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IPACHTE# V_EQV Q- Harnett County Department of Public Health 2 5 4 6 3 ()q 7 7© Improvement Permit A building permit cannot be issued with only an Improvement Permit PROPERTY LOCATION: C' _ 5,z' a, s ~ S ISSUED TO: Psi ~a 1 ~(~C oc SUBDIVISION M-rscN xi L_L LOT # Eb NEW ❑ REPAIRA EXPANSION ❑ Site Improvements required prior to Construction Authorization Issuance: Type of Structure: Proposed Wastewater System Type: Ov c-Q So to nl Projected Daily Flow: 3~0 GPD Number of bedrooms: 3 Number of Occupants: max Basement ❑Yes A No Pump Required: Yes ❑ No ❑ May be required based on final location and elevations of facilities Type of Water Supply: ❑ Community l Public ❑ Well Distance from well _ 100 feet Permit conditions: Permit valid for X Five years ❑ No expiration Authorized State Agent.: QS Date: 5 i `7I 8°I SEE ATTACHED SITE SKETCH The issuance of this permit by the Health Department in no way guarantees the issu ce of other permits. The permit holler is responsible 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 Improvement Permit 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, .1957, .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: ~~Fct-, P~flcc~~ C Facility Type: Basement? ❑ Yes No Type of Wastewater System' _ (See note below, if applicable (Initial) Wastewater Flow: GIRD Qorne` o 450/0 ko-n'ON Sys; , (Repair) Installation Requirements/Conditions Number of trenches I Septic Tank Size t 011-0 gallons Exact length of each trench a4 0 feet Trench Spacing: Feet on Center Pump Tank Size L©O~ gallons Trenches shall be installed on contour at a Soil Cover: inches Maximum Trench Depth of. f$-1S 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 inches below pipe Aggregate Depth: inches above pipe Conditions: Cfvr->) itrv c inches total 'If applicable: / anderrtand the system type specified it different from the type specified on the application. / accept the specifications of this permit. Owner/Legal Representative Signature: Date: ur, r~ nuumr¢nuou „>uuteu ru rerucauun it me sit tan, prat or me mtenaea use cnanges, the construction Authorization shall not be transferred when there is a change in ownership of the site. This Construction Authorization is subject compliance with t s e Laws and Rules for Sewage Treatment and Disposal and to the conditions of this permit SEE ATTACHED SITE SKETCH Authorized State Agent: L-5 Date: S hlo-l Constr n Authorization Expiration Date: 61 TL1 ❑ New Basement Fixtures? ❑ Yes PROPERTY LOCATION: (1,po I- 5e cL SUBDIVISION CAPsot, tL.L LOT # 16 ❑ Expansion It-,< Repair X No HTE# Permit # ~Gk~3 Harnett (bounty Department of Public Health Site Sketch PROPERTY LOCATON: c r) L~ Q,\ 0 c 5 zo ISSUED TO: SUBDIVISION Masc k )L- i- LOT # to 51111 -1 6 Authorized State Agent O~wE got s~cx2S Date: ~ (rAZL w~~~i AMY QUC.S'~10~yS p2~o(Z 10 P\ u-M 1 Q tJ t,, ,so + 'p,XIJ- "YA a v~ &,s,r 7q.t~- PFIQ~ ~h LL~/ i Q cbu.