SEPTIC D
Application # / 24Z‘4
HARNETT COUNTY CENTRAL PERMITTING
PO BOX 65 LILLINGTON NC 27546
(910) 893 -7525 FAX: (910) 893 -2793 www.harnett.org/permits
APPLICATION FOR EXISTING SEPTIC SYSTEM INSPECTION
FOR MORTGAGE COMPANIES, COMMERCIAL CHANGE OF
OWNERSHIP, FIRE DAMAGE, ETC.
NOTE: A DEED OR OFFER TO PURCHASE IS REQUIRED AT TIME OF APPLICATION.
Date: Ott aa- aDl
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Applicant/Mortgage Co: gethi < ta, A •
Mailing A dress: 591, / cute IPA •
City: I)tl.l'!r1 State: A /C'. Zip: .&Ad3'/
Telephone: tM) 6SR-OO6C Other #: (ql() 0?-37- //e/7S
Current Land Owner: l a Lk- Phone:
Property Address: C
PIN: it 7 7 - ` / 34, aaa Parcel: 07 /4 7 a 9 a/
State Road #: ; State Road Name: LAAe / f�
Name of Subdivision: a/i Lot # T////7 Of Applicable)
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Directions: (please !lye concise, complete directions from Lillington, NC to the property)
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here is a $100.00 charge for this service. This approval is subject to revocation if the
intended use of the septic system changes or if false information is provided on this
application.
Your signature below certifies that all above information is correct.
Signature of Owner, Authorized Agent or Applicant:
FOR OFFICE USE ONLY
AUTHORIZATION FOR USE OF EXISTING SEPTIC SYSTEM
Signature of Environmental Health Specialist Date
SEPTIC 4/08
NAME: Pa- fYIectcft. ((ly�4 _ APPLICATION #: `U L i ' 2 vG
*This application to be filled out when applying for a septic system inspection.*
County Health Department Application for Improvement Permit and/or Authorization to Construct
IF THE INFORMATION IN THIS APPLICATION IS FALSIFIED, CHANGED, OR THE SITE IS ALTERED, THEN THE IMPROVEMENT
PERMIT OR AUTHORIZATION TO CONSTRUCT SHALL BECOME INVALID. The permit is valid for either 60 months without ex iration
depending upon documentation submitted. (complete site plan = 60 months; complete plat = without expiration) / , %J GI q z.
910 - 893 - 7525 option 1 CONFIRMATION # (/ /
❑ Environmental Health New Septic System Code 800
• Place "pink property flags" on each corner iron of lot. All property lines must be clearly flagged approximately
every 50 feet between corners.
• Place "orange house corner flags" at each corner of the proposed structure. Also flag driveways, garages, decks,
out buildings, swimming pools, etc. Place flags per site plan developed at/for Central Permitting.
• Place orange Environmental Health card in location that is easily viewed from road to assist in locating property.
• If property is thickly wooded, Environmental Health requires that you clean out the undergrowth to allow the soil
evaluation to be performed. Inspectors should be able to walk freely around site. Do not grade property.
• Call No Cuts to locate utility lines prior to scheduling inspection. 800 - 632 - 4949 (This is a free service)
• After preparing proposed site call the voice permitting system at 910- 893 -7525 option 1 to schedule and use code
800 (after selecting notification permit if multiple permits exist) for Environmental Health inspection. Please note
confirmation number alven at end of recording for proof of request.
• Use Click2Gov or IVR to verify results. Once approved, proceed to Central Permitting for permits.
Environmental Health Existing Tank Inspections Code 800
• Follow above instructions for placing flags and card on property.
• Prepare for inspection by removing soil over door as diagram indicates. Loosen trap door cover. (Unless
inspection is for a septic tank in a mobile home park)
• After preparing trapdoor call the voice permitting system at 910- 893 -7525 option 1 & select notification permit if
multiple permits, then use code 800 for Environmental Health inspection. Please note confirmation number
given at end of recording for proof of reauest.
• Use Click2Gov or IVR to hear results. Once approved, proceed to Central Permitting for remaining permits.
SEPTIC
If applying for authorization to construct please indicate desired system type(s): can be ranked in order of preference, must choose one.
{_) Accepted {_) Innovative (_} Conventional {_1 Any
{_ ) Alternative {_) Other
The applicant shall notify the local health department upon submittal of this application if any of the following apply to the property in
question. If the answer is "yes ", applicant must attach supporting documentation.
{_ }YES ( NO Does the site contain any Jurisdictional Wetlands?
{_}YES ( NO Do you plan to have an irrieation system now or in the future?
(_ }YES ( NO Does or will the building contain any Llx ' ? Please explain.
{_ (YES 1 - NO Are there any existing wells, springs, waterlines or Wastewater Systems on this property?
(_ )YES ( NO Is any wastewater going to be generated on the site other than domestic sewage?
{ }YES ( NO Is the site subject to approval by any other Public Agency?
{ }YES ( NO Are there any easements or Right of Ways on this property?
{_ )YES { NO Does the site contain any existing water, cable, phone or underground electric lines?
If yes please call No Cuts at 800- 632 -4949 to locate the lines. This is a free service.
I Have Read This Application And Certify That The Information Provided Herein Is True, Complete And Correct. Authorized County And
State Officials Are Granted Right Of Entry To Conduct Necessary Inspections To Determine Compliance With Applicable Laws And Rules.
I Understand That I Am Solely Responsible For The Proper Identification And Labeling Of AU Property Lines And Corners And Making
The Site Accessible So That A Complete Site Evaluation Can Be Performed.
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PROPERTY OWNERS OR O W NERS LEGAL REPRESENTATIVE SIGNATURE (REQUIRED) DATE
5/08
•
DIAGRAM OF TYPIC L SEPT!' TANK
REM
• UTLET LID
POSSIBLE POSSIBLE
HOUSE HOUSE
CONNECTION - CONNECTION
POSSIBLE
HOUSE
CONNECTION
POSSIBLE LID SHAPES
I _ 1 SQUARE (SHOWN ON DIAGRAM)
RECTANGLE (OLDER TANKS) ROUND