20190449 Ver 1_PCN Form Submission_20190410

DWR
Ortslpu Of W.-10"Revourc"
Pre -Construction Notification (PCN) Form
September 29, 2018 Ver 3
Initial Review
Has this project met the requirements for acceptance into the review process?*
r Yes
r No
Is this project a public transportation project?*
r Yes r No
Change only if needed.
BIMS # Assigned
20190449
Is a payment required for this project?*
r No payment required
r Fee received
r Fee needed - send electronic notification
Select Project Reviewer*
Chad Turlington:eads\ccturlington
Information for Initial Review
1a. Name of project:
Lot 80A - Mamie Bell Ridge
1a. Who is the Primary Contact?*
Andrew Galucki
1 b. Primary Contact Email:*
[e-mail]
Date Submitted
4/10/2019
Nearest Body of Water
Duncans Creek (Stream), Upper Little River, Cape Fear River Basin
Basin
Cape Fear
Water Classification
C
Site Coordinates
Latitude: Longitude:
35.410663 -78.883509
Version# *
1
Reviewing Office*
Fayetteville Regional Office - [phone]
1c. Primary Contact Phone:*
[phone]
A. Processing Information -
County (or Counties) where the project is located:
Harnett
Is this project a public transportation project?*
r Yes r No
1a. Type(s) of approval sought from the Corps:
V Section 404 Permit (wetlands, streams and waters, Clean Water Act)
F Section 10 Permit (navigable ureters, tidal waters, Rivers and Harbors Act)
1 b. What type(s) of permit(s) do you wish to seek authorization?
rJ Nationwide Permit (NWP)
F- Regional General Permit (RGP)
rJ Standard (IP)

1c. Has the NWP or GP number been verified by the Corps?
V Yes r No
Nationwide Permit (NWP) Number:
NWP Numbers (for multiple NWPS):
1d. Type(s) of approval sought from the DWR:
C 401 Water Quality Certification - Regular
r Non -404 Jurisdictional General Permit
rJ Individual Permit
29 - Residential Developments
1e. Is this notification solelyfor the record because written approval is not required?
For the record only for DWR 401 Certification:
For the record only for Corps Permit:
F 401 Water Quality Certification - Express
r Riparian Buffer Authorization
1f. Is this an after -the -fact permit application?*
r Yes r No
1g. Is payment into a mitigation bank or in -lieu fee program proposed for mitigation of impacts?
r Yes r No
19. Is payment into a mitigation bank or in -lieu fee program proposed for mitigation of impacts?
r Yes r No
Acceptance Letter Attachment
1h. Is the project located in any of NC's twenty coastal counties?
C Yes r No
1j. Is the project located in a designated trout watershed?
r Yes r No
B. Applicant Information
1d. Who is applying for the permit?
Q Owner r Applicant (other than owner)
1e. Is there an Agent/Consultant for this project?
C Yes r No
2. Owner Information
2a. Name(s) on recorded deed:
WJH, LLC
2b. Deed book and page no.:
3522:0422
2c. Responsible party:
WJH, LLC
2d. Address
Street Address
3300 Battleground Ave, Suite 230
Address Line 2
City
State / Rmince / Piagion
Greensboro
NC
Postal / Zip Oode
Country
27410
USA
r Yes r No
r Yes r No
v
2e. Telephone Number: 2f. Fax Number:
[phone]
2g. Email Address:*
[e-mail]
C. Project Information and Prior Project History
1. Project Information

1b. Subdivision name:
(d appropriate)
Mamie Bell Ridge
1c. Nearest municipality/town:
Lillington
2. Project Identification
2a. Property Identification Number:
1500021240
2c. Project Address
Street Address
340 Tilden Howington Dr
Address Line 2
aty
Lillington
Postal / Zip aide
27546
3. Surface Waters
3a. Name of the nearest body of water to proposed project:*
Duncans Creek (Stream), Upper Little River, Cape Fear River Basin
3b. Water Resources Classification of nearest receiving water:*
C
3c. What river basin(s) is your project located in?*
Cape Fear
3d. Please provide the 12 -digit HUC in which the project is located.
030300040205
4. Project Description and History
2b. Property size:
1.62
State / Province / F;Lgion
NC
Country
USA
4a. Describe the existing conditions on the site and the general land use in the vicinity of the project at the time of this application:*
This is Lot 80A in the Mamie Bell Ridge subdivision. We are attempting to construct a home on this 1.62 acre site. I have attached a plot plan indicating where the house is intending to
sit. The location of the home will not infringe on any wetlands.
4b. Have Corps permits or DWR certifications been obtained for this project (including all prior phases) in the past?*
r Yes r No r Unknown
4d. Attach an 8 1/2 X11 excerpt from the most recent version of the USGS topographic map indicating the location of the project site. (for DWR)
LOT80A-USGS topo map.pdf 320.21 KB
LOT80A-PRE.pdf 122.97KB
4e. Attach an 8 1/2 X 11 excerpt from the most recent version of the published County NRCS Soil Survey map depicting the project site. (for DWR)
LOT80A-Soils - Mamie Bell.pdf 383.98KB
4f. List the total estimated acreage of all existing wetlands on the property:
.75
4g. List the total estimated linear feet of all existing streams on the property:
0
4h. Explain the purpose of the proposed project:*
We are attempting to construct a home on the residential lot and want to ensure that we have approval.
4i. Describe the overall project in detail, including indirect impacts and the type of equipment to be used:*
Standard home building machinery. Again, the home and construction of the project will be outside of the wetlands area.
4j. Please upload project drawings for the proposed project.
LOT80A-PRE.pdf 122.97KB
MBR 80 Septic layout.pdf 465.92KB
MBR 80 Permit.pdf 1.61MB
S. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the property or proposed impact areas?*
r Yes r No r Unknown
Comments:
5b. If the Corps made a jurisdictional determination, what type of determination was made?*
r Preliminary r Approved r Not Verified r Unknown r VA

Corps AID Number:
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known): EG
Agency/Consultant Company: Residential Land Services, PLLC
Other:
5d1. Jurisdictional determination upload
6. Future Project Plans
6a. Is this a phased project?*
r Yes r No
Are any other NWP(s), regional general permit(s), or individual permits(s) used, or intended to be used, to authorize any part of the proposed projector related activity?
Lot 78A is also in need of authorization.
D. Proposed Impacts Inventory �nj
1. Impacts Summary
1a. Where are the impacts associated with your project? (check all that apply):
R Wetlands r Streams -tributaries r Buffers
F- Open Waters r Pond Construction
2. Wetland Impacts
2a. Site #* (') 2a1 Reason(?) 2b. Impact type * (?) 2c. Type of W. * 2d. W. name * 2e. Forested * 2f. Type of 2g. Impact
Jurisdicition*(?) area*
80A Home constructionP Unknown Unknown Pb DWR 0.100
(acres)
2g. Total Temporary Wetland Impact
0.000
2g. Total Wetland Impact
0.100
2g. Total Permanent Wetland Impact
0.100
2h. Comments:
It's unknown if the wetlands will be disturbed on a permanent basis. We are attempting to install the septic drain field on a portion outside of the
wetland area, however, the pipes to the septic system may need to cross through the wetlands.
E. Impact Justification and Mitigation
1. Avoidance and Minimization
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:
It's unknown if the wetlands will be disturbed on a permanent basis. We are attempting to install the septic drain field on a portion outside of the
wetland area, however, the pipes to the septic system may need to cross through the wetlands.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:
It's unknown if the wetlands will be disturbed on a permanent basis. We are attempting to install the septic drain field on a portion outside of the
wetland area, however, the pipes to the septic system may need to cross through the wetlands.
2. Compensatory Mitigation for Impacts to Waters of the U.S. or Waters of the State
2a. Does the project require Compensatory Mitigation for impacts to Waters of the U.S. or Waters of the State?
r Yes r No
2b. If this project DOES NOT require Compensatory Mitigation, explain why:
The site RIBITs will not open so unable to confirm.
F. Stormwater Management and Diffuse Flow Plan (required by DWR)
1. Diffuse Flow Plan
1a. Does the project include or is it adjacent to protected riparian buffers identified within one of the NC Riparian Buffer Protection Rules?

