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OPHTE# Harnett County Department of Public Health 2 0 4 4 4 PERMIT # Operation Permit ❑ New Installation ❑ Septic Tank Repair ❑ Nitrification Line ❑ Expansion PROPERTY LOCATION:-/81D sr~-,~,.~~2p Name: (owner) 6441 5 SUBDIVISION LOT # System Installer: Registration # Basement with plumbing- El Garage umber of Bedrooms Type of Water Supply: ❑ Community Vpublic ❑ Well Distance from well feet System Type: (-00 VG..~d~~ . f2 - Types V and VI Systems expire in 5 years. (In accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal. This system has been instalIed in compliance with applicable North Carolina General Statutes Rules for Sewage Treatment and Disposal and all conditions of the Improvement Permit and Construction Authorization. ~s t n _.-Z"- 9 PERMIT CONDITIONS: I. Performance: System shall perform in accordance with Rule .1961. II. Monitoring: As required by Rule .1961. III. Maintenance: As required by Rule .1961. Other. Subsurface system operator required? Yes ❑ No ❑ If yes, see attached sheet for additional operation conditions, maintenance and reporting. IV. Operation: V. Other. Following are the specations for the sewage disposal system on the above captioned property. Type of system: Ll Conventional ❑ Other Subsurface No. of exact length G Drainage field ditches of each ditch 1~ x feet Septic Tank:_ _ gallons Pump Tank: gallons width of depth of ditches fPPt ditrhoc C~ inA., rent rain Required: Linear feet Authorized State Ag Date N --Z~o -6 HARNETT COUNTY HEALTH DEPARTMENT ENVIRONMENTAL HEALTH SECTION 307 CORNELIUS HARNETT BLVD. LILLINGTON, NC 27546 910-893-7547 PHONE 910.893.9371 FAX ~I.~LI~IOaV' FOR 1{EwIIR-R - -L~ &a c;,,q 9m_ g-2 o - / 2- / z NAME PHONE # (HOME) PHONE # (WORKICELL) ADDRESS MAILING ADDRESS IF DIFFERS lu / Nni `~I?C, ~2QY3 IF RENTING, LEASING, ETC., LIST PROPERTY OWNER NAME A/ ~ s /9/0 1 aCfy, SUBDIVISION NAME LOT # STATE RD NAME & # SIZE OF LOT OR TRACT Type of dwelling ❑ Modular ❑ Mobile Home ❑ Stick built ❑ Other Number of bedrooms 1 ❑ 2 ❑ 3 ❑ 4 ❑ or more ❑ Basement Other Garage ❑ Yes Q-No Water Supply: private Well ❑ Community System Garbage Disposal ❑ YesE o ❑ County Directions from Lillington to your site: 3 o l Al In order for Environmental Health to help you with your repair you will need to comply by completing the following: 1. A " surveyed and recorded map" and "deed to your property" (not your house) must be attached to this application along with a site plan showing (a) location of dwelling (b) location of driveway (c) location of any wells and other existing structures. 2. The outlet end of the tank and distribution box will need to be uncovered and property lines marked. After the tank is uncovered, property lines are marked and orange sign has been placed, you will need to call us at 910-893-7547 to let Environmental Health know that your site is ready for evaluation. 3. The system must be repaired within 30 days or the time set within receipt of a violation letter. By signing below, l certify that all of the above information is correct to the best of my knowledge. False information will result in the denial of the permit. The permit is subject to revocation if the site plan, intended use, or ownership change. nature Dishwasher ❑ Yes ❑.