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ETHTE# HARNETT COUNTY HEALTH DEPARTMENT ENVIRONMENTAL HEALTH 307 CORNELIUS HARNETT BOULEVARD LILLINGTON, NC 27546 EXISTING SEPTIC SYSTEM INSPECTION NAME PHONE # 0-C113 3 E. ADDRESS ~J aY `55 l f Cry„c ~f~~C g3 NAME OF MOBILE HOME PARK OR S/D NAME OF OWNER (IFDIFFEREN7) ADDRESS OF OWNER (IF DIFFERENT) PROPERTY LOCATION: STATE ROAD NAME AND # NC 45 The aforementioned site has been evaluated by the Harnett County Health Department Environmental Health Sectfart At the time of in"tf©rk ther* appeared to be a septla, system serving this situ. N this system should maftndkM the owner is responsible for any necessary repalm 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 S' FROM ANY PART OF SEPTIC SYSTEM Qty NOT DRIVE OR PARIS ON SEPTIC SYSTEM AUTHORIZATION OF EXISTING SYSTEM Signature of Specialist