r Yes r No
If no, explain why:
Harnett County is not subject to the NC Riparian Buffer Protection Rules.
2. Stormwater Management Plan
2a. Is this a NCDOT project subject to compliance with NCDOT's Individual NPDES permit NCS000250?*
r Yes r No
2b. Does this project meet the requirements for low density projects as defined in 15A NCAC 02H .1003(2)?
E Yes r No
Comments:
G. Supplementary Information
1. Environmental Documentation
1a. Does the project involve an expenditure of public (federal/state/local) funds or the use of public (federal/state) land?*
r Yes r No
2. Violations (DWR Requirement)
2a. Is the site in violation of DWR Water Quality Certification Rules (15A NCAC 2H .0500), Isolated Wetland Rules (15A NCAC 2H .1300), or DWR Surface Water or Wetland Standards or
Riparian Buffer Rules (15A NCAC 2B.0200)?*
r^ Yes r No
2b Provide an explanation of the violation(s):
3. Cumulative Impacts (DWR Requirement)
3a. Will this project result in additional development, which could impact nearby downstream water quality?*
r Yes r No
3b. If you answered "no," provide a short narrative description.
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project?*
r Yes r No r N/A
5. Endangered Species and Designated Critical Habitat (Corps Requirement)
5a. Will this project occur in or near an area with federally protected species or habitat?*
r Yes r No
5b. Have you checked with the USFWS concerning Endangered Species Act impacts?*
r Yes r No
5d. Is another Federal agency involved?*
r Yes r No r Unknown
5e. Is this a DOT project located within Division's 1-8?
r Yes r No
5f. Will you cut anytrees in order to conduct the work in waters of the U.S.?
r Yes r No
5g. Does this project involve bridge maintenance or removal?
r^ Yes r No
5h. Does this project involve the construction/installation of a wind turbine(s)?*
r Yes r No
51. Does this project involve (1) blasting, and/or (2) other percussive activities that will be conducted by machines, such as jackhammers, mechanized pile drivers, etc.?
r Yes r No
5j. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?
USF WS website
Consultation Documentation Upload

6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as an Essential Fish Habitat?*
r Yes r No
6b. What data sources did you use to determine whether your site would impact an Essential Fish Habitat?*
USFWS website
7. Historic or Prehistoric Cultural Resources (Corps Requirement)
7a. Will this project occur in or near an area that the state, federal or tribal governments have designated as having historic or cultural preservation status?*
r- Yes
r No
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?*
GIS
7c. Historic or Prehistoric Information Upload
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA -designated 100 -year floodplain?*
r Yes r No
8c. What source(s) did you use to make the floodplain determination?*
GIS
Fmiscellaneous
Comments
Miscellaneous attachments not previously requested.
Signature
m By checking the box and signing below, I certify that:
• I have given true, accurate, and complete information on this form;
• I agree that submission of this PCN form is a "transaction" subject to Chapter 66, Article 40 of the NC General Statutes (the "Uniform Electronic Transactions Act");
• I agree to conduct this transaction by electronic means pursuant to Chapter 66, Article 40 of the NC General Statutes (the "Uniform Electronic Transactions Act');
• I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written signature; AND
• I intend to electronically sign and submit the PCN form.
Full Name:
Andrew Galucki
Signature
•�Tlib7s: v`�i�fr�e.'dA
Date
4/10/2019
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VICINITY MAP
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PB 2013 PG 321
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JOHNNY H. &
JENNIE P. HOLLAND &
DB 2024 PG 206
CUSTOMER
CUSTOMER
DATE
DATE
WADE JURNEY REPRESENTATIVE DATE
IMPERVIOUS SURFACE AREAI
HOUSE w/ PORCH
NOTE
S.F.
