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SEPTIC Application # /P✓ G 2 '7 47 Z Harnett County Central Permitting PO Box 65 Lillington, NC 27546 Telephone Number 910- 893 -7525 Fax 910 -893 -2793 Application for Environmental Health Improvement Permit in Areas Zoned by Municipalities Land Ow r Infprmetign: Applicant Information: Name: \j HQl- NI )r gj1f y Name: ' bmE Address: ZLI 6);p RU1 < C.ti2 laU Address: ps ca._ NC.. `a- ) Phone: 2)9 yaa. - (a il - co Phone: Property Location: 7 E911 Address: ftt PIN or Parcel Number: o4 7 Z - 7 - 26 3‘, en Subdivision: Lot Number: 9 Lot Size: 7, 4 4( Zoning: A e/ Specific Directions to Job from Lillington: b m nrc I ua# e414ar UlJ 5 5 rn1)r �.Sdh1 P;, eu) ni, Vv It OQXt-- v.e..l 1.S M,iC5 !7N ,tai:. l. 1 0,1/ kc,,>SC RF<,\o Vtl, ylo.0 Proposed Use: ( ) Single Family Dwelling (Size: x ) # of Bedrooms: Basement: Basement w/ Plumbing: Deck: Slab or Crawl Space ( ) Multi Family Dwelling # of Units: # of Bedrooms/Units: ( ) Manufactured Home (Size: x ) # of Bedrooms: Garage: Deck: ( ) Business Square Footage Retail Space: Type: ( ) Industry Square Footage: Type: ( ) Home Occupation # of Rooms: Use: ( ) Addition to Existing Building Size: Use: Other: ,�v1f1.a∎ POCL_, Co )J1 Water Supply: County ( ) Well ( ) Other Sewage: ( ) New Septic Tank (Complete new tank checklist) Existing Septic Tank ( ) Sewer There is a $250.00 charge f• ew tanks, $100 for existing nks. This approval is subject to revocation if the intende . us : of . e - optic system changes or if false information is provided on this applic tion our - '•nature b - low certifies all information above is correct. Applicant Signature: /V Date: 4/07 9108932703 Harnett County Planning HARNETT CO. PLANNING SERVICES 15:07:03 10 - 31 - 2007 214 HTE# 0 — J8664 Permit # .Jyyo5 Harnett County Department of Public Health Site Sketch PROPERTY LOCATOR: 6 t crei ISSUED T0: GILC..-; 7 ARdire ge S LOT # _ 7 Authorized State Age ifh. 4-, � #sia_/ Date: /6 '3/0"'1 • t i 6 ' k 3 g ' I D Po6 iz9.0 - i F31 ` 1 �a2' --� lit. t L t{ > 41 SID t t7Sbai 1 7i ^ '`e h tv V R g � r ti �� L� �' N 1 t - ti p�'/ 3 Iv 4 4 �' l 75 126./DV 46,14 3 /S-yz, l i.( ```` ..bi P4 N •4 4 �; a pp _ w s._ m N y c11: y= Pal imilitta° \‘` A n iq 1 J$ . I iii i t �� ° � u ' se ea I i r � ii "� I - --- __ " —' CT • p . ____ "� Y. „ 171 S �R C7 D a } l 1 aiz M.eY.l —. N - . - \ 'n N 1- y � { • it 0 Q Q / 1 n�j D 4 a � 230' Cn m \ \ G l V D °4 \ I &1t � © ! ® ems, ©t „I p p N 1 \ 1 991 I rn r v+ 4 sN I \ It g -.1 1 1 st 4 1 1 LC1 L1 CREEK R g0' PUBLIC R/ r NC 1 u0 OLD BUIES ROAD ; 1 .. ' 542 f ` Ln > co Ne 114 NIL ea. Flu+ °P 146 45E NAME: APPLICATION #: I ) 1 V 29 41 2 *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. CHANCED, OR THE SITE IS ALTERED, THEN THE IMPROVEMENT PERMIT OR AUTHORIZATION TO CONSTRUCT SHALL BECOME INVALID. The permit is valid for either 60 month ;or ytithqut expiration depending upon documentation submitted. (complete site plan = 60 months; complete plat = without expiration) ✓ n 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) • fter preparing proposed site call the voice permitting system at 910 - 893 -7525 option 1 to schedule and use code 8 00 (after selecting notification permit if multiple permits exist) for Environmental Health inspection. Please note confirmation number given at end of recording for proof of request. • Use Click2Gov or IVR to verify results. Once approved, proceed to Central Permitting for permits. E nvironmental 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 piven at end of recording for proof of request. • 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 {_} 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. ( ( NO Does the site contain any Jurisdictional Wetlands? {_IYES (_) NO Do you plan to have an iaiaatien3vstem now or in the future? (_ }YES {_) NO Does or will the building contain any drains? Please explain. ( 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 {_1 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 - 6324949 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 Ins 1 , ons To D • termine Compliance With Applicable Laws And Rules. I Understand That I Am Solely Responsible For The Proper Ide' • :cation And La. li : r All Property Lines And Corners And Making The Site Accessible So That A Complete Site Evaluation Ca : e Performed. 4I e PROPERTY OWNERS OR OWNERS LEGAL REPRESENT. IVE SIGNATURE (REQUIRED) DATE 5/08 9 4 - -/ DIAGRAM OF TYPIC L SEPT TANK t IRWI •UTLET LID El POSSIBLE POSSIBLE HOUSE HOUSE CONNECTION _ CONNECTION POSSIBLE HOUSE CONNECTION POSSIBLE LID SHAPES I I SQUARE (SHOWN ON DIAGRAM) RECTANGLE (OLDER TANKS) 1 CD ROUND How to Properly Mark Property for Soil Evaluation (MUST MATCH SITE PLAN) ■ ink flag � o ' iron pink flag —• . orange flag t" ink flag Legend House iron" flag a w ag t rangeflag t pink flag iron r ®, iron ROAD