ENVH RefundHarnett
COUNTY
NORTH CAROLINA
COUNTY OF HARNETT
CHECK REQUEST FORM
Account Number: 110-0000-345-18-00
Project Number:
Vendor Name: Timothy Ensminger
Vendor Number:
Remittance Address: 308 Juno Drive
Broadway, NC 27505
Date: August 28, 2017
7X Mail to payee
7 Check to be picked up by:
(Requires approval of Finance Officer)
Approved:_ Disapproved:
Reason for check request: Per Oliver no environmental health
needed
This check request has been examined by me and is hereby approved for payment.
Department Head or Authorized Designee �//'— // Date
Graham H. Byrd, R.E.H.S " 7�/ - Z;& 9,i • /Y S 8/28/2017
is" turment has een
preaudited in the manner required
by the Local Government Budget
and Fiscal Control Act
Harnett County Finance Director
Description
Amount
ENVH Existing Tank Fee
$ 100.00
17-5-42096
$ -
308 Juno Drive
I
Total Amount Due
$ 100.00
Reason for check request: Per Oliver no environmental health
needed
This check request has been examined by me and is hereby approved for payment.
Department Head or Authorized Designee �//'— // Date
Graham H. Byrd, R.E.H.S " 7�/ - Z;& 9,i • /Y S 8/28/2017
is" turment has een
preaudited in the manner required
by the Local Government Budget
and Fiscal Control Act
Harnett County Finance Director
BP821U01 Harnett County
Application Fees Maintenance
Application number
Address . . . . .
Position to . . .
17 50042096
308 JUNO DR
Type options, press Enter.
1=Select
Amount
Opt To Apply Description
CP* MISCELLANEOUS
CREDIT/DEBIT PROC. FEE
ENVIRON HLTH REVISION FEE
EV* WELL FEE
EV*RETURN TRIP FOR SEPTIC
EXIST. TANK TEST/INSP.
HOMEOWNER RECOVERY FUND
LAND USE RENEWAL
MAIL -IN PROCESSING FEE
F3=Exit F9=Display all F12=Cancel
8/29/17
08:35:42
03
Starting characters
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.00
.00
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.00
.00
100.00
.00
.00
.00
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.00
.00
.00
.00
.00
100.00
.00
.00
.00
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In" Application Dale: % 7
Application 0 1]- i W 4109 Vf
CL.
COUNTY OF HARNETT RESIDENTM LAND USE APPLICATION
Central Permitting 109 E. Front Street, I.Mington, NC 27516 Phone: (910) 893-7525 ext2 Fax: (910) 893-2793 www.hameD.ora"rmits
-A RECORDED SURVEY AW. RECORDED DEED (OR OFFER TO PIIRCIPSE) L SITE PIAN ARE WaIIRED WHEN SIMWI TING A LAW LEE APPLICATION -
LANDOWNER. -- r) 4 Mailing Address:
'319F
��F � 4��"
City: %Iry State: rpa7So�;w_Sly�649 lHneil:I C
�Acoro:
717
-i GOM
APPUCANr: �7 +-1 l % Melling Address:
City: Nitate:Zip:_ Contact No:
*PIM"•Pout apparent iromrtion if dean ion"t than hvw; r_
frm
CONTACT NAME APPLYING IN OFFICE: Phone
PROPERTY LOCATION:
�1Subdivision: TAn -M S &A)e- Lot is AAA— Lott SSIC: • 3T
State Road • 267e + StateRoadName: Wo b o YQ • o �y Map Rook L Page: X:)% i III
Parcel: WSMP WTal Oto PIN: AS9n-34-03now
zertMkg: Flood Zone -y— watershed: Co Dees Book L Page:- 131, ny
Power eanpa:
'New structures with Progress Energy as service provider reed to supply premise number
from Progress Energy.
PROPOSED USE:
Monolithic
O SFD: (Size _x� 1 Bedroorrn:_ f Bads:_ Basemerd(Wwo beth):_ Gaaga:_ Deck:_ Crawl Space:_ Slab:_ Slab:_
(le the bonus room finished? (---) yes U no w/ a closet? (_j yes U no (N yes add In with • bedrooms)
O Mod: (Size _x� f Bedrooms_ 9 Bettis_ Basement (wlao beth)_ Garage:_ Site Built Dade_ On Frame_ OR Frame_
(Is the secant floor finished? (_) yes (__) no Any otter site built additions? (__) yes (__) no
U Manutactu ad Hann: _SW _DW _TW (Size x__j 0 Bedrooms: _ Garage:_(sile built?_) Dedk:_(site built?_j
U Duplex: (Size _x_) No. Buildings: No. Bedrooms Per
U Hare Occupation: 0 Rooms: use! Hours of Operation: #Employees:_
W- AdditionlAoeessary/Other. (Size (V x) !�1 Use:3 SPS 50^) M Closets in addilion? (_j yes�j ro
Water Supply: County _ Existing Well _ Naw Well (i of dweiangs usbg well )'Must have operable wow belora 5W
Sewage Supply: —New Septic Tank (Corrpbte C/reddfsf) )L Existing Septic Tank (Complefe Chackhsf) _ Counly Sewer
Does owner of this trail of land, own Lard that contains a manufactured hooka within five hundred leet (500') of tract listed above? U yes � no
Does the property contain any easements whether underground or overhead L_) yes ! w no
Structures (exintimg or proposed):proposed):S� family dwell ngs:_X_ ManufacturedHome
Required Residential Pimperty Lioe Setbacks:
22 '
Front WrdmtanActual
Rear 25
Closest Side (y
SidestreaUcarer let
2dimg
adj
Re,'. aeItal Land Usr Aprbr.a:.on Faye t J 2
APPLICATION CONTINUES ON BACK
Other (spay):
It permits are granted I agree to conform to all ordinances and laws of the State of North Carolina regulating such work and the specibmificns of plans submitted.
