ETHTE 11-5-26422
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
Name: Chapman Wilson Phone 424-4663
Address: 606 Hope Mills Rd Fayetteville NC 28304
Name of Mobile Home Park or S/D: Mire Branch lot 158
Name of Owner (if different): Todd Clayman
Address of Owner (if different): 927 Lakeridge Dr Cameron NC 28326
Property Location (State Road name and 1201 Ponderosa Rd
Purpose of Inspection: 18'x33' Above Ground Pool
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
cl i I
Signature of Environmental 1tkSpecialist