ETHTE 11-5-26580
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
Name: Carolina Custom Builders Phone 919-790-1234
Address: 4905 Departure Dr. Raleigh NC 27616
Name of Mobile Home Park or S/D: Pioneer Farms lot 1
Name of Owner (if different): Gary & Wanda Lutz
Address of Owner (if different): 11 Fletcher Dr. Lillington, NC 27546
Property Location (State Road name and Adcock
Purpose of Inspection: Attached Garage
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
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LQJ/
Date
of Environmental Health Specialist