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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAMEp <✓.~1 PHONE # 77
ADDRESS
NAME OF MOBILE HOME PARK OR S/D(~, r>- r
NAME OF OWNER (IF DIFFERENT)
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND
.PURPOSE OF INSPECTION,- -2 Z-
The aforern ntioned.site'has been evaluated Syr e7Ra~n" ett-Goun+ y z eajt h Department f
Environmentah Health Section: At theaime of"inspection; there appeared to,be a septic
tY r i t y 1
system serving,this site If this;systeni shoutd.malfiunction, the ownef fs responsible for;-ti
anyecessary repatrs,,'rt~
,.a aP« . J.v ~ "at;m _i:,.. _ ~ ~s~.' d'?F ~,~+~,t"?~ ,n f. , ,z P. ' p._u." ~ g'a...`~ • x ::"s' r , i y~`~'~ 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 MUST. BE 5' FROM ANY~PART OF, SEPTIC SYSTEM
` DO NOT QRI~JE O PARS ON SEPTIC:SYSTEIVt
r}4~e•zS {
AUTHORIZATION OF EXISTING SYSTEM
Sign ture of Environmental Health Specialist Date