New Well ConstructionHARNETT DEPARTMENT OF PUBLIC HEALTH PERMIT
TO CONSTRUCT A DRINKING WATER SUPPLY WELL
PIN 0682-81-8721.000 Parcel 04 0682 6024 Application 11-5-27451 Subdivision: Pointers Creek
Applicant Name: David M Byrd & Pamela L Bvrd
Address: 17 Ouarterpole, Warrenton, VA 20186
Type of Facility Served by Well: SFD
Sewage System: 25% Reduction
Permit Conditions:
Lot 3
General Permit Conditions:
• Drinking water supply well construction must meet 15A NCAC 02C.100 rules
• The permitted drinking water supply well shall be located in accordance with the SITE PLAN
• ANY ALTERATION of the site of the site (including location of structures and appurtenance) or modification in use of the well, may
subject this Permit to revocation
At~~
Authorized State A
ate
61
Grouting Inspection Witnessed Date
❑ Grouting self-certified by driller GW-1 provided? ❑ Yes ❑ No
See attachment for construction sketch
WELL CERTIFICATE OF COMPLETION
Date: Application Well Contractor:
Applicant Name:
Address:
Directions to Site:
Use of Well: Date Drilled: Total Depth: Replacement Well? ❑ Yes ❑ No
Static Water Level: Top of Casing is in. above surface. Yield: gpm at ft.
Disinfection: Type Amount
Water Zone (depth)
From To
From To
From To
Inspector:
Remarks:
Casing
From To
Diameter: Material:
From To
Diameter: Material:
From To
Diameter: Material:
On Hold Date: Release Date:
Well Head Information
Casing Height: (above finished grade) Access Port:
Well ID Tag: Pump ID Tag: Sampling Tap: _
Sample Taken? ❑ Yes ❑ No Well Head properly sealed:
Remarks:
Grout
From 0 To
Thickness: Material: Method:
From To
Thickness: Material: Method:
From To
Thickness: Material: Method:
Authorized State Agent Date
Vent Stack:
Backflow Preventer:
See Attachment for completion sketch
Application #:11-5-27451 Applicant Name: David M Byrd& Pamela L Byrd Subdivision: Pointers Creek Lot 3
Well Construction Sketch
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Well Completion Sketch
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Harnett County Department of Public Health
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Well Consti uction Pei m1t Application
11 the Information in the application for a Well Construction Permit is falcrfied
chained it the we i% alleied then the Wdl Construction Permit shall become
im alid
APPLICANT INFORMATION
pave M Pwrj A Pamela L TNrrd (540 ) 9.1?- 2361
appllL,1110Oiili; ner Phone Number
I___Q1~Gt Yf r pofe, W a r rGn-l-on , vA 20) $1v
Strcet Address, ON, State Zip Code
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Contact Information En%Ironmcntal Health Dn ision - 910 893-7517
PROPERTY INFORMATION
Proposed use of v%ell
Sint le rainiki-V MultItamlly 1 C11LIlCII - Restlttiant i Business - IIII~(Tatlon
Sticet Adtl csti {i01►~1i'EV aLet pprive. Subdii ist n/Lot
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fi r.---~ Parcel 9 191 JA97 b~ PIN #
Directions to the Site
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Driving Directions from Lilo-- North Carolina to Nc-55, Angier, N,-- 'arolma 275 Page 1 of 1
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Lilltngton, NC -
Miles Per
Miles
e
.
