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NAME: APPLICATION #: i 0 h `, 2 Q L rg
*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 6months or without expiration
)(af/
ng upon documentation submitted. (complete site plan = 60 months; complete plat = without expiration) (l ,j '
910 893 - 7525 option 1 CONFIRMATION #
nvironmental Health New Septic System Code 800
Plac e "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 given 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 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 ansryer is "yes ", applicant must attach supporting documentation.
( ( } NO Does the site contain any Jurisdictional Wetlands?
( (-" I ), O Do you plan to have an irri system now or in the future?
( ( x } / 14 Does or will the building contain any c1 ? Please explain.
( ( _ / ry0 Are there any existing wells, springs, waterlines or Wastewater Systems on this property?
{ (
lip
Is any wastewater going to be generated on the site other than domestic sewage?
(_)YES ( /I Is the site subject to approval by any other Public Agency?
(OYES { } NO Are there any easements or Right of Ways on this property?
( { /(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 All Property Lines And Corners And Making
The Site Accessible So That A Complete Site Evaluation Can Be Performed.
PROPERTY OWNERS OR OWNER REPRESENTATIVE SIGNATURE (REQUIRED) DATE
5/08
How to Properly Mark Property for Soil Evaluation
(MUST MATCH SITE PLAN)
ink flag
i • <_ iron
pink flag -- orange flag
4— ink flag
OIL
Legend House
House
iron'"
fl ag g flag/
range flag
pink flag
iron G co iron
ROAD
11611.H0 . .
- 20040291
FOR REO15TRAT1ON AE03Btgp OF DEEP5
, l7 V ! GR NI
YE
a, 1 n. ^ 4 7 CC 30 00:2 :32 Rl
�elii..:ll!41.3'3'r.1. r0t:2026 PS:349.351 FFE:$17.00
4
1 I MI 1 29@4024152
TH a. • • • s LINA GENERAL WARRANTY DEED
Excise lair
Parcel Ideatiter No.0 ::.
1 e 5 . by Canty on des _ day of , 20
By
lama to RtUINALU 13. 1 , '.n • .4 :. • ■ • , 900 S. MAIN STREt r, UL 71NC, r"N, NC 27546
This instrument was � b
R130 e• AQ. t • , 900 • '. • 1 STREET, LILLINGTON, NC 27546
Brief dcsado n foe the loda: LT 12A, JO 't T 4 TO 11 ',
THIS DERD mach this 22 d - day of Dec „ . , 20 I
MELISSA I. ARNOLD, unmRU R s a DALE BULLOCKS
1 188 MARKS ROAD 11 ' - `� AL LANE 4 r CAMERON, NC 28362 1, NC 27332
The designation Grantor end ranter asundbetsinebafinclodeseid ; _. . ..., . t#: and assigns, u4 shall btcbde
singe", plural, masculine, feminine or neuter as required by context.
WIl' NESSB7' H, that the Grantor, Re *valuable oomtldmatlon paid by the Grantee, .,. .r.. l ebyaclmowkdgeghas
and by thesepresents doeagtnm,6mgein,seB convey lmto the Grantee in fee .... .- :• •. orpareel °flood situated
in Meaty of Johnsonville Tows* 1 1 .. C I' -" a 1 /4 ... ,NarfeCaroUoasod
more particularly descried es fbfowe: .
by Melvin PIS, a monied in Map Number 2004-1280, 0 Harnett County Reg. 1 tuber 8.2004
Subject to that certain 50' access and utility easement as shown on the above refcrooned map.
The property hemitlsbove descried nos acgtmed W Grantor by imhe®ent recorded is Book .
A map showing the shove desai ed property is recorded in Plat Book 2004 Oar 12
NC Bar Association Form No. L-3 0 1976, Revised ®1977, 2002
Printed -t with the NC Bar Association - 1981 SoflPro Carpoaaticq 333 E. Six Forks Ltd., ' • 1:
PROCEDURES AND GUIDELINES FOR MANUFACTURED HOME INSPECTIONS
RA -20R & RA- 20M Certification Criteria
1, � :<.,e..„4C K / , understand that because I'm located in a RA -20R or
RA -20M Zoning District and wish to place a manufactured home in this district I must meet the
following criteria, verified by zoning inspection approval, before I will be issued a certificate of
occupancy for this home.
1. The home must have a pitched roof, for a manufactured home, whether A- shaped or
rounded, which has a minimum rise (measured at the center of the home) of twelve (12)
inches for every seven (7) feet of total width of the home. (Example: A home measuring
fourteen (14 ft.) in width must have a twenty four (24) inch rise as measured from the
center of the roofline to the baseline of the roof.) (See Illustrations Below.)
24" Minimum A-Shaped { 24" Minimum Rounded
Roof Pitch Rise ry z ;',/ Roof Pitch Rise ;::1,.1.., Yr , p. s x ro --� K , 9 t
h a - '�S . , is 1 v
l f ''" +7a no d f Nr' w ll
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r i , , .:-, '2. : de b " i 2 J 14 /;.1 y p 5r •
14' in Width '4' , i ;,i 4 y
" 'Y ' 14' in Width a '...4.,c
a F r ,e� d -er: a
w ',..:"7.i,:12:4-_77,::: s�. r- +;z
� t, ,. .. .3 . - ._r�r...i.. -, .uw3 gip? 1Fr,:a_ ��.�.s wemma,,....+.. ...- ..._.. ....._ .w�i t .r+_.... .
T qF , . , 4 Note: Most Rounded Roofs Will
p f �-- � � „ At , °' a Not Meet The Roof Pitch
-. ii Requirement As Illustrated. The
Measurement From The Peak Of
1 This Type Roof Design Will Not Meet The Roof To The Base Line Of
I ' The Requirements of Roof Pitch. The Roof Must Be 12” For Every
7' Of Total Width Of The Home.
(14' Wide Home = 24" Roof Rise)
Continued on back
2. The home must be underpinned, consisting of a brick curtain wall or have
galvanized metal sheeting, ABS or PBC plastic color skirting with
interlocking edges, installed around the perimeter of the home. Skirting
shall be consistent in appearance, in good condition, continuous,
permanent, and unpierced except for ventilation and access.
3. The homes moving apparatus must be removed, underpinned, or
landscaped. (See examples below.)
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°`_ 7 - 0 49
Signature of Property Owner / Agent Date
O By signing this form the owner / agent is stating that they have read and
understand the information on this form.