ALL DIMENSIONS, LOCATIONS AND FEATURES SHOWN ON
SETBACKS
THIS PLOT PLAN ARE APPROXIMATE AND ARE ONLY AN
DRIVEWAY & WALKS
ARTISTS RENDITION, EXACT LOCATION OF ALL FEATURES
FRONT — 35'
ARE SUBJECT TO CHANGE AND MAY NOT BE INSTALLED
EXACTLY AS SHOWN ON PLANS AND/OR IN MODELS,
SIDE — 10'
PLACEMENT OF HOME, DRIVEWAY, SIDEWALKS AND
REAR — 25'
EXTERIOR FEATURES ARE SUBJECT TO MODIFICATION AS
CORNER SIDE — 20'
DEEMED NECESSARY BY FIELD PERSONNEL.
N /F
JOHNNY H. &
JENNIE P. HOLLAND &
DB 2024 PG 206
CUSTOMER
CUSTOMER
DATE
DATE
WADE JURNEY REPRESENTATIVE DATE
IMPERVIOUS SURFACE AREAI
HOUSE w/ PORCH
1,292
S.F.
DECK/PATIO/HVAC
27
S.F.
DRIVEWAY & WALKS
630
S.F.
TOTAL (PROPOSED)=
1,949
S.F.
LOT AREA = 1
70,485
S.F.
IMPERVIOUS AREA 1
=2.8%
N 01°29'03" W 344.55!'OTAL
25_SETBACK — — — — Im
70,485 S.F.
(n
/ 1.62 AC/ ID 00/r I7, o
C4
IV
WETLANDS SCALED rm
FROM ARMY CORP OF /
ENGINEERS SKETCH r�
/ 40'x60' Op
HOUSE I �p
BOX I rn
TLAND } 35' SETBACK
FL TYP. � LINELATYP
S 02 39 37 W 291
TILDEN HOWINGTON DRIVE
50' PUBLIC R/W
CURVE
RADIUS
ARC LENGTH
CH LENGTH
CH BEARING
C1
50.00'
41.09'
39.95'
N 27°18'08" E
C2
25.00'
21.02'
20.41'
S 26°45'18" W
APPROVAL FOR STAIONQ
THIS PLOT PLAN AS PREPARED BY RESIDENTIAL LAND SERVICES,
IS CORRECT AND IS HEREBY APPROVED FOR STAKING ON THE
DATE SHOWN BELOW.
WADE JURNEY HOMES REPRESENTATIVE DATE
THIS PROPERTY MAY BE SUBJECT TO ANY AND ALL APPLICABLE DEED
RESTRICTIONS, EASEMENTS, RIGHT—OF—WAY, UTILITIES AND
RESTRICTIVE COVENANTS WHICH MAY BE OF RECORD OR IMPLIED
80 0 80
SCALE: 1" = 80'
RESIDENTIAL
LAND SERVICES, PLLC.
1917 Evans Road
Cary, North Carolina 27513
Phone [phone]
Firm License # P-0873
ITHIS DRAWING DOES NOT I
REFLECT AS -BUILT INFORMATION
PULDMARY PLAT
NOT FOR RECORDATION, CONVEYANCES, OR SM -M
HOUSE LOCATION PLOT PLAN
FOR
#340 TILDEN HOWINGTON DRIVE
LOT 80A, MAMIE BELL RIDGE, PHASE FIVE
Upper Little River Township, Harnett County, North Carolina
PROPERTY OF: WADE JURNEY HOMES
MAP BOOK 2013 PAGE 321 DEED REFERENCE
DRAWN BY: E.G. I DATE: APRIL 19, 2017

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2
OLD US HWY 421
S.R. 1291
SITE
VICINITY MAP
Not To Scale
PB 2013 PG 321
—Z
I
Z
/
N /F
JOHNNY H. &
JENNIE P. HOLLAND &
DB 2024 PG 206
CUSTOMER
CUSTOMER
DATE
DATE
WADE JURNEY REPRESENTATIVE DATE
IMPERVIOUS SURFACE AREAI
HOUSE w/ PORCH
NOTE
S.F.
ALL DIMENSIONS, LOCATIONS AND FEATURES SHOWN ON
SETBACKS
THIS PLOT PLAN ARE APPROXIMATE AND ARE ONLY AN
DRIVEWAY & WALKS
ARTISTS RENDITION, EXACT LOCATION OF ALL FEATURES
FRONT — 35'
ARE SUBJECT TO CHANGE AND MAY NOT BE INSTALLED
EXACTLY AS SHOWN ON PLANS AND/OR IN MODELS,
SIDE — 10'
PLACEMENT OF HOME, DRIVEWAY, SIDEWALKS AND
REAR — 25'
EXTERIOR FEATURES ARE SUBJECT TO MODIFICATION AS
CORNER SIDE — 20'
DEEMED NECESSARY BY FIELD PERSONNEL.
