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Initial Application Dater-11-11 Application# I T ISc 9L_
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COUNTY OF HARNETT RESIDENTIAL LAND USE APPLICATION
Central Permitting 108 E.Front Street,Ellington,NC 27546 Phone.(910)893-7525 ext 2 Fax:(910)893-2793 wwwharnett erg/permits
"A RECORDED��OJ�� SURVEY MAP,RECORDED DEED(OR
-OFFFER.T.O,PURCHASE)8 SITE PLAN ARE REQUIIRREDD WHEN
'SUBMITTING A LAND USE APPLICATION"
LANDOWNER 26143 '1it Su Wrodha- l Mailing Address I, 1,JJ'15 (1--
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APPLICANT :Z2V JQ II S' I,1.,oxrgarllailing Address. 60 I /IL}.ST�/�
Gu Sar7Fovd. State NC Zip UContactNCO6M/lie#29�pv Email[JrrrlhamlI3Olin I .00m
•Please(tll dui applicani information if different than
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CONTACT NAME APPLYING IN OFFICE:
/IcS OOof07..m EIOWell�1� Phone# ci lel LTN) (PC J 1 J
PROPERTY LOCATION:Subdivision IJ/-f I(I,YY4e'1✓os . j t Lot#. Lot ISlize �i ±i&iv'
State Road 4 1 �1 State Road Name: KN ❑La✓C� Map Book&Page: 57/X . .20l r
parce(a O°I CASlilBUS/ ! q 6Log5b1 -'ci '"118-7 apoe -2L1
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zoning��,,)'1*0`Flood zonex Watershed A212E Deed Book&Page: 3(I12 0763 Power company: P✓6gfe55 F)te✓i 383
'New structures with Progress Energy as service provider need to supply premise number from Progress Energy.
PR OSED USE:�I
PR
Ii 3101441111#310144113101441111#SFD (Size;lI x 11 )#Bedrooms/2) #Baths,C6Basement(wlwo bath). Garage: E Deck. Crawl Space: I Slab Slab._
(Is the bonus room finished'( I yes (L(no wl a closet'()yes ( )no(if yes add in with#bedrooms)
U Mod.(Size x I#Bedrooms_#Baths_Basement(wlwo bath)_Garage: Site Built Deck:_ On Frame_Off Frame
(Is the second floor finished?( )yes (_)no Any other site built additions?( 1 yes ( )no
❑ Manufactured Home:_SW OW_TW(Size x )#Bedrooms:_Garage. (site built? )Deck: (site built? I
❑ Duplex(Size x )No.Buildings: No Bedrooms Per Unit.
❑ Home Occupation.#Rooms Use: Hours of Operation. #Employees
U Addition/Accessory/Omer:(Size x )Use. Closets in addition'(—)yes (_I no
Water Supply: `• County Existing Well New Well(#of dwellings using well )'Must have operable water before final
Sewage Supply: J New Septic Tank(Complete Checklist) Existing Septic Tank(Complete Checklist) County Sewer
Does owner of this tract of land,own land that contains a manufactured home within five hundred feet(500')of tract listed above'( )yes (��o
Does the property contain any easements whether underground or overhead LI)yes (_)no
Structures(existing or ropose• -Single family dwellings.p I Manufactured Homes: Other(specify).
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It.gulred Residential
�Prropperty Line Setbbaceks: Comments:
Front Minimum ) a Actual I I-'
Rear
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Closest side
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Sidestreeucorner lot
Nearest Building
on same lot
Rasideneal Land Lens Appl4>N3p Page 1 of 2 01'11
APPLICATION CONTINUES ON SACK
SPECIFIC DIRECTIONS TO THE PROPERTY FROM LILLINGTON: !'I W 7 -21 dD P w,,/ 61 N e
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II permits are granted I agree to conform to all ordinances and laws of the State of North Carolina regulating such work and the specifications of plans submitted.
I hereby stale that forego stat ments are accurate an correct to the best of my knowledge Permit sub eel to revocationevif false information is provided.
Signatureof Owner or Owners Agent `)'DnGate�/�
**It is the ownerlapplicants responsibility to provide the county with any applicable information about the subject property,including but not limited
to:boundary information,house location,underground or overhead easements,etc.The county or its employees are not responsible for any
incorrect or missing Information that is contained within these applications."'
"This application expires 6 months from the initial date if permits have not been issued"
Hesidentia Land Use Application Page 2 oft 03111
DIPLAN�APPROVAL
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NAME:Yl-R3LF 10L()0f7 APPLICATION It:
'~'this application to be filled out when applying toe a septic system inspection.*
County Health Department Application for Improvement Permit and/or Authorization to Construct
IF TIM INFORMATION IN THIS APPLICATION IS GUSHIER CHANGPI).OR THE Mil:IS ALTERED,THEN THE IMPROVEMENT
PERMIT OR AU'T'HORIZATION TO CONSTRUCT 511AI 1-BECOME INVALID. The perm is valid dw either 60 months or without expiration
depending*pot dncumcuraann submitted. (Complete site plan=60 months,Complete plat=without expiivumn
910-S93-7525 option l CONFIRMATION x _ _
Environmental Health New Septic SvstemCode 800
• All property irons must be made visible. Place 'Mink property flags" on each corner iron of lot. All property
lines must he 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
BOO (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 lid 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
It applying for authorization to construct please indicate desired system typetsl. can he ranked in order of preference,!MIST choose one.
