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ETHTE #: 18-5-43748 HARNETT COUNTY HEALTH DEPARTMENT ENVIRONMENTAL HEALTH 307 CORNELIUS HARNETT BOULEVARD LILLINGTON, NC 27546 EXISTING SEPTIC SYSTEM INSPECTION Name: Clayton Homes of Sanford Phone #: 336-460-0329 Address: 1921 Keller Andrews Rd Sanford NC 27322 Name of Mobile Home Park or S/D: Name of Owner (if different): Johnny Knight Address of Owner (if different): 1945 Pickard Rd Sanford NC 27322 Property Location (State Road name and ft 67 Lori Ln Purpose of Inspection: Man Home (28'x68') 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 AUTHORIZATION OF EXISTING SYSTEM (10-1) Signature of Environment NJealth Specialist