SEPTIC Application # [ 5 U �
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 - V•4 0 . trR■{ n -rvV 1- 11Ank 04 0 rr so Name £ 1Vlrt3t 0t0 /tc,n l
Address ±a±30,, t ,n,, l Sf Address /04 D& s P
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Ph.ne 9 10 G l IQ - 7?) Phone fir? - 9 i r v L 3 9'/
Property Location /�
E911 Address 3 Oki Slav Ai form/ SIG xg3
PIN or Parcel Number os -Ts O 3H oto 1 pa rai 1 cn - ostt - oo ► ti
Subdivision - r' -- Lot Number --
Lot Size 9 S a cv -r', Zoning -1 l Power Co
Specific Directions to Job from Lillington tl z.j 1-o 014 Si-ac a-w,vn v a 3
rhn lts pro
Proposed Use +
(d Single Family Dwelling (Size x loco ) # of Bedrooms 3
Basement Basement w/ lumbing Deck a. 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
Water Supply / (f) 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 use of the septic system changes or if false information is
provided on this application Your signature below certifies all information above is correct
Applicant Signature e f Date 3 2 3
2/08
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NAME Li n n& i t c f Soil APPLICATION # j F ? 3l4
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 e pirate n
depending upon documentation submitted (Complete site plan = 60 months Complete plat = without expiration) 9---975) / ��
910 893 7525 option 1 CONFIRMATION # 4
❑ Environmental Health New Septic SvstemCode 800
All property irons 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 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 sod
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 tno 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
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 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 Of
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 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 authonzation to construct please indicate desired system type(s) can be ranked in order of preference must choose one
{ } Accepted {} Innovative { Conventional {_} Any
{ Alternative { } Other
The applicant shall notify the local health department upon submittal of this application if any of the followmg apply to the property in
question If the answer is yes applicant MUST ATTACH SUPPORTING DOCUMENTATION
{_ }YES { VI NO Does the site contain any Junsdicttonal Wetlands?
{_ }YES VINO Do you plan to have an mg ahon system now or in the future?
{_}YES {_} NO Does or will the building contain any drams? Please explain Skn tiler / s i A
{_}YES {} NO Are there any existing wells spnngs waterlines or Wastewater Systems on this property?
{ }YES 1 NO Is any wastewater going to be generated on the site other than domestic sewage'?
{✓' }YES {} NO Is the site subject to approval by any other Public Agency?
{_ }YES IY1 {Y1 NO Are there any Easements or Right of Ways on this property?
WI {} NO Does the site contain any existing water cable phone or underground electnc lines`?
If yes please call No Cuts at 800 632 4949 to locate the lines This is a free sere ice
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
1 Understand That 1 Am Solely Responsible For The Proper Identification And Labeling Of All Property Lines And Corners And Making
The Si e Accessible So That A Complete Site Evaluation Can Be Performed
int.,04 (IlL 3 � 1 1
PROPS O NERS OR OWNERS LEGAL REPRESENTATIVE SIGNATURE (REQUIRED) DATE
10 /10
S
11 011 11111,i111 1111111111
° Tt' 20110038 2
F i i
FOR REGISTRATION REGISTER OF DEEDS
HAR :TT COUNTY fAX ID# HAR COUNTY, NC
Q1 OSg5( pal 2011 MAR 14 10 3t 28 AM
BK 2846 PG 249 253 FEE $28 00
NC REV STAMP $5400NS52500
INSTRUMENT 112011903692
t1 ti BY ONE
NORTH CAROLINA GENERAL WARRANTY DEED
Excise Tax $ 54 00 Parcel Identifier No
Prepared By John C Wainto Attomey at Law
Return to Grantee
Bnef Description for Index
THIS DEED made this _ n? day of February 2011 by and between
GRANTOR GRANTEE
VIRGINIA BASS TART and husband TERRY EUGENE MORRISON and wife
HUGH WILLIE TART CHESTER HUGH LYNNA JEAN MORRISON
REIBER and wife SUZANNE REIBER and
WEBSTER OLIVER REIBER, HI and wife, 109 Davey Street
GAYLE REIBER Spring Lake NC 28390
7 Bryncastle Court
Durham NC 27707
The designation Grantor and Grantee as used herein shall include said parties their heirs successors and assigns and shall include
singular plural masculme femmme or neuter as required by context
WITNESSETH that the Grantor for a valuable consideration paid by the Grantee the receipt of which is hereby acknowledged has
and by these presents does grant bargain sell and convey unto the Grantee m fee simple all that certain lot or parcel of land situated
m the County of Harnett North Carolina and more particularly descnbed as follows
SEE EXHIBIT A ATTACHED
UI or a ortion of
the property er herein conveyed
P P tY yed does not include the primary residence of a Grantor (NCGS §105 317 2)