IPAC-RepairHTE# V, .,9 ,)A- Harnett county Department of Public Heaftn
Improvement Permit 2 6 6 8 2
A building permit cannot be issued with only an Improvement Permit
PROPERTY LOCATION: Po tsZ&W5~
ISSUED T0: l_ pfd st v )Up.tZS IN SUBDIVISION C bcLoLl nt p~ S _ ON S LOT # 91
NEW ❑ REPAIRS( EX SION ❑ Site Improvements required prior to Construction Authorization Issuance:
Type of Structure: 5'F0 (5 x LA )
Proposed Wastewater System Type: --G °/ov
Projected Daily Flow: 3 4 O GPD
Number of bedrooms: 3 Number of Occupants: max
Basement ❑Yes ';I!~No
Pump Required: ❑Yes -~S No ❑ May be required based on final location and elevations of facilities
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet Permit valid for: -)<Zve years
Permit conditions:
❑ No expiration
Authorized State Agent:: QE.r15 Date: ~ LO 1~ SEE ATTACHED SITE SKETCH
The issuance of this permit by the ~tepartrn ent in n o way guaran~the e of other permits. The permit hold is r ponsible 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 Impr nt 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
(Rewired for Building Permit
The construction and installation requirements of Rules .1950, .1952, .1954, .1955, .1956, .1951, .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 T0: L^~' a N g y A iJ S LNG PROPERTY LOCATION: ~oND
oSA
SUBDIVISION QA-oL, r~;,,, 511'- N5;6
N 5,
Facility Type: _5 (j - ❑ New ❑ Expansion ,IR~ Repair LOT # 2-CH
Basement? ❑ Yes -mil No Basement Fixtures? ❑ Yes AND Type of Wastewater System** (Initial) Wastewater Flow: 3 C 6
(See note below, if applicable GPD
AS% 2C5i)vc;1;0 0 N 5 15 1 LS" (Repair)
Installation Requirements/Conditions Number of trenches t
Septic Tank Size o C5 O gallons Exact length of each trench ► S0 feet Trench Spacing:
Pump Tank Size Feet on tenter
P gallons Trenches shall be installed on contour at a Soil Cover: 1a--atj inches
Maximum Trench Depth of: 2~- -3-6 inches (Maximum soil cover shall not exceed
(Trench bottoms shall be level to +1-114" 36" above the trench bottom)
in all directions)
Pump Requirements: ft. TDH vs. GPM
inches below pipe
Conditions: Aggregate Depth: inches above pipe
inches total
WATER LINES (INCLUDING IRRIGATION) MUST BE ]OFT. FROM ANY PART OF SEPTIC SYSTEM OR REPAIR AREA.
NO UTILITIES ALLOWED IN INITIAL OR REPAIR DRAIN FIELD AREA.
**If applicable: /understand the system type .specified is different from the type specified on the app/icatiom / accept the specilcationr of this permit
Owner/Legal Representativ ature:
Date:
This Construction Authorization is subject to revocati ' the site plat, or the intended use changes. The Construction Authorization shall not be transferred when there is a change in ownership of the site. This
Construction Authorization is subject t compliance the n o Laws and Rules for Sewage Treatment and Disposal and to the conditions of this permit SEE ATTACHED SITE SKETCH
Authorized State Agent: ~S Date: '8 > 0
Co on Authorization Expiration Date: 1 )6
7414/
HTE# Permit #
Harnett County Department of Public Health
Site Sketch
PROPERTY LOCATON: Po„SpEX2-0SA I Z
ISSUED T0: SUBDIVISION CWZ.01-\N!N
LOT #
1\~~ ~pL, l
Authorized State Agent: v EIS -~vti~cs0os~ Date: S l0I
G Q,Ga v L-.\ O KS VrL-
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH SECTION
307 W. CORNELIUS HARNETT BLVD.
LILLINGTON, NC 27546
910-893-7547 PHONE
910-893-9371 FAX
Application for Repair
EMAIL ADDRESS: / Q w A'IrirR, ;
NAMEL\,/ON PHONE NUMBER 3S3 0-97()
PHYSICAL ADDRESS 9_ CTr r¢ e.~ '-%w
MAILING ADDRESS (IF DIFFFERENT THAN PHYSICAL)
[ j Mobile Home
IF RENTING, LEASING, ETC., LIST PROPERTY OWNER NAME
SUBDIVISION NAME
Type of Dwelling: [ j Modular
Number of bedrooms
Garage: Yes Who [I
Water Supply: [ j Private Well
Directions from Lillington to your site:
[ j Basement
~rA40V A
STATE RD/HWY
Z
4: ~-X3 G 2
A* W
SIZE OF LOT/TRACT
[q'<tick built [ j Other
Dishwasher: Yes [ j No [
[ j Community System
N
L- ~ -t, if- S ry _
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 mao" and "deed to your property" must be attached to this application. Please inform us of any
wells on the property by showing on your survey map.
