RefundHarnett
COUNTY
Account Number:
Project Number:
Vendor Name:
Vendor Number:
Remittance Address:
COUNTY OF HARNETT
CHECK REQUEST FORM
110-0000-345.18-00 EH FX Mail to payee
Check to be picked up by:
Robin Pomoles
3743 Lockerbie Court
Fayetteville, NC 28306
Date: 4/16/2018
(Requires approval of Finance Officer)
Approved: Disapproved:
Reason for check request: Buyer has backed on buying property, requested a refund
This check request has been examined by me and is hereby approved for payment.
e or Authorized Designee Date
R.E.H.S.
This instrument has been
oreaudited in the manner required
by the Local Government Budget
and Fiscal Control Act
Harnett County Finance Director
Description
Amount
ENVH Soil Evaluation Fee
$ 750.00
18-5-43740- Jaylin Oaks Lot 24
Total Amount Due
$ 750.00
Reason for check request: Buyer has backed on buying property, requested a refund
This check request has been examined by me and is hereby approved for payment.
e or Authorized Designee Date
R.E.H.S.
This instrument has been
oreaudited in the manner required
by the Local Government Budget
and Fiscal Control Act
Harnett County Finance Director
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BP821U01
Application number
Address . . . . .
Position to . . .
Harnett County
Application Fees Maintenance
18 50043740
175 JAYLIN OAKS DR
Type options, press Enter.
1=Select
Amount
Description
P* WATER CAPACITY FEE
P* WATER TAP 1"
P* WATER TAP 3/4"
PZ FLOOD PERMIT
PZ* SITE PLAN REVISION
REVIEW RESIDENTIAL PLANS
SOIL EVAL/NEW SEPTIC TANK
911 REFLECTIVE SIGNS
F3=Exit F9=Display all F12,=Cancel
4/16/18
10:52:40
O1
Starting characters
Previously
Applied
Paid Inactive
.00
.00
.00
.00
.00
.00
.00
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.00
.00
750.00
750.00
.00
.00
Bottom
Initial Application Data. I 0
Application # _ `U_ SM -7C
COUNTY OF HARNETT RESIDENTIAL LAND USE APPLICATION
Central Permitting 108 E. Front Street,.Lillington, NC 27546 Phone: (910) 893-7525 ext:2 Fax: (910) 893-2793 www,hamett orglpermits
-A RECORDED SURVEY . MAP, RECORDED DEED (OR OFFER TO PURCHASE) &'SITE PLAN ARE REQUIRED WHEN SUBMITTING A LAND USE APPLICATION-
LANDOWNER
PPLICATION-
LANDO�O �4'WNER:�jaie-s rc�ly T1,u��. Y-,^
4 Melling Address:.z�iC-T
r
City: a likL. S1ate:�Z P.'A—O!k Contl t No: 210-1097.7d7.Z rEmail: -�t %local .L�,Vol
_ D
APPLICANT*: oS� t"Osr.. ' s Mailing Address: ffio1 GlF',f
City: I d .. �'Q✓,%lam_ State�0_Zp: r Contact No: gI®`/e70'%U7d Email: %arrcc�5 v,Lar�
'Please fill applipnt Imormation if dmerent Man Iandl t ner
CONTACT NAME APPLYING IN OFFICEPJw.a, L.oS Phone #J141 'L70-7a7,t,
PROPERTY LOCATION: Subdivision: �A��i--L 670,14 , / t0}#.�_ Lotsbree,,
State Road # 11�I\ 1 (. Stta�tee Road Name: I N @t . '�/ I u C hl ,u& WA r Map Book & Page: W 1 /
Parcel:r�n'V� VLi l LJ PIN: C7J �.���,�,f�Q.(�(�
Zoning: ' r1W A Flood Zone: Watershed: -AL Deed Book & PageaLoof, 1 fi%iP Power Company':
'New structures with Progress Energy as service provider need to supply premise number
from Progress Energy.
