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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXIS'T'ING SEP'T'IC SYSTEM INSPECTION
NAME C PHONE #f-(~~ =c^ctiS7
ADDRESS
NAME OF MOBILE HOME PARK OR SID
NAME OF OWNER (IF DIFFERENT)
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND f1i
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PURPOSE OF INSPECTION:
The aforementioned site has been evaluated by the flarneoun y ea h Department:
Eiwironmentf Health Section; At thetime~"of inspection, there appeared toe a septic
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system seNing this site If this,system should. inalfunctiotiie owner Us responsible fore;
r` any, recess r
y,repairs, f } x - c to
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
BUILDING MUST BET FROM ANY PARS` OF. SEPTIC SYSTEM „ al
DO NO DRIVE OR PARS ON SEPTIC{SYSTEW,
AUTHORIZATION OF EXISTING SYSTEM
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Si ature of Environmental Health Specialist Date