2. The outlet end of the tank and the distribution box will need to be uncovered and property lines flagged. After the tank is
uncovered, property lines flagged, underground utilities marked, and the orange sign has been placed, you will need to call
us at 910-893-7547 to confirm that your site is ready for evaluation.
Your system must be repaired within 30 days of issuance of the Improvement Permit or the time set within receipt of a violation
letter. (Whichever is applicable.)
By signing below, I 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 changes.
i
4-Y-/ - / /
Date
LOT #/TRACT #
[V(Sunty
Garbage Disposal: Yes [ j No [ j
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 violation letter for a failing system from our office? [ ] YES [(NO
Also, within the last 5 years have you completed an application for repair for this site? [ ] YES ( q-*O
Year home was built (or year of septic tank installation) 200
Installer of system "rz ' ot%.%A.•/ C. I OA-y
Septic Tank Pumper
Designer of System -p;i».
1. Number of people who live in house? # adults # children # total
2. What is your average estimated daily water usage? gallons/month or day county
water. If HCPU please give the name the bill is listed in (Lc,.~'~ (a e,,n,, rN s S' I- &A)
3. If you have a garbage disposal, how often is it used? [ ] daily [ ] 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? [ ] daily [ ] every other day
6. If you have a washing machine, how often do you use it? [ ] daily every other day [ ] weekly [
7. Do you have a water softener or treatment system? [ ] YES [ ] NO Where does it drain?
8. Do you use an "in tank" toilet bowl sanitizer? [ ] YES [ ] NO
9. Are you or any member in your household using longterm prescription drugs, antibiotics or
chemotherapy?] [ ] YES [ ] NO If yes please list
10. Do you put household cleaning chemicals down the drain? [ ] YES [ ] NO If so, what kind?
] weekly
J monthly
11. Have you put any chemicals (paints, thinners, etc.) down the drain? [ ] YES [ ] NO
12. Have you installed any water fixtures since your system has been installed? YES [ ] NO If yes,
please list any additions including any spas, whirlpool, sinks, lavatories, bath/showers, toilets
13. Do you have an underground lawn watering system? [ ] YES [ ] NO
14. Has any work been done to your structure since the initial move into your home such as, a roof, gutter
drains, basement foundation drains, landscaping, etc? If yes, please list
15. Are there any underground utilities on your lot? Please check all that apply:
[ ] Power [ ] Phone [ ] Cable [ ] Gas Water
16. Describe what is happening when you are having problems with your s=%It ystem, and when was this
first noticed? j
Qii V 4 r/ ~~t W e v w
k c-A-j 4. c u •e
17. Do you notice the proble s being patterned or linked to specific event (i.e., wash clothes, heavy
rains, and household guests?) [ ] YES [ ] NO If Yes, please list
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Department of Environment, Health and Natural Resources
Division of Environmental Health
On-Site Wastewater Section
SOIL/SITE EVALUATION
for ON-SITE WASTEWATER SYSTEM
Owner: Applicant:
Address: Date Evaluated:
Proposed Facility: 3 g6DQM M Design Flow (.1949): 5/,0 bcl
Location of Site: Property Recorded:
Water Supply: Public ❑ Individual ❑ Well
Evaluation Method: Auger Boring ❑ Pit ❑
Type of Wastewater: Sewage ❑ Industrial Process ❑
Sheet:
Property ID:
Lot
File
Code:
Property Size:
❑ Spring ❑ Other
Cut
Mixed
P
R
O
F
1
1940
OIL MORPHOLOGY
.1941
THER
PROFILE FACTORS
L
E
#
Landscape
Position/
Slope
Horizon
Depth
(In.)
.1941
Structure/
Texture
.1941
Consistence
Minemlo
.1942
Soil
wetness!
Cola
.1943
Soil
Depth IN.
.1956
Sapro
Class
.1944
ReW
Horiz
Profile
Class
LTAR
Site
Other Factors (.1946):
Site Classification (.1948):
Evaluated By: °K
Others Present: