ETHTE# 09 -5_-zjo53
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME ! / a PHONE # t/9 5-G 7- ooo 7
ADDRESS 3 5-6 VccJ-y,Lr-A Fes! `s hu-vE Saves FuG y,4, , - ~/:,✓a .U. 2 ~s z
NAME OF MOBILE HOME PARK OR S/D,~
NAME OF OWNER (IFDIFFEREN7)
ADDRESS OF OWNER (IFDIFFEREN7)
PROPERTY LOCATION: STATE ROAD NAME AND # 5/L ~f l ~.ky
-e-'O
PURPOSE OF INSPECTION: n .dc N~ ,
The aforementioned site has been evaluat byte arr a oun y ea Departure
Environmental Health Section. At the time of inspection, there appeared to be a septic"
system serving this site. If this 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 changes, 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
of Environmental Health Specialist Date
vrcrmny MAP (Mfrs)
LEGEND
NTS
NOT TO SGLE
EIP
DWHO PON PIPE
PP
POWER POLE
w/11
MATER MOM
TB
TEtEF"ONE BOX
WS
IKON PFE SET
Ux&
TR*WVRMER
MW
CABLE N BOX
L POLE U0W POLE
OHM
OW3* JC POMER LIME
F.E.S.
FlARm END
SECTgN
(P1Pfa
RCP
REBHFORCM cOFK.
PWE
WO r-
BACK OF CURB
F.N.
FIRE NYDRW
C\0
SEMTR CLEAN OUT
ES
OWING IRON STAKE
M.N.
MANHOLE
ECM
EXRTm cONCRETE MONUMENT
PX-
PAFXM KALON NAM.
(R~
116
C
M
8
i
i
' u
115
i m-1 B'
System'
SITE PLAN APPROVAL
DISTRICT USE
#BEDROOMS
Date c'( llltlf) tpnift~
V - W !.M G I W.W G+r
VICTORIA HILLS DRIVE
(50" PuBmc Rlow)
NOTE: SHOWN IS LOT 104 OF
VICTORIA HILLS S/D • PHASE 4
REF: B.O.M.2002 P0.355