IPACHTE# 1--~ Harnett County Department of Public Health
Improvement Permit 26591
A building permit cannot be issued with only an Improvement Permit
PROPERTY LOCATION: M KTf-5
ISSUED TO: -A (ZZ C v M m "N Q. SUBDIVISION ~~)A SF OLS:) LOT # 1
NEW REPAIR E:1 -xy PANSION ❑ Site Improvements required prior to Construction Authorization Issuance:
Type of Structure:
~S7V Ci LOr7 S y9 i s~
Proposed Wastewater System Type:
Projected Daily Flow: 3~C? GPD
Number of bedrooms: 3 Number of Occupants: max
Basement ❑Yes '~Q No
Pump Required: ❑Yes ~ No ❑ May be required based on final location and elevations of facilities
Type of Water Supply: EL.Community X Public ❑ Well Distance from well \0(Z) feet Permit valid for. Five years
Permit conditions: _ \e ❑ No expiration
Authorized State Agent:: Date: 1 SEE ATTACHED SITE SKETCH
The issuance of this permit by the Health Department in no way guarantees the issuanc o r permits. The permit holde is re onsible for checking with appropriate governing bodies in meeting their requirements. This
site is subject to revocation if the site plan, plat, or the intended use changes. The Improveme it shall not be affected by a change in ownership of the site. This permit is subject to compliance with the provisions of
the Laws and Rules for Sewage Treatment and Disposal and to conditions of this permit..
Construction Authorization
Required for Building Permit
The construction and installation requirements of Rules .1950, .1952, .1954, .1955, .1956, .1951, .1958. and .1959 are incorporated by references into this permit and shall be met. Systems shall be installed in accordance
with the attached system layout.
ISSUED TO: ~rtrc~ )l CuMMNNJ C~ PROPERTY LOCATION:
SUBDIVISION PAS»E'F011.Q LOT # `3 3
Facility Type: Gqo New ❑ Expansion ❑ Repair
Basement? ❑ Yes No Basement Fixtures? ❑ Yes XNo
Type of Wastewater System** a-~ °Jo Rtrov~-~ e c~ s~1 S 7+S-5 E. (Initial) Wastewater Flow: Q GPD
(See note below, if applicable
V, E0 v~x ~c~sS 12-Sr (Repair)
Installation Requirements/Conditions Number of trenches Q`- J Septic Tank Size y ® O 10 gallons Exact length of each trench 5 feet Trench Spacing: feet on tenter
Pump Tank Size gallons Trenches shall be installed on contour at a Soil Cover: Yl 'J~ inches
Maximum Trench Depth of: aL.,-30 inches (Maximum soil cover shall not exceed
(Trench bottoms shall be level to +/-1/4" 36" above the trench bottom)
in all directions)
Pump Requirements: ft. TDH vs. GPM
Conditions:
inches below pipe
Aggregate Depth: inches above pipe
inches total
WATER LINES (INCLUDING IRRIGATION) MUST BE LOFT. FROM ANY PART OF SEPTIC SYSTEM OR REPAIR AREA.
NO UTILITIES ALLOWED IN INITIAL OR REPAIR DRAIN FIELD AREA.
**If applicable: /understand the system type specified is different from the type specified on the application. / accept the specifications of this permit.
Owner/Legal Representative ure. Date:
This Construction Authorization is subject to revocation i it, plan, p t, or the intended use changes. The Construction Authorization shall not be transferred when there is a change in ownership of the site. This
Construction Authorization isubjesLto compliance wit~the " ns he s and Rules for Sewage Treatment and Disposal and to the conditions of this permit SEE ATTACHED SITE SKETCH
Authorized State Agent: Date:
Constru k Authorization Expiration Date:
HTE# 11-5" aC'414-
Permit # ' l
Harnett (county Department of Public Health
Site Sketch
1K5
Initial Application Date: D L11 Application # Ft~~ C Ir7 t~
{~i (
DATE CU#
COUNTY OF HARNETT RESIDENTIAL LAND USE APPLICATION
Central Permitting 108 E. Front Street, LiUington, NC 27546 Phone: (910) ag3-7525 Fax: (910) 893-2793 www,hamett.org/permits
r
LANDOWNER: fr'lllt< LA. ~t' ~Xr -ir/`~ :S Mailing Address:
r i
City;', Z &j t7 f Stater e Zip? 2S'tf Contact # P/,' 51'`V , 7if. ' Email:
APPLICANT*: Mailing Address:"iT ter~eil ~l
City: Zc e L S fs , State; c' Zip, 7 /Ve Contact # ft„ Emall:
"Please III outapplicent information N oftrent than tandowner
CONTACT NAME APPLYING IN OFFICE: kz it 11 17 / f.'.: Phone
PROPERTY LOCATIOW Subdivision: Lot#: j~ 7 Lot size
State Road # State Road Name: Map BookBPage: 0 It I
Parcel: 1515D<4 015S 32 PIN: X57 "~I • +st
Zoning. A2D Flood Zone: 1C Watershed: Deed BookRPage:I tLt2. Power Company:
'New structures with Progress Energy as service provider need to supply premise number C'c' . ,r c! J from Progress Energy.
SPECIFIC DIRECTIONS TO THE PROPERTY FROM LILLINGTON-' A/
7. ^ Z1 ] I'f's e` /-;I- 51t 7~/ "t r1~ f i t~ I r ll~l Lt:..Gt!/
PROPOSED USE.