Section
Driven
e
1 Start out going northeast on S Main St I US-421 N I US-401 N I NC
Go 16 Mi
1 5 mi
27 E I NC-210 E toward E Harnett St
2 Turn right onto US-421 S 1 NC-27 E
Go 3 4 Mi
4 9 mi
US 421 S is 0 2 miles past Parker Ln
If you reach Pine State St you ve gone about 0 2 miles too far
4
3 Turn left onto Leslie Campbell Ave
Go 2 0 Mi
6 8 mi
1
Leslie Campbell Ave is 0 2 miles past Johnson Farm Rd
If you reach Wade Stewart Cir you ve gone about 0 3 miles too far
T~
4 Leslie Campbell Ave becomes NC-27 -
Go 2 4 MI
9 2 mi
41 5 Turn left onto N McKinley St I NC-55 Continue to follow NC45 -
✓ NC 55
t
N C
Go 3 7 Mi j 12 9 mi
isjus
past
ame St
If you are on E Stewart St and reach N RAILROAD St you ve gone a little too far
8 NC-65
12 9 mi
Yourdeshnation is/ust past Creature Meadow Ln
If you reach Colby Ln you ve gone a We too far
AM h Nc-55 - - - -
Angler, NC 27501
12 9 mi 12 9 mi
35 460703 -78 696136
(Address is approximate)
Total Travel Estimate 12 88 miles - about 18 minutes
02011 MapQuest Inc Use of direcbons and maps is subject to the MapOuest Terris of Use We make no guarantee of the accwacy of their
content road conditions or route usability You assume all dsk of use View Terms of Use
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Pointei ( r,-Lk ( IrdLt -1) off tit HIN-t -)D I imett (Mint) \orth C -irolina
Den Ott ',t inch
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111t. puIpOSC Ot t11L lm e,pgation %,~as to dLt imine if Stu[ Met(, acceptable. tot I
Sub uitac, oasie di,posdl s-St2nl tu,LrlL alliupoud Single famih Iesuiuitt (3 hediounl
iloniL) All ratings Intl demminatiom, Aer( made In aetoidinLe with' T atvs old Ruh.,
tow 5 snit tix Se%Aapc Collection Ti- ItmLllt ai d Di~pw tl 15 k IBC ~C 18A 1900
V List one ,Ice \,4 i, IoLated ot1 tht. tiact Lontaining 6oiI, that ha\,c protiiSionalh SUitahlt
pt,lprrtiL, eNLeeding ;G InLlles lh,- Sift zss~nu ill} Tics o1 a 111iL& ,10PL --1°0)
1 in"clpL Soil boring,, conducted in most of tats aita Lonsisttd of 12 or more wi-' e, tit
loijv, ,and unctCrlaul b, sind% Ll tN 101111 -\WndinL to 10 of mote, niche, Srnl 1 et1IeS,
LIMI oI {1IItnt m tlemil (gtratet th In "l0°~) `tttS t4plLa11\ t+h Lnvcd greats r than 3? indie',
bLltn the, 1011 sill f itL A i othti ,oil ch li 1(.tLri,OL, acre elthu suitiblL or pimisionalh
VL 1111t it) at Last ^6 ind1r-,
r31,Ld ,zi ,o I burin-, ind ,itr t o,ichlions rh, site \,,ould ht dt,i(7na*Ld prtn isionalh
AM 1111L lot u Sh 1110%4 Lonventiunal "Ub UrfatL wd,Te dispt), if S},tLnl (dLpeuding on
boost loL itiun ma\ lequirL lhL USL of llumpS fill I1uIO, q e diainlim Lt(- ) The ,iIL
tintlin, etlnu~h l,itl~ision ill-, ,,utiblL aiL i 1, rLquirLd to lllo L loi subsuifact ,ep ur,
(i tai tLquirL ,«tcnaS mL'ltitnltd) \ m 11) z hovtin, thr approximate IOL-10011 OI thL aitC
aLLompanlcs thi, report (hlue ilag17,,ng, n ht fide iLprL,,tnts actual lotationi Note. No
grading ruttintl or other soil distut h ince a In OLLUi in this tic i pi for to obt lining n
pei nut from the ll ii nett ( ounta Health Dctlartmeiit Any ,it adintr without a permit
c in ifter the findings of this rt port 1
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Potential Septic Areas - Pointer Creek (Tract 3)
Harnett County, NC
0 C ~r ~iC.t'1 ta~ 5 ft+t a ~~rfs ("fAYt~ (anw l~4 fK t om; Sal l
JS S ate °Ia! 9383 1
N,rm C.rol!na 3200 bca e 1 5 000 POINTER 3 SSF
NAD 1083 (ConuS) N 0 bo0 0 81 6/2011
A F- K - 3P P.
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a eJ.
