SEPTIC 11 Application # /P ✓ - z 4 77/
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
ii •
ETC.
NOTE: A DEED OR OFFER TO PURCHASE IS REQUIRED AT TIME OF APPLICATION.
Date: 1Z 14 — /9
Applicant/Ms -S � g � M. � ./ � liv- (r�t �n-!ch
Mailing Address: /U/O 1 L%d4,6/AUL Pot
Cit Cu sncr e," it/G State: /V L Zip: Zg 3 Z (a
Telephone: Op 4 / 9 ` o / - 1 780 Other #: ( )
Current Land Owner: - '' ,- 6/0 IL r Phone:
Propert A -ss: ' t. - t'n 4-. (.innl -u / /1/L 2 -. 2-3
PIN: /. Z , AWL . ',Parcel: Oingfrallg
State Road #: / t Z// h State Ro Name: Z// •
Name of Subdivision: f f ' � Al l 4 4,i Lot # /4' (t( Appficabte)
ra re:; of emu.. e- #.fc' -.re'. .0 — I Pr i yr
.t., ..• t: t -' em. .y: I : ■ s:
Directions: (please give concise complete directions from Lillington, NC to the property)
I ei to ' f 0 � i ,1 /s 12r i ?Ke 1 - 6 7 a L4
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 information is correct.
Signature of Owner, Authorized Agent or Applicant: 1 ���%!�l - L SA,__.--
FOR OFFICE USE ONLY
FOR USE OF EXISTING SEPTIC SYSTEM
Signature of Environmental Health Specialist Date
SEPTIC 4/08
‘L‘r41/4\
Jet?, 1 917 g93 7r47 / /
NAME: J t^' n'tQvl APPLICA #: < O § 2 y /
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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
depending upon documentation submitted. (Complete site plan = 60 months; Complete plat = without expiration) I i 2 i 7
910 - 893 -7525 option 1 CONFIRMATION # !` ✓ (O
❑ 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 0 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 fines. 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
onfirmation number given at end of recording for proof of request.
se Click2Gov or IVR to verity results. Once approved, proceed to Central Permitting for permits.
Environmental Health Existing Tank Inspections Code 800
)cy
Fol low 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 lid back in place. (Unless inspection is for a septic tank in a mobile home park)
. DO NOT LEAVE LIDS OFF 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
(liven 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
{_) 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:
{_) YES {_} NO Does the site contain any Jurisdictional Wetlands?
(_)YES (_) NO Do you plan to have an }mention system now or in the future?
{_)YES (_) NO Does or will the building contain any ? Please explain.
I_)YES {_) 180 Are there any existing wells, springs, waterlines or Wastewater Systems on this property?
{_)YES {_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 {_} 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 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 ' A essfbl So Tha o to Site Evaluation Can Be Performed.
/ .✓` � ?ow 1 2- /5
PR'/ P ' OWNERS OWNERS LEGAL REPRESENTATIVE SIGNATURE (REQUIRED) DATE
10 /10
s
DIAGRAM o F A TYPICA SEPTIC T
as
— • UTLET LID
IIII
O
POSSIBLE POSSIBLE
HOUSE HOUSE
CONNECTION — CONNECTION
—/ .
POSSIBLE
HOUSE
CONNECTION
POSSIBLE LID SHAPES
I — 1 SQUARE (SHOWN ON DIAGRAM)
ill RECTANGLE (OLDER TANKS)
0 ROUND
ICO IIIIIL lopiptwolut
• - NETT COUNTY TAX 100
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_ ,= ;pi 4. IS M 20
41 ' + ' OLINA GENERAL WARRANTY DEED
Excise Tax: $ 60.00 r.
Parcel Identifier No. 05 • 9 9; 1.000 Verified by County on the _ day of , 20_
By:
MaflBox to: Thorp, Clarke, K . , ' CN. McPherson Church Road, Ste B, Fayetteville, NC 28303
This instrument was prepared by: Tho -. :, .- e & Kirby, PA, 150 N. McPherson Church Road, Ste B, Fayetteville,
Brief description for the Index: LO ' ...a.:726..
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THIS DEED made this 28th day o C> M': , 20 10 by and between
GRANTOR / GRANTEE
US Bank, NA �/ f /
4801 Frederica Street o r. n & McGurl Enterprises, LLC
Owensboro, KY 42301 1065 ' : • , • out Rd.
eron NC 28326
Enter in appropriate block for each Grantor and Grantee: name mail , : ., if appropriate, character of entity, e.g.
corporation or partnership.
The designation Grantor and Grantee as used herein shall include s; ". , ; .. - 0. - r heirs, . ceasing, and assigns, and shall include
singular, plural, masculine, feminine or neuter as required by context.
WITNESSETH, that the Grantor, for a valuable consideration paid by the .: - , a i . i ich is hereby acknowledged, Sand
by these presents does grant, Ste' sell and convey unto the Grantee in fcc .1:,,. lc, , th . of or parcel of land situated in the
ant
City of Township, , r .. -,t County, North Carolina
and more particularly described as follows: IL
BEING all of Lot 14 in a subdivisioN known as POPLAR MILLS RUN, and the s: , • -. in Plat Cabinet F,
Slide 538 -A, Harnett County Registry, North Carolina.
The property hereinabove described was acquired by Grantor by instrument recorded in Book 26 1 ' ''
All or a portion of the property herein conveyed 1_ includes a _ does not include the primary reside . y�y .
A map showing the above described property is recorded in Plat Book F page 538 -A ,
NC Bar Association Pam No. 3 0 1975. &Mal 0 I/Irrale
Prinwd by Apeaawnl with the NC Bar Association ,
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