Butler (3)

CERTIFICATION OF EXEMPTION
FROM REQUIRING A CAMA PERMIT
as authorized by the State of North Carolina,
Department of Environment, Health, and Natural Resources and the Coastal Resources Commission
in an area of environmental concern pursuant to 15 NCAC Subchapter 7K .0203.
Applicant Name ( LA t U t l c-,r- Phone Number
Address Cu I `- Uri i I delf i ut
City a ; State kJ Li Zip 2 2-2(p
Project Location (County, State Road, Water Body, etc.) c u r - ) , ( k-- C c�wY.*Ut , 3 S'
U Airr\r� n�+-o Id r� -1-Co Ad , U A-r ryi rr (AA) LQ ckuJ xi rJl 11
Type and Dimensions of Project p\ c e-rNC-r.-} 0 F- err\ K t +`n 5 Q P:1C/ .395-k—M
f n o r *k r, 140 ' f ern rye-,�-r\ h i c}I,, Li A t-c-f' b L.,ctt-- 1-� n d
* . 1n \cfE p,n LA) I+1,\ �f �t '(^� S �J ,C (()u-\+1 #� I 1 . �U (�
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The proposed project to be located and constructed as described This certification of exemption from requiring a CAMA permit is
above is hereby certified as exempt from the CAMA permit re- valid for 90 days from the date of issuance. Following expiration,
quirement pursuant to 15 NCAC 7K .0203. This exemption to a re-examination of the project and project site may be necessary
CAMA permit requirements does not alleviate the necessity of to continue this certification.
your obtaining any other State, Federal,or Local authorization.
SKETCH (SCALE:
b-‘0 eft+ to o d u c� fps 0L,(4 v d u n
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wor - i s 1 i 0 tJe CI oSc C "4\ A-n 401 +(, -HA
x f S{- nc' b 1 P o m h h (A.)14 .
Any person who proceeds with a development without the con- .01141h, 1
sent of a CAMA official under the mistaken assumption that the Applicant's signature
development is exempted,will be in violation of the CAMA if there
is a subsequent determination that a permit was required for the
development. ( CAM Official's signs ure ,
The applicant certifies by signing this exemption that (1)the ap- I
Issuing date
plicant has read and will abide by the conditions of this exemp-
tion,and(2)a written statement has been obtained from adjacent ( � ! v
landowners certifying that they have no objections to the Expiration date
proposed work.
Attachment: 15 North Carolina Administrative Code 7K.0203

43
•
8rainswick County Health Department Application #13/,-" 0
Environmental Health Section Tax Parcel#*P" .`17 Ott At.
Alternative Sewage Treatment and Disposal System System Type—5A
AUTHORIZATION TO CONSTRUCT
FOR
WASTEWATER COLLECTION,TREATMENT,AND DISPOSAL SYSTEM
In accordance with the provisions of Article 11 of Chapter 130A, General Statutes of North Carolina as amended,
AND other applicable Laws and Rules
PERMISSION IS HEREBY GRANTED TO
Owner 14e410,,r
Address -645 Qwx 1 `itr<r•1
Phone r�;> -- .-Z C q4;
to construct, install a sew ge treatment and disposal system as described be! w:
To Serve:Residential Bedrooms Commercial/t0kt #Employeesi'!i$,Max Occupany_5.
Comments,Descrbtion:
' THIS INSTALLATION TO HANDLE DOMESTIC WASTEWATER ONLY, NO FOOD SERVICE. INDUSTRIAL OR PROCESS
WASTEWATERS. ' )
SUBDIVISION `g,�s,. tr•-/C"..n.9 LOT BLO K SECTION
ADDRESS/LOCATION:
The system components consists of:Type system—IWWS-98-1,"PURAFLO PEAT BIOFILTER,TYPE A
Design Flow—Z4t) GPD
I. COLLECTION SYSTEM:CONVENTIONAL PLUMBING
(MUST COMPLY WITH ALL APPLICABLE STATE AND LOCAL PLUMBING CODES)
Il. TANKAGE: A. SEPTIC TANK(S) q C) GALLONS CAPACITY
B. PUMP TANK •400. GALLONS CAPACITY
D. OTHER: the septic tank shall be equiped with an effulent filter at the outlet,a screened pump vault in
the pump tank. or equivalent effulent filtration device. as specified by Bord Na Mona.
ALL TANKS, FORCE MAINS, PRESSURE LINES TO BE LEAK TESTED AND CERTIFIED BY APPROPREIATE
PARTIES_All tanks and risers shall be tested to be watertight by a 24 hour hydrostatic leakage test conducted at the site
prior to system startup.A water level change of+/-%inch or more over 24 hours, or visual observation of leakage shall
be cause for failure of the test.