N /F
JOHNNY H. &
JENNIE P. HOLLAND &
DB 2024 PG 206
CUSTOMER
CUSTOMER
DATE
DATE
WADE JURNEY REPRESENTATIVE DATE
IMPERVIOUS SURFACE AREAI
HOUSE w/ PORCH
1,292
S.F.
DECK/PATIO/HVAC
27
S.F.
DRIVEWAY & WALKS
630
S.F.
TOTAL (PROPOSED)=
1,949
S.F.
LOT AREA = 1
70,485
S.F.
IMPERVIOUS AREA 1
=2.8%
N 01°29'03" W 344.55!'OTAL
25_SETBACK — — — — Im
70,485 S.F.
(n
/ 1.62 AC/ ID 00/r I7, o
C4
IV
WETLANDS SCALED rm
FROM ARMY CORP OF /
ENGINEERS SKETCH r�
/ 40'x60' Op
HOUSE I �p
BOX I rn
TLAND } 35' SETBACK
FL TYP. � LINELATYP
S 02 39 37 W 291
TILDEN HOWINGTON DRIVE
50' PUBLIC R/W
CURVE
RADIUS
ARC LENGTH
CH LENGTH
CH BEARING
C1
50.00'
41.09'
39.95'
N 27°18'08" E
C2
25.00'
21.02'
20.41'
S 26°45'18" W
APPROVAL FOR STAIONQ
THIS PLOT PLAN AS PREPARED BY RESIDENTIAL LAND SERVICES,
IS CORRECT AND IS HEREBY APPROVED FOR STAKING ON THE
DATE SHOWN BELOW.
WADE JURNEY HOMES REPRESENTATIVE DATE
THIS PROPERTY MAY BE SUBJECT TO ANY AND ALL APPLICABLE DEED
RESTRICTIONS, EASEMENTS, RIGHT—OF—WAY, UTILITIES AND
RESTRICTIVE COVENANTS WHICH MAY BE OF RECORD OR IMPLIED
80 0 80
SCALE: 1" = 80'
RESIDENTIAL
LAND SERVICES, PLLC.
1917 Evans Road
Cary, North Carolina 27513
Phone [phone]
Firm License # P-0873
ITHIS DRAWING DOES NOT I
REFLECT AS -BUILT INFORMATION
PULDMARY PLAT
NOT FOR RECORDATION, CONVEYANCES, OR SM -M
HOUSE LOCATION PLOT PLAN
FOR
#340 TILDEN HOWINGTON DRIVE
LOT 80A, MAMIE BELL RIDGE, PHASE FIVE
Upper Little River Township, Harnett County, North Carolina
PROPERTY OF: WADE JURNEY HOMES
MAP BOOK 2013 PAGE 321 DEED REFERENCE
DRAWN BY: E.G. I DATE: APRIL 19, 2017

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swisstopo, © OpenStreetMap contributors, and the GIS User Community
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April 10, 2019
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3/19/2019 Permit
PERMIT NO: CPSF17-
ON-LINE PERMIT
50041429
HARNETT COUNTY
PERMIT TYPE
APPLIED DATE
BUILDING RESIDENTIAL
5/19/2017
DEVELOPMENT SERVICES
PERMIT SUB -TYPE
SINGLE FAMILY
108 E. Front Street, NC 27546
APPROVED DATE
2/22/2019
INSPECTION REQUEST LINE
DWELLING
[phone]
OR
ISSUED DATE
Harnett
SCHEDULE EXISTING INSPECTION
JOB VALUE 196320
6/20/2017
ON-LINE
C 0 U N j Y
WvW.CrW.COm
APN 0630-44-7421.000
"R1HL A R 0 LINT"".