~PS~O ~a~ i Hav:~C { S1T~ I _GXtsS~^i~ A+1.A alo Division of Environmental Health v v V y yJVU VyJ JIICtlI. On-site Wastewater Section Property ID: Lot SOIL/SITE EVALUATION File for ON-SITE WASTEWATER SYSTEM Code: Owner: Address: Applicant: Proposed Facility: 1ao1L- Date Evaluated: Design Flow (.1949): Location of Site: Property Size: Water Supply: 'Public [ I Individual Property Recorded: Well [ I Spring Evaluation Method: ""``S Auger Boring Pit [)Other Type of Wastewater: ~~ew,age Cut . [ J Industrial Process [)Mixed P R a SOIL MORPHOLOGY 3 .1944' ' ,'494f1 PROFIt FAGTQR9 ~.andscaps' orf ` iioriz` Positfor>; Depth `Sfrv T ` i9dt F i z 5GIir a s 4 n "io tiS 4" F ctur Consistence r}; . I 1 k ~95Q/°x R k+g a tir Y Wetndsalttf~- Sa ; + y~ Ott`&i' 0 r Slo 9f,' IPi.} Text s Mineral olor, ~ r✓ ~~r tl - LU"Zscrlprjon Initial System Repaf System Available Space (,1945) Other Factors 1946): System Type(s) Site Classification (.1948): Evaluated By: v.1 ifte LTAR Others Present: ENVIRONOI MAL HEALTH SPCTM 307 CORNELIUS MMETT BLV- D. • LIL~OTS47 PHQNE InD493-M FAX *TEA -7 71 SOT r~~fi w, ' Albert C. Adcock office- 919-774-9582, cell- 919-775- NAM NEMEi(FiOqSI ELL) 9782 ,P.O. Box 3367, Sanford, IBC 27330 Vaud "&j ADDRESS WA JNG AURW IF WFW NSA q 141 -4 ! I LIRDq<* F RlB1TW LEAW ETC., UST PROPERTY Owl1Et MANE - Mason )lilt Lot #10 (262 Mason Rill Lana) 0.50 acre SUBDMSiOM NAME LOT O STATE RD MANE B # S ZE OF LOT OR TRACT Type of dwoftg O Modular 04& Home 0 Slick NO 0 Other Number of bedr== 1112 0 3 ® 4 0 or man 4 Sasemw Other Gwa" 0 Yes Q No Dlshwr 12 Yes 0 No Garbage Disposal 0 Yes G No Water Supply: 0 PdVabe WON Ci Community System ® County Dlrsrti" from Ulgngton m your Sat: Highway #42-1 west from Lillington to Cool Springs Road East; take right onto Coal Springs Road East; subdivision is appr. one mile on right,sitee is on right side of Mason Hill Lane In order A w &wku=sntel Health to hip,yov With yaw rspair jqw wX need to camper by camping to kftwhA= 1. A " sure ed and recorded mad' and "deed to our ro eri (not your house) ffust be atta" to this application aft with a sde plan suing (a) location of dwelling (b) kcatin of driveway (c) location of any wefts and other exL*q sfructures. 2. The outW end of tt►e tone and disftution box will need to be uncovered and property Wm marked. After the tank is Ixl Wered, property des are marked aN or sign hn been placed, you wig need to call us at 914893.7647 to let En*onmenW Health know that your site is ready for evaluation. 3. The system must be repaired whin 34 days or the time set within receipt of a vtob Mw !altar. By *ft bedbw, I ow* 9W air of the abm sdamWon is oohed ta ft beef of wry k vm%* False k*mmft W Arent in the dermal of ft Permit the P WW b sibjW to r im If ft s* pift #*vx ad usA or owE 3i* d►aW 44/oy r P. 4_15-09 ad►re Date Installer of system Septic Tank Pumper Designer of System Unknown- mobile home to be moved to site and sold or rented 1. Number of people who live in house? # adults _ # e eo # tow L What is your avessge estimated daily wMer usage? dWndmamth or day county water N R M plfeasc She 00 mas>M that the water bid is rm,I P I in? I If you have a garbage disposal, law often is usod? I I daily f I weeldy [ I =osthly 4. When was the septic tank last pumped? ~ How often do you have: it per? S. If you have a dishwasher, how often do you use it? [ I daily f I every other day [ I weeldy b. If you have a washing machine, how often do you use it? I ) daW I I every other day ( I weeldy [ j noa ft 7. Do yon have a water softcne r or treatment system? I I YES I I NO Where does it drain? 