1 hereby slate that taagoirg sts ts and terra Lre-besl of m edge. Permit subject— � d n false information is provided.
7
Signature Owner's Agent
'it is the owner/applicants responsibility to provide the county with any applicable information about the subject property, including but not SMtsd
to: boundary information, house location, underground or overhead statements, etc. The county or Its employees ars not responsible for any
incorrect or missing information that is contained within thsss spplicatlons."'
"This application expires 6 months from the initial date If permits have not been issued"
HTE# JHarif.ct County Department of Public' .aealth
0 fPermit
21182
PERMIT # Z Fera I— +;f
�1� New Installatiol�--Septic Tank ❑ Repair "' ification Line
1 PROPERTY LOCATION: c
(' 1, SUBDIVISIONLOT
Name: (owner) ��� °��
System Installer:
d� �� ,� Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water SupplK. ❑ Communityf Public L] Well Distance from well Typfeet es and VI Systems expire in S years.
System Type: �rii iib � y Casa a k VP
Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
(In accordance with in compliance with applicable North Carolina General Statutes, Rules for Sewa a Treatment and Disposal, and all conditions of the Improvement Permit and Construction A
This system has been installedTable
�
i
rannu
I. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No'�
If yes, see attached sheet for additional operation c
and reporting.
❑ Expansion
F.iw
tJ
IV. Operation: a" (�
i^ `v "" "<
c
V. Other:
Following are the specifications for
Type of system: ❑ Conventional
Subsurface No. of
Drainage Field ditches
french Drain Required:
l
the sewage disposal svXem on the above ca boned, prop rt • �q Septic lank: / '�
Other 1I51AT b width of
exact length G 3
of each ditch feet ditches
Linear feet y
��I� Date
gallons Pump Tank gallons
depth of ^
feet ditches inches
�yl� o
Authorized State Agents
ApplWation/perm# t o j -SM W W 1 (Y
Pursuant to NCG5153A-352 (Cl, 2, 3 D),
I ROBERT JBRACKEN, PE have
personally (or had an agent under my direct supervision) performed an
inspection of the work done at the following location address:
3G8 JUNO DR. , BROADWAY NC 27505
Scope of work was:
Tn CONDUCT AN ASBUILT INVESTIGATION OF A "NON CONDITIONED" ROOM ADDITION TO
AN EXISTING RESIDENCE.
I hereby certify that the work done meets all aspects of the North
Carolina Building and technical codes in effect at the time of my
inspection.
Signature J&a Date AUGUST 16, 2017
Seal Here PSN cp�o
�� oFEsS.
NAME: APPLICATION C-11 MW 1�fl
"This application to be rolled 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 months or without expiration
depending upon documentation submitted. (Complete site plan = 60 months; Complete plat = without expiration)
910-893-7525 option I CONFIRMATION N f
❑ Environmental Health New Septic SvstemCode 800
• All property irons must be made visible. Place `pink property flags" on each corner it n o 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 attfor 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.
• 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 Eidstina 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 lid back In place. (Unless inspection is for a septic tank in a mobile home park)
• 00 NOT LEAVE UDS 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 typeis): can be ranked in order of preference, must choose rine.
1_1 Accepted I—I Innovative I_) Conventional I—) Any
I_) Alternative I_1 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 A7"1'ACII SUPPORTING DOCUMENTATION:
I_)YES I_) NO Does the site contain any Jurisdictional Wetlands'!
I_)YES 1-1 NO Do you plan to have an irrigation -wasgu now or in the future?
I_)YF.S I^) NO Does or will the building contain any drains'! Please explain.
I—)YES 1-1 NO Are there any existing wells, springs, waterlines or Wastewater Systems on this property?
I_)YES I_) NO Is any waslewater going to he generated on the site other than domestic sewage?
(_LYES I-1 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?
i_1YES I—) 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
Slate Officials Are Granted Right Of Entry To Conduct Necessary Inspections To Determine Compliance With Applicable Lars And Rules.
I t!ndersland That t Am Solely Responsible For The Proper Identification And Labeling Of All Property Lines And Corners And Making
The Site Accessible Su That A Complete Site Evaluatiu ' n Be Performed.
PROPERTY OWNERS OR OWNERS LEGAL. REPRESENTATIVE SIGNATURE (REQUIRED) DATE.
10110