E r -it u,,! :)r, S-!L °r r ic. ! iLfw 5 lli 7 U-E/SLSDIV SIr4 PLANNING
` L ' N ~ ~ L ~ ~ T E-TA cd ~(S7MS EVALUATION $ DESISh
NA,N,, Davi Nd m t'c~ APPLICATION # ~S ~10 ~7 ~;7/
Pamela L
This ~p IIC1tlon to bt, filled out when tpphing fot t st:ptte system Inspection
Count% Health Dcpai tment APPIlLation foi Imps ovement Pet mit and/oi Fluthoi ization to Constt uct
II rHE I\ FORNI ATION IV THIS APPLICATION IS FALSIFIED CHANGLD OR I HE SITI IS AL rEKED f HEN THE INIPROVEMEM
PLRNI11 OR At1TiIORIZA I ION TOCONSIRDCTSH \LL BECOIIF I NV A[ ID Ilit, pumit 1, t the tot ctill, 1 60 numths of ttttlitiut t.\pn it ion
dt puldul upon dtiutnlcnl turn uhnutt,d (Contplt.tt ,ilL pl ut = h0 n)nnths CnmpiLtLpl u = tt tihtiut cvpu cu(In)
910 S91 752-) option I CONFIRNIATION
✓ Environmental Health New Septic Syste Code 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 sod
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 reauest
• 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 to place (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
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
tit PI Ic.
11 lppit 111_ 101 unh0n/ 111011 its Lonstiuct pie Ise mdit tie des11ed svstem r%pe(s) L u) be t Inked to oidet of pieteieni a Must LIIOOsL tine
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Aliuntust. (_IOthet
TILL iphliL utt sh ill 110(1h thL loc It ht. Ilth dLp uuttent upon submttt tl of this IPPI1LItton It Inv of the tollollnt,_ tppl) to LIIL P10I)Lits III
yticsUOn If (ht. utsllt:I Is st.S tpphc int MUST ATTACH SUPPORTING DOCU\ILNTATION
1-1) ES (i/) NO DOLL the SHL cont. un utI Juitsdittion,tl Wed Inds'
IL/ Il I S 1_1 NO D0 volt pl to to h I%L 111 1111,111011 s tt.n nosy of III tht. (t11111t,
{_;l FS (_I NO Dot S 01 Is 111 tits buildtn, uxrtvn ills di tins' Pic Isl. t.Xpl tin
i NO AIL that. tin LXISttit= Iscils spi111; s is laI IIIILS 01 W 1Stt.w ttt.t Svstems an this pioputs'
I l ES ;JL) NO Is tit) w tstt" tat join, to bL 011-1 ILLd on the silt, othei th tit doIIlLStlc sLw Int.'
(_I) ES 11/1 NO Is the SI(L subit.ct to ippim it bs IIIS othd PubIlL A,uu.s'
i ✓Il Es NO Att, IIILIc im E tsements o1 Right 01 W iss on this piopt.ity'
1_11 t. 5 (✓I NO Dot the SILL cunt 1111 utv L\isttnt~ is ILLI clbli. phone o1 undciMound t.h.euic titles'
11 ',LS pit.ISL c Ill No Cuts it 800 6)2 4949 to logy tit. tit. hnt.s This is t IILL SLI s ict.
I H M. Rt td 1111% apple Itton %nd Ccrtth I'll It 1111. Intorm Ition Pi o% idLd Het Lin Is I rue Complete and Cot ret t Authorised Counts %nd
M Iii. 011m its \rc C r inted RIB ht Of I lift I 10 Con(tuct Net.OSS 11 s InspectwnS 10 DLtei nine Comph tnce With Apphc Ible I I%% s and Rldcs
I Undu st Ind I h it I ant bolth Responsibic hor I he Pt Opel I(knutic Ition Ind L ibein% Of All Propertl I Ines and Cornets UId \I Wit,.
I IIL Sn( kL^sible So I It it 1 Conplete Aile I I iluyktion C in ReRe1 tot
PROPFIZI 1 OWNrRS OR
I EGAI RFPRFsrNTkI IN E
lelt _2011
A fURI (RLQUIRI D) Da T
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