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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME .;}InQO I ftr~
P • PHONE # "I,) _ ox 2 y
ADDRESS
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IF DIFFERENT) Ste-
ADDRESS OF OWNER (IFDIFFEREN7)
PROPERTY LOCATION: STATE ROAD NAME AND # The aforementioned site has been evaluated by the Harnett County Health Department #
Environmental Health Section. At the tims of lnspectfom there appeared to be a septle,
system serving this sites N this system should maftnctlon the owner is responsible for@111
any necessary repal
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 PART OF SEPTIC SYSTEM =
00 NOT DRIVE OR PARK ON SEPTIC SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
Pt \ r,
tal Health Specialist
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Date