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244 <br />N W-A lk,41" *6111 M111J Oki VAN <br />Effic E <br />DEPARTMENT OF HEALTH AND HUMAN SERVICES <br />Division of Public Health <br />On -Site Water Protection Branch <br />1642 Mail Service Center <br />Raleigh, NC 27699 <br />(919) 707 -5874 <br />Fax (919) 845 -3973 <br />PREAPPLICATION, APPLICATION AND DESIGN FLOW CONFIRMATION <br />1. Preapplication: <br />Applicant and local health department (LHD) hold pre - application conference to review and transmit <br />application forms, checklists +, guidance documents' and rules +, and to discuss project, information <br />needs, field and review requirements and projected time frames. Applicant's consultant(s) should <br />attend and On -Site Water Protection Branch (OSWP) Regional Staff may attend upon request by either <br />party. <br />2. Application for Improvement Permit (Site Approval): <br />a. Applicant Submits completed application to LHD, including <br />• Project title, <br />• property location shown on plat or boundary survey, PIN number and locator map <br />® name /address /phone /fax /E -Mail numbers for owner, agent, engineer and soils <br />consultant <br />® whether the proposed system is new, a repair, an expansion, a replacement, or <br />modification to an existing system <br />® description and location of water supplies (existing and proposed) and surface waters <br />® description and location of facilities (existing and proposed) to be served by system, <br />occupancy and projected use patterns <br />• list of wastewater sources, water use fixtures (points of wastewater entry into system), <br />and projected wastewater characteristics (e.g. provide wastewater quality data for any <br />non - domestic sources), and description of projected flow patterns <br />• description and location of wastewater system components (existing and proposed) <br />® proposed phasing schedule for facilities and system components <br />® projected wastewater design flow rate(s) for each system component and phase of <br />development, and basis for determining (by applicant's engineer) <br />+- checklists, guidance documents and rules can be accessed on -line from the OSWP HomePage, at <br />htt a: ilclrs. r�c.aub9ichealth,cE_�mfs�sw �s/ <br />