-No 411 I/P / /V HOMEOWNER INTERVIEW FORM It is important that you answer the following questions for our inspectors. Please do not leave any blanks if possible and answer all questions to the best of your ability. Thank you. Have you received a letter for a failing septic system from our office? [ J YES f NO Also, within the last 5 years have you completed an application for repair for this `site? [ ) YES [ J NO Installer Septic Tank Pumper Designer of System 1. Number of people who live in house? # adults # children # total 2. What is your average estimated daily water usage? Rallons/month or day county water If HCPU please give the name that the water bill is listed in? 3. If you have a garbage disposal, how often is used? [ j daily [ j weekly [ ] monthly 4. When was the septic tank last pumped? How often do you have it pumped? 5. If you have a dishwasher, how often do you use it? [ j daily [ ) every other day [ ) weekly 6. If you have a washing machine, how often do you use it? [ j daily [ ) every other day [ ) weekly [ ] monthly 7. Do you have a water softener or treatment system? [ j YES [ j NO Where does it drain? 8. Do you use an "in tank" toilet bowl sanitizer? [ ] YES [ j NO 9. Are you or any member in your family using long term prescription drug(s), antibiotics or chemotherapy? [ J YES [ ) NO If yes, please list 10. Do you put household cleaning chemicals down the drain? [ j YES [ ] NO If so, what kind? 11. Have you put any chemicals (paints, thinners, etc.) down the drain? [ ]YES [ j NO If yes, what kind? 12. Have you installed any water fixtures since your system has been installed? [ ) YES [ ) NO If yes, please list any additions including any spas, whirlpools, sinks, lavatories, bath/showers, toilets. 13. Do you have an underground lawn watering system? [ j YES [ j NO 14. Has any work been done to your structure since your initial move, such a roof, gutter drains, basement foundation drains, landscaping, etc? [ j YES [ ) NO If yes, please list 15. Are there any underground utilities on your lot? [ j YES [ j NO Please check all that apply [ ) Power [ j Phone [ ) Cable [ ] Gas [ ] Water 16. Describe what is happening when you have problems with your septic system and when was it first noticed. 17. Do you notice the problem as being patterned or linked to a specific event (i.e., wash clothes, heavy-rains, household guests)? [ j YES [ ] NO If yes, please list a rn i rnrn N~ IdiS193d uNn00 LL3NdVH S'SE 39Vd `96 H009 uVW WOdd HIHON a o m~ on tp n mm ~ oa FE 00 S~ 9ta cn N r Of d' 'a 00) 0 OD z~ z r Ca w W i-7 ~0 n a r7 d 01 J m 2 30 mo w w 14t o o In O N 1 I W cb INo fSl Od `ZLS 80 U) I 1OOJ3HV8 'O'0 ONV m 0° `d''- ~ S3000H 33l SIMOQ = ~ ao 00 I `a a I £6t 0d `91/ 80 WOd3 tr4'ZZtl f-- - M.,69,C OS a ~fi w wl w . ~ N m~ Oc(o Q ~ O"'u S02-01'47E N 6)" _ r N 217'91 ~3 } /i - o' 0 n 30' WIDE EASMEENT o v c o X30' WIDE EASMEENT o tiL. o N m 50.00 O co v) N0704'16"W N02'01'46 "W _ wT~~ ~ 644.32 217.91 m 7 m I ° w o > of U] w Q m 10 wl mW N ro r.. Q a ~n 4 ~ _ d'ILO }Q Fg n M aila a N ~ O zl L6 o o I c°a~ mF y w O Ko w ~ I ~ ~a v I w r ~ ~o V a=_ o`er -T_"-„o i an I 1 ~ `f I r a M~~i O I rN o I '0(2~ 3 I a K o m I o Q z v I oa ~a ~ m Hd co in I ~a T r ° I\ a n _ W O I J~-° ~o~. `n o0 I In I m` e I a _a I \ ~ ~ a rn _ II ~ ODO 30~ EASEMF~T -{~Zr Ma ~~o~\ I I 1 m I~ c~ ~ I - ~ M N I a N I +~4. p'Y` ( f * ~ l of °rn~ I v mho I tD I o4o IMI an ~ ~ J \ _'a o d M _ I-------~- - - 30' EA EMENT 'w w \ I \ ( w a I I I I I 31 N I .n I o :Ico