8. Do you use an "in tmAr t: des bowl sanitize& [ I YES [ ] No 9. Are you or any member in your family using long term gt'estxiphon x'+401 ana'bWucs or chetrmatherapy'1 [ I YES I I NO If yea, plMe livt 10. Do you put household cleaning chemicals down the drain? [ I YES [ ) NO if so, what ]Hind? 11. Have you put any c=icals Onfi ts, ffikwm etc.) down the drain? [ ]YES j j NO If yes, what kind? 12. Have yOu installed any wales fixtures SMO your system has bean installed? [ ) M I I NO If yes, please list any additions inchmding any spas, +mv#mirlpoola, sinks, lavaaoriea, bath/showers, toilets. 13. Do you have an underground lawn watering system? I I YES Yj NO 14. Has auy work been dame to your atrwure sirmce your initial move, such s roof, Butter drains. ba nmermt fr undWon drains, etc? [ 1 YES [ I NO If m please lid 1S. Are there any undaWound utdities on yowr lot? [ ] YES [ I NO nease check aS that apply [ I Power [ I Phone ( I Cable [ I Cos I ) wager 6. Describe what is happening when you have problems with your septic system and when was it first noticed, Previous owner damaged existing system when mobile. home was removed from sitee. Oliver Tolksdorf requested we submit Application oz epair to determine how to handle repair/new system so that a di.fferent~mobile home can be move ro a si a an pre e upludy (sale or rearaIt'.j. 17. Do you notice the problem as being pattenoed or linked to a specific event (i.e., wash clothes, beavy rains, househoM guesb)? I I YES [ I NO ff yes, please list THE ADCOCKCOMPANIES P_O_ Box 3367, Sanford, NC 27330 Fax: (919) 776-1981 E-Mail. appraisalaa wave-net_net Adcock Appraisals, Inc 1103 S. Homer Blvd. Sanford, NC 27330 Phone (919) 7749582 Homestead, Inc. 1103 S. Horner Blvd_ Sanford, NC 27330 Phone (919) 774-9582 San-Lee Builders, Inc. 1103 S. Homer Blvd. Sanford, NC 27330 Phone (919) 775-5429 ACA/PJA. LLC 1103 S. Homer Blvd. Sanford, NC 27330 Phone (919) 774-95a2 Date: `T~ TI To: From: Adcock Rental Management, Inc. 1111 S. Horner Blvd. Sanford, NC 27330 Phone (919) 774-6046 Security Maintenance &Repair, Ina 912 Fields Drive Sanford. NC 27330 Phone (919) 775-2376 Re: Sending _ pages (including this cover page) IF YOU DO NOT RECEIVE THIS NUMBER OF PAGES OR IF THERE ARE PROBLEMS WITH THE TRANSMISSION, PLEASE CALL 919-774-9582 AND ASK FOR )Vk-f-- Comments: CJlk ~v Or--- trt (e UAW 6 Cf C 44 eOtAA~ 01L U ~~t ~vsnwa at YlQ o V* The . . 11o ~ N •4h ••••••••••••vr perri~i permlI is the she plan, e►>:ta~p4ad use, , or orrr►evsh4D fh x•40 °t ~ \ ~ -'b ~ fy f~ ~ O ~ vOA a 'CN• L~ ~ 5 3..L~ •00'6 u A \ t•' EIS 9~•,L O °S Ly 5 Z a pt . a Z. ib1~t s \ cr a ® a\v q 4 z 3 40. ~ p . A ,'~c \ fig` ~ SAT' x+ I" cn ~t r~ ~ $ ~ ~ ~ t+ s O A 6£ L S ~ ~ O a tk t! V ~ Ott' ~,l S ~S a .o _ -10 yl'~• N L 3° N O ma ~ ;„s4A oo P $ ~ `i p .4L{s 4 \ 3~ /`•`/I ' yam! `d ~ O ~y,bt ` l O G' Dft Ic, p 4 n J / i 0 i 0~c~c»~nc»~ 1 tr ♦.WN+ m `y Cl S V 'Y NNW NNAOOPV VVVN ~ J au•~ewu•~o ~n~owq~uv~a 0O c,S ~ b~ G $~$8!ClY:= O O C-A N 4. ~DOCeN{000~vOO~in ~ ai q Z 1 ~?~J`~. fO 1J0 y.NP0~+ ~IVO~ Q A J• f ~J~NNW-~N~ ENO 0 = ~ j t+•~ W o~orwav.°aoowvo~~~,wi ~ A r aYrN~~Cf»88~°'888~ ~ rrl 0 9 0 N~w;~ii~v m ;u °u, 0afaw°uwwo4N ~l m ni ni~f ~EttMAA O _ D Z G I V Im J O~ D T COUNTY HEALTH DEPARIW T N EE~'' ARONMENTAL HEALTH SECTION 1414 5 OPERATIONS PERMIT Name: (owner) Zie7 6V ew Installation Septic Tank Property Location: SR# ❑ Repairs A Nitrification Line Subdivision 12 ~ e)L All Lot # /'0 TAX 1D# C«1 Contractor: Basement with Plumbing: ❑ Garage: ❑ Water Supply: ❑ Well ',Public ❑ Community Distance From Well: ft, Quadrant # Registration # Following are the specifications for the sewage disposal system on above captioned property. Type of system: (konventional ❑ Other Size of tank: Septic Tank: L(L gallons Pump Tank: gallons Subsurface No. of exact length width of depth of~ Drainage Field ditches of each ditch ft. ditches ft. ditches / in. French Drain: Linear feet Date: 09-7 2-0 0 CD PERMIT NO. Inspected by: Environmental Health S . alist sny-~v3 HARNE COUNTY HEALTH DEPARTME NO-17273 N° 17273 IMPROVEMENT PERMIT Be it ordained by the Harnett County Board of Health as follows: Section III, Item B. "No Person shall begin construc- tion of any building at which a septic tank system is to be used for disposal of sewage without first obtaining a written permit from the Harnett County Health Department." Name: (owner) //(~A: 4 ❑ New Installation ❑ Septic Tank Property Location: SR#.-4 I- S ❑ Repairs ❑ Nitrification Line Subdivision A/ _r, Tax ID # Number of Bedrooms Proposed: Quadrant # Lot Size: . Sy.~ Basement with Plumbing: ❑ Garage: ❑ Lot # /o Water Supply: ❑ Well ❑ Public ❑ Community Distance From Well: ft. Following is. the minimum specifications for sewage disposal system on above captioned property. Subject to final approval. Type of system: (3 Conventional ❑ Other Size of tank: Septic Tank: 1,e-, ,2 gallons Pump Tank: gallons Subsurface No. of exact length width of depth of Drainage Field ditches of each ditch -fie ft. ditches ft. ditches 1~ -1? in. French Drain Required: Linear feet This permit is subject to revocation if site plans or intended use change. Date: 2~/rD0 Signed: Environmelatal ealth Specialist /rt u \B A \ 5~ N ] Harnett a7 COUNTY Department of Environmental Health NORTH CAROLINA www.harnett.org Harnett County Government Complex 307 W. Cornelius Harnett Boulevard March 24, 2009 bilington, NC 27546 Albert C. Adcock ph: 910-893-7547 P O Box 3367 fax 910-893-9371 Sanford, NC 27331-3367 RE: Existing Septic System Inspection HTE# 09-5-21770 Dear Mr. Adcock, An attempt was made to evaluate your property for the purpose of issuing an Existing Tank Permit. The evaluation could not be completed for one or more of the following reasons. 1. Uncover outlet lid on septic tank and break seal ($25.00 fee incurred) 2. Have system pumped out 3. Replace sanitary T -X-4. Other - Lot corners not marked, house corners not marked, no orange sign posted. ($25.00 fee incurred) Your application will be put on hold until the selected items above have been addressed. When completed call 893-7547 to confirm that the items mentioned have been corrected, we will then reschedule your property for evaluation. Oliver Tolksdorf, R.S. Environmental Health Soil Scient' t Harnett County Department of Public Health Environmental Health OT/sgs Copy - Central Permitting strong roots - new growth