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Existing Sewage System Report For. �obile Home Replacement
Addition Type: � i
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Original Pemvit Located: Water Supply:� '1 � V
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Septic System Designed For: ✓ Residential Business
# Bedrooms,,�._ # Employees Other
Other
System Type: l"(� V e.t l�..: f1,MY Tank Size: Nitrification Line:
I)ate Installed:
Certified Operator Required: � �t
On-site wastewater disposal system shows no visual si�ms of malfunction on �a� � ^
Permission is granted
Environmental Health Specialist Date: � �� / ��V
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'�°��t NOfZTH CAROLIN/l, PERSON COUI�QY Notary;Publ��do herebY certif}i
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that under my supervislon snd befae me this d�y and acknawl•
direction this map wa5 drawn frti�� the due execiition cf tha toregoi
an actual field s��r:e anQ ti�et tt� instrument Y:itness my hand an
error of ctosure i� � no �al seai thK ��ay ot
Wit/ness my hand a�d pe�aj �ta (� 19
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