ETHTE#
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME - )2~-) c°( PHONE # ADDRESS 2--2 ,7 NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IF DIFFEREN7) 9A"
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND
PURPOSE. OF.INSPF_CTIQN
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The aforomentioned site bias been evaluated by-t arne oun y .eaffh Department
Envirortmenta! Health Section`At~th:etime of inspection, there appeared to be aseptic"-~
system serving this site .If this,system should malfunction, the owner fs`resporisibie for;
a
any necessar}r repairs
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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 changes, and/or
(4) after six months
. .'es-*a ~ rb,~'= 'C=` r s lta~' ~'~xs ss Y ~
BI1iLDING ~NUST.:~.EE'S _FROM ANY PARTe'OF, SEPTf--SYSTEM
NOT DRIVE OR PARK ON SEPTIC SYSTEM
DO
AUTHORIZATION OF EXISTING SYSTEM
g#ature of Environments Health Specialist Date