SEPTIC a / -7- / l I )60 .76
Application # 1
Harnett County Central Permitting
PO Box 65 Lillington, NC 27546
910 - 893 -7525 Fax 910 - 893 -2793 www.harnett.org /permits
Application for Environmental Health Permit in Towns /Areas Zoned by Municipalities
Land Owner Information: , / �__ Applicant Information:
Name: ..� L 1, C 1 _ 6 fi e ()tQSName: Lt ci 1.0 DJ r gP /14
L
Addre : . • n i L Address: ,-9 02 1= It ! ✓ % ■1(
m:�is�• Ot a >t, n ) 1 • c
Phone: " j<? tic IC 7 Phone: O` ( a(c 3 /`,1 2 g
Property Location: I,` {p �
E911 Address: (0 q W te*\ 'F-�Y
PIN or Parcel Number:
Subdivision: Lot Number: n�
Lot Size: Zoning: Power Co: 1 6�buly/ ess 1 - j
Specific Directions to J from Lilli ton: 0 , ` q 1 ( !Y
1 1 1M ( Z . P . n ` h i c ) i N - V W t 6p,d (AI 1 , , ten a t, c , 1, -, )•
Proposed Use: V
() Single Family Dwelling (Size: x ) # of Bedrooms:
Basement: Basement w/ Plumbing:_ Deck: Slab or Crawl Space
() Multi Family Dwelling # of Units: # of Bedrooms /Units:
() Manufactured Home (Size: x ) # of Bedrooms:
Garage: Deck:
() Business Square Footage Retail Space: Type:
() Industry Square Footage: Type:
() Home Occupation # of Rooms: Use:
() Addition to Existing Building Size: / Use:
- Other: ,C)lj 7 S/ e ,)l/ r KJ (In r -- ( el r �o 3a
Water Supply: County ( ) Well ( ) Other
Sewage: ( ) New Septic Tank (Complete new tank checklist) ( ) Existing Septic Tank ( ) Sewer
There is a $250.00 charge for new tanks, $100 for existing tanks. This approval is subject to
revocation if the intended u - • the septic system changes or if false information is
provided on this applicati • ignature .elo certifies all information above is correct„
Applicant Signat _ Date: 1 �
ifr
■
• 2 /08
NAME: n..L.CU ■ INN ' • APPLICATION #: 1 1 S6C 2 (Con
*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)
9107893 4525 option' 1 ,. ‘-t "`' 1 CONFIRMATION #
❑ Environmental Health New Septic SvstemCode 800
• All property Irons must be made visible. Place "pink property fags" 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 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 comers 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
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 Exlstlna 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 t Iid`back in plate. (Unless inspection is for a septic tank in a mobile home park)
•" • ddNOT• LEAVE'LIDS 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 applyin_ for authorization to construct please indicate desired system type(s): can be ranked in order of preference, must choose one.
{_} Ac. pted { Innovative } Conventional {_} Any
{_} Alte •tive {_} Other
The applic • t shall notify the local heal • epartment upo: submittal of this application if any of the folio '. g apply to the property in
question. I the answer is "yes ", applic: t MUST ATTA 411 SUPPORTING DOCUMENTATION:
{_ }YES _} NO Does the si contain any Jurisdi• ional Wetlands?
{_ }YES t } NO Do you pl to have an • •i . • • • , stem now or in the future?
{_ }YES } NO Does or 11 the building contain . drains? Please explain.
{}YES { } NO Are the any existing wells, springs, waterlines or Wastewater Systems on is property?
{_ } YES { } NO Is any astewater going to be generate. on the site other than domestic se age?
{ }YES L_ NO Is the .ite subject to approval by any oth• Public Agency?
{_ }YES {_} . 0 Are i.ere any Easements or Right of Ways .n this property?
{_ }YES {_} N D• es the site contain any existing water, cab': phone or undergro .. electric lines?
If yes please call No Cuts at 80 -4949 to loc. - the lines. ' is is a free service.
1 Have Read This Appllcatlo • - d Certify That The Info ation Provided Herein Is True, Complete And Correct. Authorized County And
State Officials Are Grante . RI t Of Entry To Conduct ecessary Inspections To Determine Compliance With Applicable Laws And Rules.
1 Understan. . at I A • Sol Responsible Fyr�ht.F per Identification And Labeling Of All Property Lines And Corners And Making
The Site A. . e t ' SI["ee a do Can Be Performed.
•
2
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PROPE'' ' MINERS OR O VV$iER LEGAL R SENTATIVE SIGNATURE (REQUIRED) D, TE
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02324 Nee 1�t II A '8 B
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REG /S?glt QF ID"
.... —._ Mott, DEEDS NO
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Ratording Time, Hoot and Page
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Tar Lot Na ..-- ..... _. Parcel Identifier No... o.. ..a*. .91. -a O o 0
Vended W ...._..... ......_. v: eu,..,e.,v:: County on the .... ........... dal of 19.. ..._._..
by ....._...._.._._.._....._...... . : :::. nr ...- ..- ...._.' Jr...w:wewaa MMP.4W'A..y11!..r.9:`L' °' :r :1 -.. •x . .. .......... ............. ..........._......
Mail after recording to .. V ae1..McLeod,..Attorney
0. O 943, Dunn, NC 28334
'• Tide Instrument was prepared y... ...- Brief description for the Index A c e el•. McLeod ......................._........._..............,.. ..............__........... -.,. ...
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NORTH CA of 0 ENERAL WARRANTY DEED TENS TH DEED made this ...25th. day of ..- . ...._a .................. 1 by and between
GRANTOR 0. GRANTEE
HOWARD L. TART & Wife, KENNETH RANDALL GREEN & Wife,
RUTH W. TART CLAUDETTE TART GREEN
502 South Layton Avenue , • South Layton Avenue
go Dunn, North Carolina 283 • •, North Carolina 28334
11110
min la appropriate bleat ter nob party: acme, ad.lnc, as. II a.... . is •- et mall, ea. emyoraVva or partntublp.
The designation Grantor and Grantee as need herein shall in. ude sai• •... their heirs„ successors, and asalgns, and
shall include singular, plural, masonline, feminine or neuter as . . • •y eon - •
WITNESSETH, that the Grantor, for a valuable consideration pal. by e. e ra • tee, the receipt of which L hereby
. atlmowledged, has and by theme presents does grant, bargain" sell • d . iv• • • the Grantee in fee simple, all that
certain lot or parcel of land situated in the City at ..'v-esa.0bOxo Township,
Harnett County. North Carolina end more particular - • - d a: 0l ows:
BEGINNING at a PR nail set in the center of - - at- Ho— 794, which
PE nail is located North 74 deg. 04 min. 12 se•. W. -- 31 feet
from the intersection of the centerline of Stet- •. -d ' 7' with the
centerline of U.S. Highway 4421, and runs thence :ou '5 •eg. 00
min. 00 sec. West 346.30 feet to the centerline o - • tch ence
along the centerline of said ditch North 39 deg 4 ...n. - • s= . West
139.17 feet to a point in the centerline of said di'c , .e -e North
15 deg. 00 min. 00 sec. East 254.43 feet to a net P -. . . 1e
center of State Road 01794; thence along the center o s: • ta-- • Road, South 75 deg. 55 min. 48 sec. East 65 feet to a : . K� . �� ( �2 . - 1
Ella South 74 deg. 04 min. 12 sec. East 65 feet to the B P. V' ontaining
90 /100ths of an acre, more or less.
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' N Geaf&Id+em ne.141,76. anted 41977- +..eenisatier W. w■xr,•ataa