IL Accepted ( I Innovative 14 Conventional I-1 Any
Alternative I—I Other _.
The applicant shall notify the local health department upon submittal of this application if any of the following apply to tl e property in
question. lithe answer is`yes'.applicant MUST ATTACH SUPPORTING DOCUMENTATION:
- I YES I1 NO Does the.sift contain any Jurisdictional Wetlands'?
_LYES III NO Do you plan to have an illiut 'oh systen now or in the future?
YES 111 NO Does or will the building contain any drains'.' Please explain.
-_IVIS III No Are there any existing wells. springs, waterlines or Wastewater Systems on this properly?
L_I YES f NO Is any wastewater going to be generated on the site other than domestic sewage?
I YES I L I NO Is the site subject to approval by any other Public Agency?
I_IYFS II NO Are there any Easements or Right of Ways on this property'
I—I YES I/I NO (Does the sire 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'Phis Application And Certify That The Information Provided Herein Is True,Complete And Correct. Authorized County And
Stale Officials Are Granted Right Of Entry To Conduct Necessary Inspections To Determine Compliance Willi Applicahle Laws And Rides.
I Understand Thal I Am Solely Responsible For The Proper Identification And Labeling Of All Properly Lines And Corners And Making
the.Site essihle So Thi 1 A COMq etc Site v Mallon Can Be Performed.
ill 22 a
PROPERTY OWN RS OR OWNERS LEGAL REPRESENTATIVE SIGNATURE(REQUIRED) DATE
I til M
Southeastern Soil & Environmental Associates, Inc.
P.O. Box 9321
Fayetteville, NC 28311
Phone/Fax (910) 8224540
Email mikeLesoulheaSlemsoil.cnm
November 6,2017
Harnett County Health Department
307 Cornelius Harnett Blvd.
Lillington. N.C. 27546
Re: Soil evaluation and final septic recommendation, 100 acre lot, Randall Scott
Woodham, NCSR 1201, Harnett County, North Carolina
To whom it may concern,
A preliminary soils investigation has been completed for the above referenced lot &
attached off site drainfield area(attached by a 15 foot utility strip). The property is
located on NCSR 1201 as shown on the accompanying map. The purpose of the
investigation was to determine the ability of the soil to support a subsurface waste
disposal system for the proposed lot. All ratings uid determinations were made in
accordance with "Laws and Rules for Sanitary Sewage Collection, Treatment, and
Disposal. 15A NCAC I8A .1900".
The off-site area (sec map) appears to contain at least one soil area that meets minimum
criteria for a pump to conventional/innovative subsurface waste disposal system to serve
a proposed mechanical shop (up to 4 employees: 100 gpd;domestic wastewater only;no
industrial wastewater). Soil characteristics in the usable soil area were dominantly
provisionally suitable to at least 30 incites including those spec tied in rules .1940, .1941,
.1942, .1943, .1944 and .1945. A soil map indicating typical soil areas that meet these
criteria is enclosed. The off-site area appears to contain sufficient available space for a
repair area for the proposed use.
This lot may require specific design/layout on our part prior to action by the local
health department due to space and soil considerations (at separate cost to client).
There should be no grading, logging or other site disturbance in soil areas
designated as usable for subsurface waste disposal until approved by the local
health department(any site disturbance could remove soil and render the area
unusable).
When evaluated, the soil areas designated as usable for subsurface waste disposal
were dry to at least 24 inches. During wetter time periods, subsurface water could
be found in any of these soil areas at shallower depths. The local health
SOIL/SITE EVALUATION •501L i't1YSI[ AL AN/0 YSIE • AND uSEbSui NI ICN PLANNING•WETLANDS nc nn
department has the authority to deny a permit to any soil where water saturates a
soil boring. SSEA cannot be certain that this will not occur on any of these lots. If
this occurs (and cannot be remedied with a French Drain or other drainage), any of
these lots could become unsuitable due to .1942 (soil wetness).
As with any property, this report does not guarantee, represent or imply approval or
issuance of improvement permit as needed by the client from the local health department
(as suelt,:iny potential buyers of these properties should obtain appropriate permits
front the local health department prior to making and/or completing purchase
obligations or financial commitments. Since professional opinions sometimes
differ, an actual improvement permit issuance by the local health department is the
only guarantee of a site's suitability for a buyer intended use.). This report only
addresses Hiles in force at the time of evaluation. Permits will only be granted if the
local health department concurs with the findings of this report. This report only
represents my professional opinion as a licensed soil scientist. I trust this is the
information you require ac this time. If)(xi have any questions, please cal.
Sincerely,
_EpSOIL sej� .
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Mike Eaker " '`r
NC Licensed Sod Scientist '�5t
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HARNETT COUNTY CASH RECEIPTS
K0* CUSTONER RECEIPT aaa
Oper: RQCN
JO17 52
Type: CP Drawer: 7
Receipt no:
116255 77
Year Humber
2817 58842812 Amount
91749 TECH 2
LILLINOTOH, NC 27546
B4 HG - ENV HEALTH FEES
HEW TANK 3750.98
S NOOBNAN TRUCKING
Tender detail
CE CHECK PATTEN
42812 $758.80
Total tendered
Total papent $750.00
Trans date: $750.90
11/27/17 Time: 13:32:88
* THANK YOU FOR YOUR PAYMENT as