PROPOSED USE:
❑ SFD: Sfze"� q L4$ #Bedrooms: Monolithic
( roa. x_) a # Baths:, Basement(wtwo bath): Garage:_ Deck:_ Crawl Space:_ Slab:_ Slab:_
(Is the bonus room finished? (_) yes L) no w/ a closet? L_) yes U no (If yes add In with # bedrooms)
❑ Mod: (Size _x_) # Bedrooms_ # Beths_ Basement (whvo bath)_ Garage:_ Site Built Deck:_ On Frame_ ON Frame
(Is the second floor finished? L) yes (_)no Any other site built addh ons? (_) yes U no
❑ Manufactured Home: _SW _DW _TW (Size) if Bedrooms: _ Garage:_(site bulit?--) Deck:_(site built?_)
❑ Duplex: (Size _x_) No. Bullrings: No. Bedrooms Per Unit:
❑ Home Occupation: # Rooms: Use: Hours of Operation: #Employees:_
❑ Addition/Accessory/Other: (Size
Closets In addition? (—) yes U no
Water Supply: k County _ Exisgng Well _ New Well (# of dwellings using well.) *Must have operable water before final
Sewage Supply:-)( —New Septic Tank (Complete Checklist) _ Existing Septic Tank (Complete Checklist) _ CountySewer
Does owner of this tract of land, own land that contains a manufactured home within five hundred feet (500') of tract listed. above?(_) yes no
Does the property contain any easements whether underground or overhead L) yes tXi no
Structures (existing or proposed): Single family dwellings: ja—yv�"anufactured Homes: "'� Other (specify):
Required Residential Property Line Setbacks:
FrontMinimum`< __ Actual Cn�
Rearf —10/,S
L
Closest Side 4-6
SidestreeUmrner lot
Nearest Building
on same lot
Y
Residential Land Use Application Page 1 of 2 03/11
APPLICATION CONTINUES ON BACK
SPECIFIC DIRECTIONS TO THE PROPERTY FROM LILLINGTON: Id
If permits are granted I agree to conform to all o5ices and laws of the State of North Caroline regulating such work and the specifications of plans submitted.
I hereby state that foregoing q atements s e ac �6ra ntl correct to the best of my krxiwledga. Permit subject to revoccaatiooniH false Information Is provided.
S' naW re of Owner or Owner's Agent a
te
—It is the owner/applicants 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"
Residential Land Use Application Page 2 of 2 03/11
COMMENTS:
LANDSCAPE POSITIONS GROUP TEXTURES
R -RIDGE I
S -SAND
S -SHOULDER SLOPE
LS -LOAMY SAND
L -LINEAR SLOPE
FS-FOOTSLOPE 11
SL -SANDY LOAM
N -NOSE SLOPE
L -LOAM
H -HEAD SLOPE
CC -CONCLAVE SLOPE III
SI -SILT
CV -CONVEX SLOPE
SIL -SILT LOAM
T -TERRACE
CL -CLAY LOAM
FP -FLOOD PLAN
SCL SANDY CLAY LOAM
IV
SIC-SILTYCLAY
C -CLAY
SC -SANDY CLAY
STRUCTURE
MINERALOGY
SG -SINGLE GRAIN
SLIGHTLY EXPANSIVE
M- MASSIVE
CR -CRUMB
EXPANSIVE
GR -GRANULAR
SBK-SUBANGULAR BLOCKY
ABK-ANGULAR BLOCKY
PL -PLATY
PR -PRISMATIC
ana
F—
.1955 LTA R
CONSISTENCE MOIST
1.2-0.8
VFR-VERY FRIABLE
FR -FRIABLE
0.8-0.6
FI -FIRM
VFI-VERY FIRM
EFI-EXTREMELY FIRM
0.6-0.3
0.4-0.1
FILE #
"I W
NS -NON -STICKY
SS-SLIGHTY STICKY
S -STICKY
VS -VERY STICKY
NP -NON -PLASTIC
SP -SLIGHTLY STICKY
P -PLASTIC
VP -VERY PLASTIC
. r w r _ .. _..._.. _ _. _ .
HTE# _0%— No
Harnett County Department of Public Health 25029
Authorized State Agent: '
The issuance al Ali permn by she Nwlth anent in now le D7re. 10 1 CS$ SEE ATTACHED SITE SKETCH
OW de gutanun the issuance Mer rmin Tae rnit holder u roponsible for chedung with appropria a governing bodies m meeting rheic requirement. %
site is word to es for Sew g the sift plan, plat or Me intended oft is of A. The ,At.swipmeet Pdmn shill no be anected by a dung¢ in awnership of Me AM ihb permit is subject m compliance with the proymom of
she laws and Rules for Stwage irnnnem and Dispmal and M <ondidom of dxs permit.