I I Ir 1 g c _tIARNETT COUNTY HEALTH DFT - RTMENT ENVIRONMENTAL HEALTH S,-. TION N013707 OPERATIONS PERMIT Name: (owner) J1 cles► A5., 5 New Installation :'Nitrification e tic Tank Property Location: SR#_1 ~'~D "-u2 ❑ Repairs Line Subdivision ES L Lot # TAX ID# Quadrant Contractor: Zb~;Za/dRegistration # Basement with Plumbing: ❑ Garage: ❑ Water Supply: ❑ Well (Public ❑ Community Distance From Well: ft. Following are the specifications for the sewage disposal system on above captioned property. Type of system: Conventional ❑ Other Size of tank: Septic Tank: iz v gallons Pump Tank: gallons Subsurface No. of r - exact length width of depth of Drainage Field ditches / of each ditch 60 ft. ditches ft. ditches in. French Drain: Linear feet Date: ` U PERMIT NO. 16'9 75 Inspected by: nvironmental Health Specialist ,6 t o i ~ ~omr Fl HARNr`T COUNTY HEALTH DEPARTM ITT N0_ 7 IM~f~OVEMENT PERMI 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) New Installation Septic Tank Property Location: SR# Z~~/ f -f ❑ Repairs ~Nlitrification Line Subdivision Tax ID # Number of Bedrooms Proposed: Basement with Plumbing: Water Supply: ❑ Well Distance From Well: Following is the minimum specifications for sewage disposal system on above captioned property. Subject to final approval. Type of system: Conventional ❑ Other Size of tank: Septic Tank: 76 gallons Pump Tank: _ Subsurface No. of exact length width of Drainage Field ditches "t of each ditch e2 ft. ditches _ French Drain Required: gallons depth of - ft. ditches I~ in. Garage: ❑ ❑ Community ft. Linear feet n, r t Date: l This permit is subiect to -revocation if site plans(~r intended use change. Signed: L.. Environmental Health Specialist dPublic t'y 1 rte; Quadrant # Lot Size: / " , Lot # f L , t ' r " a/ - o//dad HA{` ETT COUNTY HEALTH DEPAI! `ZENT AUTHORIZATION TO CONSTRUCT Authorization is hereby given to construct a wastewater system to the specifications described by Harnett County Health Department Improvement Permit # /6V~ This authorization shall be valid for a period not to exceed five (5) years from the date of issuance. This authorization will be invalid if ownership, site plans, or intended use change. Owner or Authorized Agent Name: 6 fit= &2222~ Telephone # _1/-"• ' ? _ ft,! Address: -To ?=h" yzao I-A Do 10 ,N N C za334 Property Location: SR # I& Road Name New Installation 'Repair Septic Tank. a Nitrification Lines Lot # Subdivision Number of Bedrooms Proposed: 4 Lot size: Q-c-ce Basement With Plumbing Without Plumbing Water Supply: Well _ / _ Public Minimum Well Setback: 510' ft Type of System: Conventional Other Tank Volume: Septic Tank -17,~g_ gallons Pnmp Chamber gallons Nitrification Field Specifications Number of fields Z Number of Lines per Field q._ Length of lines / Gd Width of ditches ft. Depth of ditches 15"-Zb inches French Drain: Linear feet required Depth of gravel No wastewater system shall be covered or placed into use by any person until an inspection by the Harnett County Health Department has determined'that the system has been installed according to the conditions of the improvement permit and that a valid operations permit has been issued. Authorized Agent for Harnett County Health Department Name: Date: (Revised 2/96)crrsrxcr.wpn Initial Application Date: 4? Application #O1- s Ct ._4TY OF HARNETT LAND USE APPLICATIC l ~a l Planning Department 102 E. Front