LAND USE Initial Application Date:,/ Application # 8 5 Z(9 24
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COUNTY OF HARNETT RESIDENTIAL LAND USE APPLICATION
Central Permitting 108 E. Front Street, Lillirigton, NC 27546 Phone: (910) 893 -7525 Fax: (910)) -2793 www.harnett.orglpermits
LANDOWNER: goril £2i/,q 412 or c Mailing Address: 7 Z /y 1d/.7.r' s kca
City: / ,' /// .7� /on state:NC Zip:275 # 9/0 - 2' ` � / 6 920Email: /
APPLIC T'AN /��/ /yn l�4L[/n� ^P Mailing Address: �79Y /Y �/a A?.t /f r' /
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City. / / , fdin State/2/r, Zip:a 753/6--Contact /
Contact # //l3 - O ! / - 672o Email:
'please fill out appllca information it different than landowner
CONTACT NAME APPLYING IN OFFICE : A i / Phone # / I - 2O p2 - O yo 6
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PROPERTY LOCATION: Subdivision: I ,/ /1//) c- L o t # : S Lot Size: /!'
State Road # a 0 /7 State Road Name: // 6/Q/� C "9/, ,['"' 7 Map Book & P D/ 0 , O Sot
Parcel: JO O ,S� f 0 0 7/ 0i PIN: t'/ 6 — J (G, — I� / / / �r 'o
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Zoning /Q/9' Flood Zone: / / /IDeedBook& Page: 2W2 - 7 /' ie ems
•New structures with Progress Energy as service provider need to supply premise number ,�// .77149 / from Progress Energy.
SPECIFIC DIRECTIONS TO THE PROPERTY FROM LILLINGTON: .r�L y r /7 -5� 6
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PROPOSED IISE: Monolithic
❑ SFD: (Size . x , ... ) # Bedrooms:__ # Baths:- Basement(w /wo bath):_ Garage:_ Deck:_ Crawl Space:_ Slab:_ Slab:_
(Is the bonus room finished? (_) yes (_)no wI a closet? (_) yes ( )no (if yes add in with # bedrooms)
Mod: (Size 2? x5;6" ># Bedrooms # Baths Basement (w/wo bath)_ Garage:_ Site Built Deck:_ On Frame Off Frame kr
(Is the second floor finished? (_,) yes (_)no Any other site built additions? (___) yes (_)no
❑ Manufactured Home: _SW _DW _TW (Size _x 1 # Bedrooms: _ Garage: (site built ?_) Deck: (site built? )
❑ Duplex: (Size x ) No. Buildings: No. Bedrooms Per Unit:
❑ Home Occupation. # Rooms: Use: Hours of Operation: #Employees:
❑ Addition /Accessory /Other: (Size _x ) Use: Closets in addition? ( ) yes ( )no
Water Supply 1s / County _ Existing Well _ New Well (# of dwellings using well ) 'MUST have operable water before final
Sewage Supply. Y New Septic Tank (Complete Checklist) Existing Septic Tank (Complete Checklist) County Sewer �
Does owner of This tract of land, own land that contains a manufactured home within five hundred feet (500') of tract listed above? (__) yes (_y)no
Structures (existing or proposed): Single family dwellings: Manufactured Homes: Other (specify):
Required Residential Property Line Setbacks: Comments: L
Front Minimum 3.7 / Actual / n n / , a `/ /T p /^r /1 / q //
Rear z5 / ITr 717e2st/ce_rn &ntc t /acatidr,f.
Closest Side /0 ' n /?1 g r c r ' t y (0/170
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Sides n, ,Olc)�c
beellcorner lot �' /
Nearest Building
on same lot
It permits are granted I agree to conform to all ordinances and laws of the State of North Carolina regulating such work and the specifications of plans submitted.
I hereby slate that foregoing statements are accurate and correct to the best of my knowledge. Permit subject to revocation if false information is provided.
ature of O ..11;
er or Owner's Age . - Date
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This application expires 6 months from the Initial date If permits have not been issued
A RECORDED SURVEY MAP, RECORDED DEED (OR OFFER TO PURCHASE) AND PLAT ARE REQUIRED WHEN APPLYING FOR LAND USE APPLICATION
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NA N1 E: pzr(xCj /74 ideNsi/1 of rs APPLICATION #: {i � 2I/`_ U O'"t'J
*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
I F ME INFORMATION IN THIS APPLICATION IS FALSIFIED, CFIANGED, 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 #
N/ Environmental Health New Septic System Code 8 00
• All property irons must be made v IsIble. Place "pink p roperty flags" o n each corner i ron 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 En vironmental 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.
D Environmental Health Existing Tank Inspections Cod e 800
• Follow above instructions for placing flags and card on property.
• Prepare for inspection by removing soil over over outlet end as diagram indicates, and lift lid straight up (if
possible) and then close back down. (Unless inspection is for a septic tank in a mobile home park)
• After uncovering outlet end call the voice permitting system at 910 -893 -7525 option 1 & select notification permit if
multiple permits, then u se code 800 for Environmental Health ins pection. Please n ote c onfirmation number
given at end of recording for proof of request.
