LAND USE NAME: APPLICATION #: 1 • 5 — ' a 2 b
*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 or without expiration
pending upon documentation submitted. (Complete site plan = 60 months; Complete plat = without expiration) v 3 00
910- 893 -7525 option I 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 lid. 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 ExistIna 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 putid back In place. (Unless inspection is for a septic tank in a mobile home park)
•,. `DO NOT LEAVE LIDS;OFFOF SEFTIC,TANK
• 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 desir ystem 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 an' er is "yes ", applicant MUST ATTACH SUPPORTING DOCUMENTATION:
{_ }YES { Does the site contain any Jurisdictional Wetlands?
P Y
{_]YES (_) ou
Do plan to have an irrieation system now or in the future?
(_)YES {} I}k) N Does or will the building contain any drains? Please explain.
(_ }YES I O Are there any existing wells, springs, waterlines or Wastewater Systems on this property?
(_)YES { Is any wastewater going to be generated on the site other than domestic sewage?
{_)YES ( I%i N ; Is the site subject to approval by any other Public Agency?
1_1 YES 1 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.
1 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 Identinc And Labeling Of All Property Lines And Corners And Making
The Site Accessible So That A Complete Site Evaluation Can Be armed. / s 25 20(0
PROPERTY OWNERS OR OWNERS LEGAL REPRES TIVE SIGNATURE (REQUIRED) DATE
10 /10
0 X11/'/'
VON ., ),:r V rat OF cats
C E OUN't`Y TAX ID# ,'r' C 1 63;41: PO O a wig .• RK:2464 PC:616413 FEE: N
NC REV SW: ' ,e
i wr I1111ENT I ipl 41
' � $;,
s . • : MENA GENERAL WARRANTY DEED
Excise Tax $ 50.00
Panel ldentlfer No. • 10 . . of, . • by Colony on the_.... day of , 20
By: .
Mall/Box to: REGINALD B. KELL • • a BO !A I TON, NC 27546
This im em nem was prepared by. REG -. t. . , • i i : • AIN STREET, LILLINGTON, NC 27546
Brief description fir der India:
THIS DEED made this 10th day of December . 20 'r -
GRANTEE
JAMES L. MOBLEY and atLb p L. � MOBLEY,
TRUSTEES OF THE JAMES L MOBLEY AND �r WILLIAM BAKER
MABLE L. MOBLEY REVOCABLE LIVING TRUST / PATA : A LANE
DATED 11/01/2002 0 NC 28390
117 RED OAK DRIVE
SPRING LAKE, NC 28390
a
r
The designation Cantor and Grantee w wad herein shall include add . t : , imdassignsouid dmll%chide
singular, phnsl, masculine, feminine or neuter as required by tomsexa
WITNES SETH, that the Gramm, fors vahablecamefderatiompaidby the Chants% . : acknowledged, has
and by these presemsdoea grant, bargain ,seU and conveytrmo the Grantee in Ike a,•..' •
.,4.,. parcel of hod sainted
in the Cityd SPRING LAKE , ANDERSON CREEK Township, \` .i t, North Quota and
more path* described as Snows:
Sec Attached
Tbe property heminabove deecdbed was acquired by Grantor by mahamant recorded to Book 16:. ' 4 : . 0 _ •
A nap slowing the above deam'bedpropefty is recorded in Plat Book Page
NC Bar Association Fonn No. L•3 01976, Revised 0 1977, 2002
Printed by Agreement with the NC Bar Alsooiatlotl —1981 SotPro Capetian, 333 E. Six Fodor Rd., ' . ifew . 4
How to Properly Mark Property for Soil Evaluation
(MUST MATCH SITE PLAN)
ink flag
iron
pink flag diming �
Legend . House
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/ iikte fl
t rnaig.flag'
pink
iron • iron
ROAD