DESCRIPTION
50X50 4BDR MONO W/
GARAGE
PERMIT INFORMATION
FEE SUMMARY
SITE 340 TILDEN HOWINGTON DR
ENVIRONMENTAL HEALTH FEES
$25.00
LILLINGTON, NC 27546
HOMEOWNER RECOVERY FUND
LAND USE PERMIT FEE
$10.00
$25.00
APPLICANT DAKOTA LAND PARTNERS LLC #80A
REVIEW RESIDENTIAL PLANS
$25.00
5511 RAMSEY ST
SOIL EVAUNEW SEPTIC TANK
$750.00
FAYETTEVILLE NC 27546
PERMIT FEES-CPSF00
Total Fees Charged:
$805.00
$1,640.00
OWNER
DAKOTA LAND PARTNERS LLC
551 RAMSEY STREET
FAYETTEVILLE NC 27546
CONTRACTOR WJH LLC
3300 BATTLEGROUND AVE
GREENSBORO NC 27546
NOTES This job copy of this permit shall be kept on the job site to make the required entries thereon. The permit will expire if work is not started in 180 days, is
abandoned, or does not receive an inspection for more than 180
days. Additional fees will be collected to renew expired permits. This is a Building Permit when property filled out, signed and validated, and is not transferable.
Construction Hour:
Construction is limited to the hours of 7:00am
to 7 00pm each day. No work shall be performed on certain holidays (MMC V -213-3(b)).
LICENSED CONTRACTORS DECLARATION
INSPECTION SUMMARY
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the
Business and Professions Code, and my license is in full force and effect.
License No: Expiration Date: Contractor:
ENVIR.
HLTH. CONFIRMATION
OWNER -BUILDER DECLARATION
ENVIR
OPERATIONS PERMIT
I hereby affirm under penalty of perjury that I am exempt from the contractors license Law for the following reason (Sec. 7031.5, Business and
Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance,
also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Pofessions Code) or that he or she is exempt
therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by an applicant for a permit subjects the applicant to a civil
penalty of not more than five hundred dollars ($500).):
1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended
ore red for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner or property who
builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided
that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the
caner -builder will have the burdon of proving that he or she did not build or improve for the purpose of sale.)
I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and
Professions Code: The Contractors License Law does not apply to an owner or Property who builds or improves thereon, and who contracts for
uch projects with a contractor(s) licensed pursuant to the Contractors License Law.)
I am exempt under Sec. B.P.C. for this reason
DATE OWNER
WORKERS COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by Section 3700 of the Labor
Code, for the performance of the permit is ussued.
I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the
work for which this permit is issued. My workers' compensation insurance carrier and policy number are:
Carrier/Policy No:
This section need not be completed if the permit is for one hundred dollars ($100) or less).
I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any number so as to become
subject to the workers' compensation laws or California, and agree that if I should become subject to the workers' compensation provisions of
Section 3700 of the Labor Code, I shall forthwith comply with those provisions.
DATE APPLICANT:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO
CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF
COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is
issued (Sec. 3097, Civ. C.).
DATE APPLICANT:
' I certify that I have read this application and state that the above information is correct. I agree to comply with all city ordinances and state
laws relating to building construction, and hereby authorize representatives of this city to enter upon the above-mentioned property for
inspection purposes.
SIGNATURE OF APPLICANT OR AGENT ; DATE
Permit Finaled Date: Inspector Name: Signature:
https://permits.harnett.org/eTRAKiT/printPermit.aspx?permitNo=CPSF17-50041429 1/1

App# CPSF1 7,.50041429R
10
Harnett County Department of Public Health
Imprvement Permit
A building permit cannot be issued with only an. Improvement Permit
PROPERTY LOCATION: 340 Tilden Howin-aton Dr.
