ETHTE 11-5-27467
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
Name: Stephen Koscelek Phone 910-893-113
Address: 76 Old Hundred Loop Lillington, NC 27546
Name of Mobile Home Park or S/D: Longleaf Acres lot16
Name of Owner (if different): RES Properties of Harnett Co.
Address of Owner (if different): 3404 Dogwood Dr. Greensboro, NC27403
Property Location (State Road name and 27 West
Purpose of Inspection: New 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
BUILDING MUST BE 5' FROM ANY PART OF SEPTIC SYSTEM
DO NOT DRIVE OR PARK ON SEPTIC SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
4"r
of Environmental Health Specialist
Date