Street, Lillington, NC 27545 Phone: (910) 893-7525 Fax: (910) 893-279, fQ d LUnCLIA / LANDOWNER:. c/, j s S (//Qt,- Address: i00 + ~~b6 r r City: nn State: Zip: 833- Phone APPLICANT: ~lyd~Sfa.. l'k:ld~s' Address: City: .tn State: . Zip: 3/ Phone#: /~-Zo7-09?Y PROPERTY LOCATION: SR~1#: SR Name: ~ )tom! Parcel: Q~ - 15 3 6 - / 06-0 PIN: 3° 5 ✓sU g Zoning: F-A Subdivision: ~ 10~~ df Ne &//fte Lot -U Lot Size. Flood Plain: Panel: 1 Z.0 Watershed: - Deed Book/Pa e: /I g Plat Book/Page: DIRECTIONS TO THE PROPERTY FROM LILLINGTON: -{cam it 77 mac w.,z5 ~ 1 C4,00 a4 S-4~4+ (34 PROPOSED USE: (Le::~r`Sg. Family Dwelling (Size~x~ # of Bedrooms Basement Garage Deck _ Multi-Family Dwelling No. Units No. Bedrooms/Unit Manufactured Home (Size x_--) # of Bedrooms Garage Deck Comments: Lumber of persons per household Business Sq. Ft. Retail Space Type Industry Sq. Ft. Type Home Occupation (Size x__) # Rooms Use U Accessory Building (Size x__j Use Addition to Existing Building (Size xUse Other Water Supply: Cje~-tounty (__)Well (No. dwellings ) Other Sewer: (-J,~<eptic Tank/ Existing: YES (S-;) ( ) County Other Erosion & Sedimentation Control Plan Required? YES Qsiq~/) Structures on this tract of land: Single family dwellings Manufactured homes Other (specify) Property owner of this tract of land own land that contains a manufactured home w/in five hundred feet (500') of tract listed above? YES NO Required Property Line Setbacks: Minimum Actual Minimum Actual Front Rear r Side Corner ~b Nearest Building / r If permits are granted I agree to conform to all ordinances and the laws of the State of North Carolina regulating such work and the specifications or plan4o~ reby swear that the foregoing statements are accurate and correct to the best of my knowledge. • SignaDate te SITE/Su1L EVALUATION FOR ON-SIi ~ WASTEWATER APPLICANT NAME DATE FACTORS PROFILES 1 2 3 4 5 6 7 8 8 10 LANDSCAPE POSITION .1940 L L L Cam. SLOPE .1940 'L Z L IL HORIZON 1 DEPTH 12-0 o - -6 - S~ Texture Gro .1941(A)(1) L tL St- SL Consistence .1941 rilc 0f1-- ;r-rt- I-C. Structure .1941(A)(2) e;;.#C Mineralogy .1941 A 3 ASAP P AWP HORIZON 2 DEPTH 1 Z Y Z ' Z to Texture Group .1941(A)(1) L 5e- L $c t, SGT Consistence .1941 Apt #Cv'C. fs•L rx Structure .1941(A)(2) AW--oe- Minera!qff .1941(A)(3) P ASST' HORIZON 3 DEPTH (Z- Z ' 6- Texture Group .1941(A)(1) CL ce GL CL ec Consistence .1941 rsl. -'Z !g'L pjy- Structure .19411-All 2 Mineralogy .1941(A)(3) fP HORIZON 4 DEPTH Texture Group .1941 (N -m Consistence .1941 Structure .1941 A 2 Mineralogy .1941(A)(3) SOIL WETNESS .1942 RESTRICTIVE HORIZON .1944 SAPROUTE .1943/.1956 CLASSIFICATION .1948 s LONG TERM ACCEPTANCE RATE .1955 + ~t Requi DISTRICT QA 5E 5FD ."`Lire Setbacks #BEDROOMS Front - 35 Actual ZCJ side /L7 5 Corner `e Zon ng Ac nistrato Rear y Nearest Buikiino I l ~ WILLIAM JERRY NORRIS ~ 1 DB 1,309, PG 469 N89'46 ° * " ' ' " 58 E ER B N89 E N89 47 25 47 23 EI€' 486,27 200. RB 122.03 Z Pf~OP ! SE V r 41 `.J a I ...a 1.0; CR I Cr) I f SRB ?00, t S$9'47r ;N i L4 N 1200 V, ~ I INTGOMERY BALLARD SR, m 15.21. ACRES .ED FOUNDATIONS BIBLE COLLEGE" 6/25/99 'BY LAMBERT SURVEYING INC UJ , m am 1 0 M 6 - /y -4 J 1 N h l 1. 1 1 wJ MJ MR L 4, j Ld N Lt) 4> t~Id C,4 J U x ~ © ©I Z m ED BOOK 776, PAGE 193-194 { I 0 0 ACT TWO 31.218 ACRES 7,90 -ACRES i z © I 4'a ~ "A" to "A" "B" 586'15'00"E " " ' ' " 593.58' frorr ' ~'cra. cs to ( B 586 15 25 E fr 590.00 orr r