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ETHTE #: 15-5-36909 HARNETT COUNTY HEALTH DEPARTMENT ENVIRONMENTAL HEALTH 307 CORNELIUS HARNETT BOULEVARD LILLINGTON, NC 27546 Name: Krystal Paradise & Robert Mikellski Phone #: Address: 3050 Thompson Rd Bunnlevel NC 28323 Name of Mobile Home Park or S/D: Sean Benson Name of Owner (if different): Tammy Benson Address of Owner (if different): 26 Riverwond Dr Spring Lake NC 28323 Property Location (State Road name and #): Thompson Rd Purpose of Inspection: Man Home (14'x80') 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 1� 1 1I W. W, . O AUTHORIZATION OF EXISTING SYSTEM 0 Signature o Environmenta ealth Specialist W