SEPTIC Application # / 5 - 69 :5
HARNETT COUNTY CENTRAL PERMITTING
PO BOX 65 LILLINGTON NC 27546
(910) 893 -7525 FAX: (910) 893 -2793 www.harnett.org /permits SCANNED
APPLICATION FOR EXISTING SEPTIC SYSTEM INSPECTION
FOR MORTGAGE COMPANIES, COMMERCIAL CHANGE OF ,
OWNERSHIP, FIRE DAMAGE, ETC.
---- NOTE: -A DEED OR OFFER TO PURCHASE IS REQUIRED AT TIME OFAPPLICAN.
TIO
Date: /0 --?9 �J
/ t/ //
Proposed Buyer or Business Name: A( 7yinr - 'v'
Applicant/Mortgage Co:
Mailing Address: 4
City: pi, W h/ State: W, ° C, Zip: 2 j9-'79a-184-141
Telephone: ( ) Other #: ( ) 9
Current Land Owner: d -e
Property Address: ' GO r o-. £P • 53 3
PIN: Parcel:
State Road #: State Road Name:
Name of Subdivision: L6f # �— (irAppiicati�c)
Daycare: # of employees # of children Hours:
Restaurant: # of employees # of seats Hours:
(please give oncise, com lete dire tions from ton, NC to thy prope� )-r
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There is a $100.00 charge for this service. 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 that all above informatiomis correct.
• Signature of Owner, Authorized Agent or Applicant:. Of ,CX >9
FOR OFFICE USE ONLY
AUTHORIZATION FOR USE OF EXISTING SEPTIC SYSTEM
Signature of Environmental Health Specialist Date
SEPTIC 112 619 4/08
certain lot heretofore conveyed by L.F. West and wife Katie Session West to and which is now owned
by Fannie Belle Page, and runs thence with the diving line between L.F. West one and one -half acre
tract and the Mary S. McKay Property, North 42 degrees 19 minutes East 50.99 feet to an iron pin; the
southeast corner of Arthur J. Johnson's lot; thence South 88 degrees 03 minutes West 109.73 feet to
the east margin of said State Road #1775; thence with the east margin of said State Road. South 0
degrees 57 minutes East 61.98 feet to an iron pin. another comer with Fannie Belle Page's lot; thence
North 89 degrees, 40 minutes East 101.53 feet to the BEGINNING. containing 0,178 acres, more or
less, and being a part of the land described in deed from Katie Sessoms West, widow, to Broncho F.
West and wife, Mozelle P. West, recorded in Book 638, Page 370, Harnett County Registry.
TRACT B
Tract 1
BEING a part of Tract #3, as shown on Map of Mary S. McKay Division, recorded in Map Book 5,
Harnett County Registry, more particularly described as follows:
BEGINNING at a stake, R.A. Bass corner, and runs with R.A. Bass line North 35 feet to a stake;
thence East 102 feet to a line of the Mary S. McKay division Tract #2; thence with line of Tract #2,
SW 49 feet to R.A. Bass comer; thence with his line West 69 feet to the point of beginning.
TRACT2
BEGINNING at a stake in the edge of Averasboro Road, run east about 1 16'A feet to a stake; thence
Northwest 15 feet to a stake and corner of J.C. West; thence with J.C. West line, West 102 feet to a
stake in the edge of Averashoro Road; thence North with Averasboro Road 15 feet to the point of
beginning.
TRACT3
BEING a portion of Tract #3 of Mary S. McKay property according to a map surveyed and prepared
by R.F. Duncan on December 22, 1947; said map recorded in Map Book 5, at Page , Harnett
County Registry, described as follows:
BEGINNING at a stake on the west corner of James C. West lot situated on the East side of
Averasboro Road between the Towns of Dunn and Erwin, and runs thence South 73 feet to a stake
joining the Mary S. McKay property; thence running Northeast 100 feet following the line of Mary S.
