SEPTIC Application # /9 r:717 2 5 75
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
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NOTE: A DEED OR OFFER TO PURCHASE IS REQUIRED AT TIME OF APPLICATION.
Date: /7 — 6 - /0
Applicant/hdam +: ( '/ i ,
Mailin_ Address: Z '9 // i1 ' !- a
City: - 1 • tl,. State: At Zip: r .1r[ ', 7
Telephone: g IJ' ' Other #: ( )
Current Land Owner: citi Phone:
Property Address: ;I 11�f�/A/S47 l. ' #
PIN: Z ' — ' 0 — 2f F' Parcel: O r OJf r
State Road #: y State Road Name: Al
Name of Subdivision: Lot # (trAppiicabie)
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Directions (please give concise omplete directions fro. illington, NC to the pro.ert%
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There 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 informati is Cory ct. /
Signature of Owner, Authorized Agent or Applic . ' 61,
FOR OFFICE USE ON
AUTHORIZATION FOR USE OF EXISTING SEPTIC SYSTEM
Signature of Environmental Health Specialist Date
SEPTIC 4/08
/ .
/
NAME • / k £ c APPLICATION #: cP0 Zr 75
*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 months or without expiration
depending upon documentation submitted. (Complete site plan = 60 months; Complete plat = without expiration)
910- 893 -7525 option 1 CONFIRMATION #
❑ Environmental Health New Septic SystemCode 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 houst3 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 Tots to be addressed within 10 business days after confirmation. $25.00 return trip fee may be Incurred
for failure to uncover outlet ltd, mark house corners and property lines, etc. once lot confirmed ready.
• Atter 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 put'Ild,back in place. (Unless inspection is for a septic tank in a mobile home park)
• ' DO NOT_LEAVE LIDS OFF OF, SEPTIC 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 desired system type(s): can be ranked in order of preference, must choose one.
{_J Accepted {_) Innovative (_) Conventional I_) Any
{_1 Altemative {_) 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:
{_DYES {_) NO Does the site contain any Jurisdictional Wetlands?
(_ }YES (_) NO Do you plan to have an j jgntinn system now or in the future?
{_)YES {_) NO Does or will the building contain any drains? Please explain.
I ( NO Are there any existing wells, springs, waterlines or Wastewater Systems on this property?
{_)YES 1_1 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 - 632 -4949 to locate the lines. This is a free service.
I Have Read This ,4plication And Certify That The Information Provided Herein Is True, Complete And Correct. Authorized County And
State Officials Art Granted Right Of Entry To Conduct Necessary inspections To Determine Compliance With Applicable Laws And Rules.
I Understandihat I Am Sole% Responsible For The Proper Identification And Labeling Of All Property Lines And Corners And Maldng
The S So � A om ate Site E lualion Can Be Performed. f ;` 3/7
PIIOPER<fc -NERS ORER AL REPRESENTATIVE SIGNATURE (REQUIRED) DATE
10/10
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DIAGRAM O ATYPIC L SEPTIC T K.
- / ■ UTLEt LID
f
POSSIBLE POSSIBLE
HOUSE HOUSE
CONNECTION CONNECTION
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l
POSSIBLE
HOUSE
CONNECTION
POSSIBLE LID SHAPES
1 - I SQUARE (SHOWN ON DIAGRAM)
RECTANGLE (OLDER TANKS) 0 ROUND