• Use Click2Gov or IVR to hear results. Once approved, proceed to Central Permitting for remaining permits.
SEPTIC
It apply ine fm authorization to construct please indicate desired system type(s): can be ranked in order of preference, must choose one.
} Accepted {} Innovative {V Conventional {_} Any
' Alternative {_} Other
The applicant shall notify the local health department upon submittal of this application if any of the following apply to the property in
question. If the answer is "yes ", applicant must attach supporting documentation.
{ I YES { v(NO Does the site contain any Jurisdictional Wetlands?
{; YES I Vi NO Do you plan to have an jg zTation systain now or in the future?
I;1'LS I'!TNO Does or will the building contain any drains? Please explain.
YIi VINO Are there any existing wells, springs, waterlines or Wastewater Systems on this property?
YES { V} ! NO Is any wastewater going to be generated on the site other than domestic sewage?
; YES { VNO Is the site subject to approval by any other Public Agency?
_I YES I t!} NO Are there any Easements or Right of Ways on this property?
;YES Does the site contain any existing water, cable, phone or underground electric lines?
If yes please call No Cuts at 800 - 632 -4949 to locate the lines. This is a free service
I l b w e Read This Application And Certify That The Information Provided Herein Is T)ve, Complete And Correct. Authorized County And
State Officials Arc Granted Right Of Entry To Conduct Necessary Inspections To Determine Compliance With Applicable Laws And Rules.
11nderstand That I Am Solely Responsible For The Proper Identification And Labeling Of All Property Lines And Corners And Making
The Site Accessible So That A Complete Site Evaluation Can Be Performed.
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I'ROPF' N' OW / E / R O WNE LEGAL REPRESENTATIVE SIGNATURE (REQUIRED) ATE
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HAL OWEN & ASSOCIATES, INC.
SOIL & ENVIRONMENTAL SCIENTISTS
P.O. Box 400, 266 Old Coats Road
Lillington, NC 27546 -0400
Phone (910) 893 -8743 / Fax (910) 893 -3594
www.halowensoil.com
8 December, 2010
Mr. Mickey Bennett
Bennett Surveys, Inc.
1662 Clark Road
Lillington, NC 27546
Reference: Final Report for Comprehensive Soil Investigation
Marilyn Dawn Rogers Property — 1.50 Acres
Dear Mr. Bennett,
A comprehensive soil investigation has been conducted at the above referenced property,
located on the southern side of Adams Road (SR 2017), Lillington Township, Harnett County,
North Carolina. The purpose of the investigation was to determine the ability of this lot to
support a subsurface sewage waste disposal system and repair area for a typical three- bedroom
home. All soil ratings and determinations were made in accordance with "Laws and Rules for
Sewage Treatment and Disposal Systems, 15A NCAC 18A .1900 ". It is my understanding that
an individual septic system and public water supply will be utilized at this site. The maximum
house footprint used for this evaluation was 50 X 60 feet. Wetlands were not present on the
property.
This lot was observed to be underlain by a mixture of soils that range from provisionally
suitable for conventional systems to unsuitable for subsurface sewage waste disposal (see
attached map). The provisionally suitable soils were observed to be firm clay loams to greater
than 30 inches and appear adequate to support long term acceptance rates of 0.3 gal(day /sgfi.
The soils shown as provisionally suitable for modified or alternative systems also had firm clay
loam subsoils but were limited in the 24 to 30 inch zone below surface by soil wetness
conditions. These soils appear adequate to support long term acceptance rates of 0.25 to 0.3
gal/day/sqft. for ultra shallow conventional drainlines. It appears that the soils on this lot are
adequate to support a conventional septic system and repair area for one residence.
This soil investigation report and map, when provided to the Harnett County Health
Department, should allow them to sign the maps for recordation. I appreciate the opportunity to
provide this service and hope to be allowed to assist you again in the future. If you have any
questions or need additional information, please contact me at your convenience.
Sincerely,
/ / y
C) • -. ViNt
f ./ " .
i
Hal Owen � • z f „
Licensed Soil Scientist
(A t
Soil Science Investigations • Wetland Delineations, Permitting, and Consulting
t-'repareu oy.
s 1 Hal Owen & Associates, inc. 4 �
�x PKN CL INTERSECTION OF Soit & Environmental Scientist
NCSR tl 201692969 P.O. Box 400. Liltington, NC 27546
in
Ph (910)893 -8743 Fax (910)893 -35
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9 r All distances are Paced
0 , and Approximate.
NOS'. 5511413'E � '9 ,�..
1 51 8 1 oNCS _ _ _ 9
90.5 � — G8 18'
of
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55�
m I i ,, Provisionally Suitable Soil
1.50 AC TOTAL
W i - 0.14 AC Riwj r Provisionally Suitable Soil ki
11, o . 36 A C TI i " t _ .` 3
For Modified Or Alternative System
s. y Unsuitable Soil 1 '
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MInIMUM BUILDING SET BACKS Ij l
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SIDE LOT S O T
CORNER LOT SWE YARD 00'
HELEN M ROGERS MMIMIN HEIGHT 15'
.