McKay to a stake; thence West 68 feet to the James C. West corner at the beginning, being a triangular
shaped property.
For reference to said property see deed from James A. Tyndall to Henry M. Tyndall recorded in Book
850, at Page 615 -616, Harnett County Registry.
The property herein above described was acquired by the Grantor by instrument recorded in Book
1339, Page 722 -725, Harnett County Registry.
This property being acquired by grantor in Book 1561 at page 108 -110, Harnett County Registry.
The grantor direct the grantee to pay all utility expenses and taxes in a timely manner in order to keep
and maintain said property and to keep the same in good condition. _.. _....____.__......_.
JO HAVE AND TO HOLD the aforesaid lot or parcel of land and all privileges and appurtenances ': Deleted: IF
thereto belonging to the Grantee in fee simple.
And the Grantor covenants with the Grantee, that Grantor is seized of the premises in lee simple, has
the right to convey the same in fee simple, that title is marketable and free and clear of all
encumbrances. and that Grantor will warrant and defend the title against the lawful claims of all
persons whomsoever except for the exceptions hereinafter stated.
Title to the property herein above described is subject to the following exceptions:
a) Easements, roadways, and rights -of -way of record.
b) Easements visible by an inspection of the premises.
c) Restrictions of record
IN. W ITNESS THEREOF, the Grantors have hereunto set their hands and seals, or if corporate, has
c��. this instrument to he signed in its corporate name by its duly authorized officers and its seal to
• reunto affixed • a - ority of its Board of Directors, the day and year first above written.
4 _ A (SEAL)
"in -arl Tynd. I
(SEAL)
SEAL - STAMP NORTH CAROLINA, Harnett County.
1, L. Randolph Doffermyre, III, a Notary Public for said County and State, do hereby certify that Kevin
Earl Tyndall personally appeared before me this day and acknowledged the due execution of the
foregoing instrument.
Witnpsss y han• and official stamp or seal, this 3 ( day of August, 2010.
i
L. R•n.olph Doffe if(re, III f , 4 ; -
,crn';�gVRE, 111
L. RANDULPH : ,
My commission expires: June 2015. NO Tf`ii'i i'USLIC
FiARNETT COUNTY,
SEAL: STAMP NORTH CAROLINA, Harnett County. N.C.
The foregoing Certificate (s) of L. Randolph Doffermyre, III is /are certified to be correct. This
instrument and this certificate are duly registered at the date and time and in the Book and Page shown
on the first page hereof.
REGISTER OF DEEDS FOR
COUNTY
B Deputy / Assistant - Register of Deeds.
•
c o
py
Tax Lot Number TIN PIN
Mail after recording to L. R. Dolrennyre, III, P.O. Box] 029, Dunn. NC 28335
This instrument was prepared by L. Randolph Doffermyre, lit, Attorney -at -Law, P.O. Box 1029, Dunn, North Carolina 28335 (910)-892 -2145.
97 Chicora Road, Dunn, NC 28334
Brief Description for the Index
Wamanty Deed
THIS DEED, made this the day August, 2010, by and between:
GRANTEES
GRANTORS
Kevin Earl Tyndall Allen Keith Tyndall, unmarried
411 North Spring Branch Road 97 Chicora Road
Dunn, NC 28334
Dunn, NC 28334
The designation Grantor and Grantee as used herein shall include said parties, their heirs, successors, and assigns, and shall include
singular, plural, masculine, feminine or neuter as required by context.
WITNESSETH, that the Grantors, 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 in fee simple, all that certain lot or parcel of land situated in
the City ofinvio, Duke Township, Harnett County, North Carolina and more particularly described as follows:
PROPERTY DESCRIPTION
TRACT A
BEGINNING at a point in the dividing line between Mary S. McKay, widow, and the one and one -
half acre tract conveyed to L.F. West and wife, Katie Session West, by deed recorded in Book 305,
Page 631, l-lamett County Registry, which point of beginning located at the east most corner of that
L. RANDOLPH DOFFERMYRE III, P.A
ATTORNEY AT LAW
D
DI , NC IVINE 283
I .
