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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME
ADDRESS
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PH/O~NE #
NAME OF MOBILE HOME PARK OR S/D L
NAME OF OWNER (IFDIFFERENI)
ADDRESS OF OWNER (IFDIFFERENI)
PROPERTY LOCATION: STATE ROAD NAME AND # il- I a\~
The aforementioned site has been evaluated by the Harnett County Health Department
Environmental Health Sectiorr At the time ofinspedoiW there appeared tot'* a septle
system serving thle situ. if this system should: malfi,r7ctl6n; the owner Is responsible ford
any necessary repalc 3.
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 T FROM ANY PARS' O SEPTIC SYSTEII4
DOS NOT DRIVE OR PARIS ON SEPTIC SYSTEIIIt- `
AUTHORIZATION OF EXISTING SYSTEM
Li
of Environmental Health Specialist Date