ETHTE #: 13 -5 -31832
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
Name: Robert Miller Phone #: 910- 850 -1564
Address: 615 Word Church Ln. Lillington, NC 27546
Name of Mobile Home Park or S /D: Land mark dev. lot 32
Name of Owner (if different):
Address of Owner (if different):
Property Location (State Road name and #): Word Church Ln.
Purpose of Inspection: replace home
The aforementioned site has been evaluated by the Harnett County Health Department
Environmental Health Section. At the time of inspection, there appeared to be a septic
system serving this site. If the system should malfunction, the owner is responsible for any
necessary repairs.
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 change, and /or
4. after six months
AUTHORIZATION OF EXISTING SYSTEM
IN
Signature of vironmental Health Specialist
IW
Date