ISSUED TO: W 11 LLC SUBDIVISION OT #&QA,_�,
M_
NEW BE PAIR EXPANSION -d prior to (onstruction Authorization lssuanm
ED Site Improvements require
SFD (40,'X T
Type of Structum —_ _A1,_O�tb%I­­ - ---------
Proposed Wastewater System TyDe: PU t
ffl P _M_Q_25%jRe_dU_Qti1Qr1
Projected Daily flow: 1�.a..GPD
Number of bedrooms: 3,_ Number of Otcupants# 6
ma
Basement ge 0 No
Pump Required: ResI El No [].May be required based on rina.1 location and tlevations of facilities
Type. of Water Supply-. El Community §9 : 'Public 0 Well Distance from well feet Permit valid for-, Five years
Permit conditions:— ----------- ........ 0 No expiration
Authorized State Agenc_-. 5
EE ATTA(HED SITE SKETC
Date:
he issuance of this er it by the Health Departme
p M nt io w way gua;:3n14A
issuafice Of other permkshe permit holder is responsible fogy (he(king with appro b di i- meetin their Th,
vat, governing , o its in i g, eir reqtisremeno is
site is subject to revocation it the site plaa, plat, or the intende hang "`*e IMP(ovement Permit shall not be affetted by a thange i ownership of the -sim Thi * ' i N
sub' to s permit is �Su Jett to Compliance With the provisions of
the Laws and Rules for Sewage. Treatment and Disposal and tp tonditim of this, permit..
(onstrqction Authorization
lie sired for Building, Permit)
The construction and installation requiremehts of Rules .19SO, JM, 1954, A155. W6, A957. .1158i atid 1959 are incur by referemes into this permit and shall be met Systems 5hall he iflstalfe-,dJo a(cordance
with the atta(hed system, layout
ISSUED TO: WJH1 LLC PROPERTY LOCATION: 340 ... Tilden
sumvisiom Aamie Bell Ridae, tOT DA
f a-cility Type: S.FD C40Ix
0 New El 'ESxpan- ton 0 Repair
Basement.) Yes No Basement fixture0 Yes 59 No
Type of Waste -water System" PUMP to.,25%R t
e ion System (Initial) Wa5tt. Ioi
ev 1 e GPD
duc,
t f W 360
(See note below, if applicable 11)
Pinto 25% Red u ction... SVSe R r)
lnstalLagon--lie guirements/Condltlon$ Number of' trenches "I
Septic Tank Sizellon Exact length
of' eath trench et
Pu. m -p Tank Size IM --gallons Trenches shall be, Installed on contour at 'a
Maxiffl.um Tren . ch Depth of., JB in hes
(Trench bottoms shall be level to. +/-1/41T
in all directions)
Pump Requirements: . ft. TD H vs. GPM
Trench Spacing:.2. ..... Feet on Center
.Soil Cover: 6 _ inches
(Maximum soil cover shall not exceed
3614 above the trench bottom)
inches below pipe
gat
treeWe Depth: inches above
Conditions: See all conditions on site sketch.
.�ssgd i ioso a, o0d Ad oodes- Inches total
WATER LINES (INCLUDING IRRIGATION) MUST 81 10FTJROM ANY PART OF SEPTIC SYSTEM OR REPAIR AREA.
NO UTILITIES ALLOWED IN INITIAL OR REPAIR DRAIN FIELD AREA.
is e; Ywderstd#d the s rt ir differefit from the t e
Y. em t1pe soecifled rpe speifted ofl the p&, is / iccept the spedfleitions of thl� perx,
Owner/Legal Representative Signature., Date:
----------_
This (onstruction Authorization is subje(_t'
Construction Authotization Is sahtui to 4
too if the site plan, plat, or the intended use changes. The Construction Authorization sball not be tramlerred when there is achange in i ownership of the site. This
wit i --pt,
ovisions of the Laws and Rules for Sewage Treatment ani Disposal and to the conditions of this permit, SEE ATTACHED SITE SKETCH
-2/9
Authorized State Agent: �
------ ---- � Date: 2/2201
tlon Authoriufion Expiratio
n Date: 212
.2L20,24

r% to"* t —) — S 0(!!A1J4"'j,4j Q,
HTE# Permit
Harnett oi.nty I)epartament of Flubli Health.
Site 1ieteh
PROPERTY LOCATON:N vro
ISSUED TO: '0Z kk�_,c SUBDIVISION �PNZ4,i& LOT # IRCXN
----------- - ----- ------- ----------- - ---
10�
hitt
orized State Aget- Dat -e: ---------------
4
I llll�"117111