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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME PHONE # X5-2 - 71(Ir -11$0
ADDRESS ~7
NAME OF MOBILE HOME PARK OR S/D~~,' /2
NAME OF OWNER (IF DIFFEREN7)
ADDRESS OF OWNER (IFDIFFEREN7)
PROPERTY LOCATION: STATE ROAD NAME AND
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The afor~ementione s~tehas been evaluated b}~Ft~ie F~arne`~burTy Health De partmer~t x
`Ev ronmental HealthSectionlAtthe~ime ofinspection,tieappeareYdtabe aQs ptic1
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systerr~ serui ^ng,this si$e If thins ste " should malfunction-r,:t ' e owner,ls=res onsible for
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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
# BUILDI9 MUST bE 59~ ROIi NY PART,017 SEPTIC SYSTEM
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y = ~ f' D.®NOT~~,, DRIVE OR .PARK ON,SEPT~~ SYS~Efi~=
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AUTHORIZATION OF EXISTING SYSTEM
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S~/nature of Environmental Health Specialist Date