Construction Authorization
(Required for Building Permit)
The wnsnunion and a mlayouton, requiumenrs of Auks .11fo, .H52, .1951, .1955, .19s6, .1951, .1958. and .1959 are iatarpouhd by nkrcnns iota this fiction aced shall he met Sysmm shad be hnulkd in accordant
with Me azuched system layout
ISSUED 10: Z5 PRpPt » PROPERTY LOCATION: Claf&4m s " Cq dy-A
Rao
SUBDIVISION s`n ydL ft, Ciny e, LOT # _
Facility Type: SFD (`dAi' x� New ❑ Expansion ❑ Repair
Basement? ElYes � No Basement Fixtures? ❑Yes No
Type of Wastewater System" 25% PFnurs6oc� `�YsTP+w1
(See note below, d applicable ❑) (Initial) Wastewater Flow. XD GPD
Pu n� j . �►, CE'U'O 0aa Svs-*^(Repair)
Installation Requirements/Conditions Number of trenches t-1
Septic Tank Size sono gallons Exact length of each trench 5C) (tet Trench Spacing. q Feet on Center
Pump Tank Size gallons Trenches shall be installed on contour at a
Soil Cover, a—ta inches
Maximum Trench Depth of: t$_ay inches (Maximum soil cover shall not exceed
(French bottoms shall be level to +1-114" 36" above the trench bottom)
in all directions)
Pump Requirements: ft. TON vs. _ GPM
nches below pipe
Conditions: Aggregate Depth: inches above pipe
inches total
N anolicable• / oadeataod the system type speafved it d/'&Iwthon the type speafied on rhe app/itafteo. /accept the rpeafcaaotn of &lf permit
Date:
Thu Cnnswmon Ault ---on is subject m uraenon d Me tie plan, plat or de intended use changes. Thr (onseucton Authnnrat" suit oat be -M-dewed when Mee u a dung¢ in ownership of the sire. This
Conssmction Authorization is tote ea co ampdan w rico the law: and Rules kr Sewage inatmenr and Disposal and te dce cendiriom of this ion
a SEE ATTACHED SITE SKETCH
Authorized State Agent: �5 Date: 10
__ Const n Authorization Expiration Date: s o 1 113
Improvement Permit
A building permit cannot be issued with only an Improvement Permit
ISSUED TO:5S
Qrwt'Erx�t
PROPERTY LOCATION: _�¢ssc:w%124 G,s
NEW
REPAIR ❑
SUBDIVISION 5p.sb_,, C0r.,cS
EXPANSION ❑
LOT # aa}
Site Improvements required prior to Construction Authorization
Type of Structure: aSd/o Q.Eouo6'ce., Sy t
Issuance:
ProposedWastewater
Projected
System Tppe: 5Fp Q4�%6�''
Daily Flow:
bm
GPD
Number of bedrooms:
_-3, _
Number of Occupants: Gmax
Basement ❑Yes
;M He
Pump Required: ❑Yes
❑ No
May be required based on final location
Type of Water Supply:
Permit condition:
❑ Community
and elevation of facilities
,� Public ❑ Wen Distance from well s feet Permit valid for
Five years
❑ No expiration
Authorized State Agent: '
The issuance al Ali permn by she Nwlth anent in now le D7re. 10 1 CS$ SEE ATTACHED SITE SKETCH
OW de gutanun the issuance Mer rmin Tae rnit holder u roponsible for chedung with appropria a governing bodies m meeting rheic requirement. %
site is word to es for Sew g the sift plan, plat or Me intended oft is of A. The ,At.swipmeet Pdmn shill no be anected by a dung¢ in awnership of Me AM ihb permit is subject m compliance with the proymom of
she laws and Rules for Stwage irnnnem and Dispmal and M <ondidom of dxs permit.
