ETHTE #: 17-5-41234
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
Name: Adam Ruiz Lopez & Reyna Reminez Phone #: 919-827-3354
Address: 178 Kinton Farms Rdg. Fuquay-Varina, NC 27526
Name of Mobile Home Park or S/D: Olive Branch Subdivision
Name of Owner (if different): Same
Address of Owner (if different): Same
Property Location (State Road name and #): 178 Kinton Farms Rdg (Kipling Rd. - SR 1403)
Purpose of Inspection: Existing Tank -Screen Porch (16'x16')
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
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Signature of Environmental Health Specialist Date