ETHTE 10-5-24769
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
Name: Impact Home Solutions Phone 919-917-6877
Address: 5528 Caheba Way Raleigh NC 27616
Name of Mobile Home Park or S/D: Peachtree Crossing lot 42
Name of Owner (if different): Kristen Deconnick
Address of Owner (if different): 78 White Oak Circle Sanford NC 27332
Property Location (State Road name and Buffalo Lake 1115
Purpose of Inspection: Screen Porch/Deck
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
AUTHORIZATION OF EXISTING SYSTEM
ignature of Environmental Health Specialist
Z 2C"/ v
Date