SEPTIC Application # 6 / 9 9t7 L , L /,�
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 Tank in a Mobile Home Park
Applicant Name: �c�17 / � 757e Date: 3 — 5 //
Address: 7 to 2- n /, / /..f r S r 4 /21 1,M iel A. e
Telephone: V/ / - 42/7,-73q-? Email:
Property Owner: / 2 / aciety 74
a r/// Phone: 9/% y7, - 73Y
Lot Address: 36 P K.o( , ti: c/ c±
Name of Park: / .. - ll 1 4(t•; c{ Lot Number: 15
Parcel f/h ✓ 9 /3 d y97 1 9 5 PIN:
SW _ DW TW (Size /`/ x 7c ) # Bedrooms: 3 Year:
Power Company: SoJTa S -te2 (For Progress Energy we need the premise number.)
Specific Directions to Job from Lillington: L J
f D -/ 7 l fl rrt +0 c5» r Co 1.' i /� ct �a_ke �r q 4t f e
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There is a $100.00 charge for this service. This certification is subject to revocation if the
intended use of the septic system changes, or if false information is provided on this
application.
You signature below certifies that all above information is correct.
Signature of owner or authorized agent: C L�
DO NOT SIGN BELOW - FOR OFFICE USE ONLY
Authorization of Existing System
Signature of Environmental Health Specialist Date
q il i ft --- / /c — / ,
E- Health For Mobile Home Park 1 of 1 06/10
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NAME: APPLICATION #:
*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)
910- 893 -7525 option 1 CONFIRMATION #
❑ Environmental Health New Septic System Code 8 00
• All property irons must be made v isible. Place "pink p roperty flags" o n each corner i ron 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 oracle property.
• All Tots 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.
• Aker 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 En vironmental 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.
tri. Environmental Health Existing Tank Inspections Cod e 800
• Follow above instructions for placing flags and card on property.
• Prepare for inspection by removing soil over over outlet end as diagram indicates, and lift lid straight up (if
possible) and then close back down. (Unless inspection is for a septic tank in a mobile home park)
• After uncovering outlet end call the voice permitting system at 910 - 893 -7525 option 1 & select notification permit if
multiple pe rmits, then u se co de 800 for.Environmental Health ins pection. Please n ote confirmation number
piven at end of recording for proof of request.
• Use Click2Gov or IVR to hear results. Once approved, proceed to Central Permitting for remaining permits.
PTIC
If ap • ing for authorization to construct please indicate desired system type(s): can he ranked in order of pre • nee, must choose one.
{_} Accep { Innovative - { Conventional { Any
{_ Alternative {_} Other
The applicant shall notify the loc • • ealth department upon submittal of this • • ication if any of the following apply to the property in
question. If the answer is "yes ", applic • • ust attach supporting do entation.
{ }YES { NO Does the site contain any • -s' tional Wetlands?
{_ }YES {__} NO Do you plan to have . • .1 , • I t,,: r ow or in the future?
{_ }YES {} NO Does or wi e building contain any drains? Ple. _ - • lain.
{_ }YES {_) NO Ar ere any existing wells, springs, waterlines or Wastewat tems on this property?
{ }YES {_} NO Is any wastewater going to be generated on the site other than domestic r _ ,ge?
{ }YES _ NO Is the site subject to approval by any other Public Agency?
{_ }Y S {_} 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
1 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 Site Accessible So T at A Complete Site Evaluation Can Be Performed.
/ 41(. " 3 -5Y /7
P • .• PE' TY O j ERS OR y r ERS GAL REPRESENTATIVE SIGNATURE (REQUIRED) DATE
E- Health / Checklist 1 of 3 12/10