 Fayetteville Rd Raleigh, NC 27603
Name of Mobile Home Park or S/D:
Name of Owner (if different): Stuart Black
Address of Owner (if different): 1320 Southeast 2nd Ave Dannia Beach FL 33004
Property Location (State Road name and NC27W
Purpose of Inspection: Man Home Placement
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
BUILDING MUST BE 5' FROM ANY PART OF SEPTIC SYSTEM
DO NOT DRIVE OR PARK ON SEPTIC SYSTEM
TION OF EXISTING SYSTEM
Signature of Environmental Health Speciali
S