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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME f j~-y~, 2 ) r c) PHONE #
ADDRESS
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IF DIFFERENT) ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND # M ` IV,,.,` CVN
The aforementioned site has been evaluated by the Harnett County Health Department
Environmental Health Section. At the dmt of Inspecdom there appeared to be a septic
system serving this sita N this system should malfUncttoM the owner Is responsible for =
any necessary repairs. t
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 DUST BE 5' FROM ANY PART QP SEPTIC SYSTEM
DQ NOT DRIVE OR PARK ON SEPTIC SYSTEM
Signatu
AUTHORIZATION OF EXISTING SYSTEM
of Environmental Health Specialist
)-OK
Date