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ETHTE #: 13 -5 -30505 HARNETT COUNTY HEALTH DEPARTMENT ENVIRONMENTAL HEALTH 307 CORNELIUS HARNETT BOULEVARD LILLINGTON, NC 27546 1 - Name: Melquiades Ibanez Gonzales Phone #: 910 - 644 -7205 Address: 86 Deborah Dr. Spring Lake, NC 28390 Name of Mobile Home Park or S /D: Pine ridge Estates Lot 22 Name of Owner (if different): Address of Owner (if different): Property Location (State Road name and #): Stage Purpose of Inspection: replace home 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 11101110 U LVA 1W M MAIN AUTHORIZATION OF EXISTING SYSTEM wig of Environmental Health Specialist (ZC 1':7 Date