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,- NAME: APPLICATION #: / _ 500- ZS S 0 S
*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 expiration
depending upon documentation submitted. (Complete site plan = 60 months; Complete plat = without expiration) - . (
910 - 893 - 7525 option 1 CONFIRMATION # l
❑ 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 soil
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 trip 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 (if
possible) and then put ltd' back 'In piece. (Unless inspection is for a septic tank in a mobile home park)
• DO NOT LEAVE LIDS OFF OF SEPTIC 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
(liven at end of recording for proof of reauest.
• Use Click2Gov 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 {_) Innovative ( Conventional (_} Any
(_} Altema ve (_J Other
The applicant sha `fy the local health department upon submittal of this application if any of the following apply to the property in
question. If the answet^ts "yes ", applicant MUST ATTACH SUPPORTING DOCUMENTATION::
{_ }YES (_J NO Does.the site contain any Jurisdictional Wetlands?
(_)YES (_I NO Do you pinu. have an urination siesta]] now or in the future, -
(_)YES {_ J NO Does or will the building contain any ? Please ;vim.
I — )YES { No Are there any existing wells, springs, waterlipes or Wastewater Systems on this property?
--..,
(_)YES (_ I NO Is any wastewater going to be generated on the site other than domestic sewage?
(_)YES (_) NO Is the site subject to approval-11y any other,public Agency?
(_) YES {_} NO Are there any Easeptefi[s or Right of Ways on ihis,property?
{_ }YES (_) NO Does the site contain any existing water, cable, phone or erground electric lines?
yes please call No Cuts at 800- 632 -4949 to locate the lines. This is a free service.
I 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,
I Understand That I Am Solely Responsible For The Proper Identification And Labeling Of All Property Lines And Corners And Making
The Site A 1 o That Complete Site valuation Can Be Performed.
Ra
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The is
PROPS OWNER OR C E LEGAL REPRESENTATIVE SIGNATURE (REQUIRED) DATE
10 /10
Application #
Harnett County Central Permitting
PO Box 65 Lillington, NC 27546
910- 893 -7525 Fax 910- 893 -2793
www.harnett.org/permits
Certification of Work Performed By Owner /Contractor
C. ,//�� (Individual Trade Application) 919 _ 9 - 18 Yet
Owner (s) of Structur / 1 7 ry ke el, 1 (
Phone:
Owner (s) Mailing Address: 9 / CA ; G or& AI
p0we/, me, d, 3 :5 4 1
Land Owner Name (s): Phone:
Construction or Site Address:
PIN or Parcel # from GIS:
Job Cost: Description of Work to be done LLEL ve-£cOnn LLB"
Mechanical: New Unit With Ductwork New Unit Without Ductwork _ Gas Piping
Electrical *: 200 Amp _ <200 Amp _ Service Change _ Service R econnect Other _
* For Progress Energy customers we need the premise number
Plumbing: Water /Sewer Tap Number of Baths Water Heater
4 Specific Directions to Job from Lillington: // ,} �}
l.f�. is Er-:..v a/ Ahi`c.acA (k ,4- 0''1.
( -k cwt.. A €1 3 h dr La )04-
Subdivision: Lot #:
I 4})e" ice: f L 1i f (f a t t will provide the E«.cin -a1/4 L- labor on this structure.
(Contractors Name) (Trade)
I am the building owner or my NC state license number is ouDrtl£.12 , which entitles me to
perform such work on the above structure legally. All work shall comply with the State Building Code
and all other applicable State and local laws, ordinances and regulations.
Structure owner(s) signature: eta-- „Y�.. -26. Date: /0 ” a% n
-
Company Name: Q Phone:
Address: County:
Contractor's License #: Email Address:
Contractor's Signature: Date:
*Company name, address, & pho ne must match information on license.
Individual Trade Application 1 of 1 06/10