Construction Authorization
(Required for Building Permit)
The wnsnunion and a mlayouton, requiumenrs of Auks .11fo, .H52, .1951, .1955, .19s6, .1951, .1958. and .1959 are iatarpouhd by nkrcnns iota this fiction aced shall he met Sysmm shad be hnulkd in accordant
with Me azuched system layout
ISSUED 10: Z5 PRpPt » PROPERTY LOCATION: Claf&4m s " Cq dy-A
Rao
SUBDIVISION s`n ydL ft, Ciny e, LOT # _
Facility Type: SFD (`dAi' x� New ❑ Expansion ❑ Repair
Basement? ElYes � No Basement Fixtures? ❑Yes No
Type of Wastewater System" 25% PFnurs6oc� `�YsTP+w1
(See note below, d applicable ❑) (Initial) Wastewater Flow. XD GPD
Pu n� j . �►, CE'U'O 0aa Svs-*^(Repair)
Installation Requirements/Conditions Number of trenches t-1
Septic Tank Size sono gallons Exact length of each trench 5C) (tet Trench Spacing. q Feet on Center
Pump Tank Size gallons Trenches shall be installed on contour at a
Soil Cover, a—ta inches
Maximum Trench Depth of: t$_ay inches (Maximum soil cover shall not exceed
(French bottoms shall be level to +1-114" 36" above the trench bottom)
in all directions)
Pump Requirements: ft. TON vs. _ GPM
nches below pipe
Conditions: Aggregate Depth: inches above pipe
inches total
N anolicable• / oadeataod the system type speafved it d/'&Iwthon the type speafied on rhe app/itafteo. /accept the rpeafcaaotn of &lf permit
Date:
Thu Cnnswmon Ault ---on is subject m uraenon d Me tie plan, plat or de intended use changes. Thr (onseucton Authnnrat" suit oat be -M-dewed when Mee u a dung¢ in ownership of the sire. This
Conssmction Authorization is tote ea co ampdan w rico the law: and Rules kr Sewage inatmenr and Disposal and te dce cendiriom of this ion
a SEE ATTACHED SITE SKETCH
Authorized State Agent: �5 Date: 10
__ Const n Authorization Expiration Date: s o 1 113
HTE#
Permit # a.Soaa
HaTllett Coilnty Department of Aiblic Health
Site Sketch
PROPERTYLO(ATON: CQetYsvit� Cti a�Q�
ISSUED T0: Z5 Qrto SUBDIVISION - wry u v O ocr,
Eor At a9
Authorized State Agent.
(ptivfp.`SOt.`t. Er Date: 1C, W07
_ Is
I—
epon rA1, a*. 1 E
5o I-0UGTION I ? ��o
SE�gAcy. Q
1
A
H
3y ass
IYAaC�41,., I 4
50
Division of Environmental Health J1OO1
On-site Wastewater Section Property ID:
Lot #:
SOII✓SITE EVALUATION File #:
for ON-SITE WASTEWATER SYSTEM Code.
Owner:
Address: Applicant
Proposed Facility: 0't0q,03 Design Flow (.1949):
Location of Site:
Water Supply: -RA Public I) Individual () Well
Evaluation Method: Auger Boring
(]Pit
Type of Wastewater: Sewage
()Industrial Process
P
R
O SOIL MORPHOLOG K
F ..
I - Q -,�o 4;5- VPZ �r3��,tP
16-wd 5g�{ �L r(Z c<)4
-'- I VFa
r'IS"V SL \ICn
- � G L
3 Q
t$-JAI 5C3u
System Type(s)'
ED
Site LTAR
Dale Evaluated: CJ,\Jq
Property Size:
Property Recorded:
[) Spring
( J Cut
[ J Mixed
IER i r,
®-��t�ttltt�rr_�
Other Factors (.1946):
Site Classification (.1948): Qom`
Evaluated By: OM /01
Others Present:
NAME: _ APPLICATION #:
*This application to be filled out when applying for a septic system inspection.*
IF THE INFORMATION IN THIS APPLICATION IS FALSIFIED, CHANGED, OR THE SITE IS ALTERED, THEN THE IMPROVEMENTS
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 I CONFIRMATION #
/ Environmental Health Hew Septic SvstemCode 800
V/ •All property frons 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 comers.
• 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.
•h -
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 Exisfing 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 (it
possi
ble) and then put Whack in -pine. (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 authorisation to construct please indicate desired system type(s): can be ranked in order of preference, must choose one.
(_) Accepted (_) Innovative t_) 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 answer is "yes", applicant MUST ATTACH SUPPORTING DOCUMENTATION:
(_)YES
(() NO
Does the site contain any Jurisdictional Wetlands?
(_)YES
(C) NO
Do you plan to have an iGiz9j2jLjx= now or in the future?
(_)YES
(,,X) NO
Does or will the building contain any drains? Please explain.
(_)YES
{�) NO
Are there any existing wells, springs, waterlines or Wastewater Systems on this property?
{_)YES
(.X) NO
Is any wastewater going to be generated on the site other than domestic sewage?
{_)YES
(1) NO
Is the site subject to approval by any other Public Agency?
(_)YES
11) NO
Are there any Easements or Right of Ways on this property?
(OYES
(_) 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 P
Res For The Proper Identification AndLabelingOf All Property Liam And Corners And Making
The Site Acc�ible So Thaaj4tby o Evaluation Can Be Performed.
OWNERS LEGAL REPRESENTATIVE SIGNATURE (REQUIRED)
DATE
10110