Monolithic
SFp: (Size _x_! ) # Bedrooms:- # Bather ,B~sement(wlwo bath): Garage ✓ D : Orawi Space: 4 ab:-Slab:_ _
(is the bonus room finished? yes Uno wl a closet? yes { nok(if yes add in with # bedrooms)
U Mod. (Size x_^) # Bedrooms,-,-, # Baths^ Basement (wMro bath)- Garage: Site Built peck:- On Frame- Off Frame
(Is the second floor finished? (_j yes (__)no Any other site built additions? yes (_)no
O Manufactured Home: SW _DW _TW {size x~ # Bedrooms: _ Garage -(site built?_) neck: (site built?__j
O Duplex: (Size x-( No. Buildings: No. Bedrooms per Unit:
❑ Home Occupation: # Rooms: Use: Hours of Operation: #Employeew. _
0 AdditlonlAccessory/Other. (Size x!( Use: Closets In addition? yes ((no
Water Supply: +f~gunty Existing Weil Now Well of dweNngs using' well) `MUST have operable water before final
sewage Supply: New Septic Tank (Complete Checklist) Existing Septic Tank (Complete Checkiist) _ County Bower
Does owner of this tract of land, own land that contains a manufactured home within five hundred feet (500') of tract listed above' yes (ono
Structures (existing or proposed): Single family dwellings: e/ Manufactured Homes: Other (specify):
Required Residential Property Line Setbacks: Comments:
Front Minimum 35 Actual
Rear J. /f 7
Closest Side a S
Sidestreet/comer lot d~ h
Nearest Building 40
on same lot
If permits are granted I agree to conform to all ordinances and taws of the State of North Carolina regulating such work and the specifications of plans submitted.
I hereby state that foregoing statements are accurate and correct to the best of my knowledge. Permit sub)ect to revocation if false information is provided.
Signature of Owner or Owner's Agent Crate
"This application expires 6 months from the initial date if permits have not been issued"
A RECORDED SURVEY MAP, RECORDED DEED (OR OFFER TO PURCHASE1 AND PLM AttE REOWREd WHEN APPLYING FOR LAND USE APPLICATION
Residential Land Use Application Page 1 of 1 10110
CU-,. f01 /V(r ~S
NAME: K4nn e~_-k OLMM 1 Q55Z_~T
APPLICATION 0.5C'0_7t06bb
*This application to be filled out when applying for a septic system inspection.*
w waaai,a wti.r
IF THE INFORMATION IN THIS APPLICATION IS FALSIFIED, CHANGEp, OR THE SITE IS ALTERED, THEM THE IMPROVEMENT
PERMrr OR AUTHORIZATION ToJ 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 piat =without expiration)
910-893-7525 option I CONFIRMATION
En
vlronmental Health ftv Sac & StrstemCode 800 _
• All property irons must be mado 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 underarowwth to allow the soil
evaluation to be performed. Inspectors should be able to walk freely around site. Do not grade property.
• All Int-a to tfE!srrlAr~rcerf 1"Ohi- IA h- ww . . -
rrewM Yf,Y
• 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
confirmat€on number given at end of recording for proof of request
• Use CIIck2Gov or IVR to verify results. Once approved, proceed to Central Permitting for permits.
D Environmental Neal h Exlstlna Tank lnsnectlons Code 800
• Follow above instructions for placing flags and card on property,
• Prepare for inspection by removing soil over outlet and of tank as diagram indicates, and lift lid straight up (if
possible) and then put ild, bacft lii'p1a6e. (Unless inspection is for a septic tank in a mobile home park)
DO hf®(:43=1IYE CIDS..GFf PFSEPFIC7ANK
• After uncovering outlet end call the voice permitting system at 810.893-7525 option 1 & select notification permit
if multiple permits, then use code 800 for Environmental Health inspection. Please note confirmation number
rriven at end of recording for proof of Le
.guest.
• Use CIIck2Gov or IVR to hear results. Once approved, proceed to Central Permitting for remaining permits.
SEPTIC
If applying for authorization to construct please indicate desired system type(s): can be ranked in order of preference, must choose one,
{ - ) Accepted
{ - { Alternative
Innovative { -1-r-c-onventional Any
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:
I-) YES { O Does the site contain any Jurisdictional Wetlands?
{-}YES { y45~ Do you plan to have an irrigation system now or in the future?
f_ {YES {_f' O Does or will the building contain any des? Please explain.
{_,}YES I_ No Are there any existing wells, springs, waterlines or Wastewater Systems on this property?
YES {__04-6,
Id Is any wastewater going to be generated on the site other than domestic sewage?
YES {!f NPO Is the site subject to approval by any other Public Agency?
{_}YES { Are there any Easements or Right of Ways on this property?
(_)YES { __f~o 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 Stead 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 That A Complete Site Evaluation Can Be Performed,
PROPEfilt OWNERS OR OWNERS 11-GAL REPRESENTATIVE SIGNATURE (REQUIRED) DATE
10/10
Department of Em'imument, Health and Natural Res um" Sheet:
Division of Environmental Health Property 1D:
On-Site Wastewater Section Lot Property
SOIUSITE EVALUATION Fite
f ON Code:
or -SITE WASTEWAT)£R.STSTEN
Owner. Applicant
Address: Date Evaluated: \
Proposed Facility: 3 vc~,e DeAP Flow (1949): ~>6O ~Cl Pmpettj Siu:
LocatlotE Site: Property Recorded:
Watet 9uppir, rAuger lic ❑ Individual ❑ Well spring
Evaluation' Mithot Baring ❑ Pit 13. Cut.
Type of Wastewater. age ❑ Industrial Process Mixed
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