ETHTE 11-5-26567
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
Name: Shirley McCoy Phone 514-2926
Address: 950 Leaflet Church Rd Lillington NC 27546
Name of Mobile Home Park or SID: Western Harnett Meadows
Name of Owner (if different): Phillip Kelly
Address of Owner (if different): PO Box 151 Sanford NC 27331
Property Location (State Road name and Pioneer Ct
Purpose of Inspection: Man Home Placement
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
BUILDING MUST BE 5' FROM ANY PART OF SEPTIC SYSTEM
DO NOT DRIVE OR PARK ON SEPTIC SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
i 4A-5
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Signature of Environmental'Health Specialist
1.