DO 1998.PG 821
PLAT CAB. F.SLIDE - 687-A r /� ,r
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DEED REFERENCE: DEED BK 1998,PAGE 8 1
MAP REFERENCE PLAT CAB.F,SLIDE - 6877A
OWNER: HELEN M. ROGERS
4019 CLINTON RD
FAYETTEVILLE,NC 28301
810308 -0879
MINOR 5)0 I
- -` suaveYFOR:
BENNETT SURVEYS,INC. c -loco
MARILYN DAWN ROGERS 1662 CLARK RD..LILLINGTON,N. 27546
19101 893.5252
_ _ FIELD BOOK
I _ HARNETT 3I I 60 I SURVEYED BV'. JRM I DC 81
_1ATE NORTH CAROLINA
TOWNSHIP I
1GWNS
DRAWN BY: RVB DRAWING NO.
. — 1 I DATE - SCALE D. 60'
: '.
F TAY PARCEL I 10506 —i
Bone rv.mnsn[D LEE CHECKED 6 CLOSURE BY: RVB 1 —
R ___
11111 Ell I11 1111111111
2011000843
FOR REGISTRATION REGISTER OF DEEDS
KIMBERLY S. HARGROVE
HARNETT COUNTY TAX lay 2011 J AN 1 9 11 AM
- 007 l ., fie r
BK:2828 PG:477 -479 FEE:$22.00
- - - -- INSTRUMENT # 2011000845
1 w� :-.i- �. -air YiJ
This Deed Prepared by Reginald 13. Kelly, Attorney at Law , P.O. Box 1118; Lillington, NC
PID#:100569 0071 05
NO TITLE CERTIFICATION
REVENUE STAMPS: -0-
STATE OF NORTH CAROLINA WARRANTY
COUNTY OF HARNETT DEED
This WARRANTY DEED is made the Ilth day of January, 2011, by and between
Walter Edgerton Rogers and wife, Helen M. Rogers, of 4019 Clinton Road, Fayetteville, NC
28312 (hereinafter referred to in the neuter singular as "the Grantor ") and Marilyn Dawn
Rogers of PO Box 636, Lillington, NC 27546 (hereinafter referred to in the neuter singular as
"the Grantee ");
WITNESSETH:
THAT said Grantor, for valuable consideration, receipt of which is hereby
acknowledged, has given, granted, bargained, sold and conveyed, and by these presents does
hereby give, grant, bargain, sell and convey unto said Grantee, its heirs, successors,
administrators and assigns, all of that certain piece, parcel or tract of land situate, lying and
being in Lillington Township of said County and State, and more particularly described as
follows:
BEING ALL OF TRACT 145, CONTAINING 1.50 ACRES TOTAL (0.14
ACRE IN ROAD RIGHT OF WAY) LEAVING A NET OF 1.36 ACRES AS
SHOWN ON MAP ENTITLED SURVEY FOR: "MARILYN DAWN ROGERS ",
DATED DECEMBER 8, 2010, BY MICKEY R. BENNETT, PLS AND
RECORDED IN MAP NUMBER 2010 -852, HARNETT COUNTY REGISTRY.
For further reference to chain of title see Book 1998, Page 821, Harnett County
Registry.
* *The property herein described is () or is not (X) the primary residence of the
Grantor (NCGS 105- 317.2)
TO HAVE AND TO HOLD the above - described lands and premises, together with all
appurtenances thereunto belonging, or in anywise appertaining, unto the Grantee, its heirs,
successors, administrators and assigns forever, but subject always, however ,to the limitations
set out above.
AND the said Grantor covenants to and with said Grantee, its heirs, successors,
administrators and assigns that it is lawfully seized in fee simple of said lands and premises,
and has full right and power to convey the same to the Grantee in fee simple (but subject,
however, to the limitations set out above) and that said lands and premises are free from any
and all encumbrances, except as set forth above, and that it will, and its heirs, successors,
administrators and assigns shall forever warrant and defend the title to the same lands and
premises. together with the appurtenances thereunto appertaining, unto the Grantee, its heirs,
successors, administrators and assigns against the lawful claims of all persons whomsoever.
IN WITNESS WHEREOF, the Grantor has hereunto set its hand and seal and does
adopt the printed word "SEAL" beside its name as its lawful seal.
GRAN
�
.7o / g'' ti (SEAL)
Walter Edgerton Roge 's
%.jI1 n 1 le OZ:le (SEAL)
Helen M. Rogers
STATE OF NC.
COUNTY OF Hrirneit
1. a Notary Public of the County and State aforesaid, certify that Walter Edgerton Rogers and
wife, Helen M. Rogers personally appeared before me this day and acknowledged the due
execution of the foregoing instrument.
Witness my hand and official seal, this !/ day of 44.1 2011.
(notarial a APRIL M. McLAP4s
NOTARY PUBLIC
HARNETT COUNTY, N s
My Commissio Expires -77 - ;Z c ..1 Notary Public
My Commission Expires: 7 J - 1/