LAND USE 01/05/2005 06:02 9109935281 WALKERS F 03
HAL OWEN & ASSOCIATES, INC.
This soil investigation report and map, when provided to the Harnett County Health
Department, should allow them to sign the maps for recordation. 1 appreciate the opportunity to
provide this service and hope to be allowed to assist you again in the future. If you have any
questions or need additional information, please contact me at your convenience.
Hal Owen
Licensed Soil Scientist
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Soil Science Investigations • Wetland Delineations, Permitting, and Consulting
01/05/2005 06:02 9108935281 WALKERS PAGE 02
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NAME: APPLICATION #: /()) � 5 777 24 IV
flhis 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 mo the or without expiration
pen ing upon documentation submitted. (Complete site plan= 60 months; Complete plat = without expiration) P7 /ti,
910- 893 -7525 option 1 CONFIRMATION # /
Environmental Health New Septic SvstemCode 800
• All property irons must be made visible. 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.
• All lots to be addressed within 10 business days after confirmation. $25.00 return trip fee may be incurred
for failure to uncover outlet Hd, mark house corners and property lines, etc. once lot confirmed ready.
• 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 outlet end of tank as diagram indicates, and lift lid straight up (if
possible) and then close back down.(Unless inspection is for a septic tank in a mobile home park)
• After uncovering outlet end 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 {_I 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?
[_ I YES (NO Do you plan to have an irrination system now or in the future?
{_I YES Lk-)'NO Does or will the building contain any ? Please explain.
{_I YES I4NO 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?
{_I YES { Li / NO Is the site subject to approval by any other Public Agency?
(_) YES (!'J / NO Are there any easements or Right of Ways on this property?
I 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 All Property Lines And Corners And Making
The Site Accessible So That A Complete S' ,• Evaluation Can Be Performed.
6 cJcif-- efr- lai-th
PROPERTY OWNER O: s WNERS LEGAL REPRESENTATIVE SIGNATURE (REQUIRED) DATE
11/09
•