ACCESS RISERS REQUIRED ON ALL INSPECTIONS€SERVICE HATCHES ON TANKS-RISERS TO EXTEND 4-6"
ABOVE FINISHED GRADE
III. PUMP CHAMBER/DOSING TANK:
A. DOSING PUMP(S):.SIZE,.MAKE,MODEL#: Z. t//2-r
NUMBER OF PUMPS REQUIRED: 1
B. DISCHARGE PIPING: SIZE:2 'INCH MATERIAL: SCH 40 PVC GATE VALVES:YES, INTERNAL
CHECK VALVE:YES UNION/DISCONNECT:YES(PVC) LIFT CHAIN-OR ROPE:YES, NON-CORROSIVE
ANTISIPON HOLE:YES(3/16IN.)
C. DOSE VOLUME: , ) gallons DRAW DOWN DEPTH:l _INCHES, It 2-- #of doses per day ""
IV. DOSING MAIN: SIZE -V' INCH MATERIAL: SCH 40 PVC VALVING: CLEANOLjTS:
V. CONTROL PANEL:: TYPE: fit f=r- x-
TO INCLUDE: NEMA 4X ENCLOSURE;MANUAL DISCONNECTS/BREAKERS FOR PUMP AND ALARM
(SEPARATE CIRCUITS FOR PUMP AND-ALARM), H-O-A SWITCH, ALARM(AUDIBLE AND VISIBLE)
SIMPLEX X WITH ALTERNATOR AND ELASPED TIME COUNTERS/EVENT COUNTERS
FLOATS: OFF X ALARM/.LAG X
(MUST COMPLY WITH ALL APPLICABLE STATE AND LOCAL ELECTRICAL CODES)
VI. PEAT BIOFILTER: .. #OF MODULES REQIRED MANIFOLD SIZE 2— INCHES
MODULES EQUIPED WITH WEEP HOLES AT BOTTOM
TYPE A INSTALLATION: SAMPLE CHAMBERS NEXT TO MODULES
permitaut 1
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VII. DISPOSAL FIELD: LIAR ��% TRENCH DEPTH ..‘--•
/!
BACKFILL:TO BE INSTALLED OVER GRAVEL BEDS AND NEXT TO MODULES.
MODULE TOPS TO REMAIN AT 6 INCHES ABOVE FINISHED GRADE. MIN COVER OVER ROCK BEDS IS 6
INCHES. BACKFILL TO BE INSTALLED WITH A SIDESLOPE OF AT LEAST 1:4 SIDESLOPE
A. TYPE A: / s
1. UTILIZING A ROCK BED UNDER EACH MODULE. BED LENGTH L FT. WIDTH /t FT.
DEPTH OF ROCK USED FOR BED(81N MIN.) INCH
comments:aeotextile fabric(capable of rem ovine silt sized particles)is to be use on all exposed surfaces ofthe rock
bed(no fabric is to be located under the modules). NO MACHINERY OR EQUIPMENT SHALL BE
ALLOWED OVER THE INSTALLATION OR SITE ONCE THE SITE MODIFICATIONS ARE STARTED.
MACHINERY MAY NOT CROSS TRAVEL OVER OR BE USED ON THE INSTALLATION.
ADDITIONAL COMMENTS:
VIII. APPURTENANCES TO SYSTEMS: ,,
A. SUBSURFACE DRAINAGE: TYPE: 4. / DEPTH: 4/i t
INSTALLER: .4
B. AREA FILL: FILL DEPTH: MATERIAL:SAND/LOAMY SAND SIZE OF BASAL AREA: WIDE x LONG
SEE FILL PLAN FOR ADDITIONAL-DETAILS AND SPECIFICATIONS. FOR TYPE A SYSTEMS,NO EQUIPMENT
OR MACHINERY SHALL BE ALLOWED OVER THE.EXPOSED SITE. -
C. LANDSCAPING: ALL SITES SHALL BE LANDSCAPED SUFFICIENT TO PROVIDE SURFACE RUNOFF AND TO
PREVENT PONDING OF RAIN OR OTHER SURFACE WATERS.
D. COMMENTS,SITE MODIFICATIONS, ETC.,
The Owner shall be subject to the following conditions,limitations,and construction requirements for the installation of this
system:
1. This authorization is effective only with respect to the specific design flow and facilities,and the nature and volume of
waste described in the Permit Application,and other-supporting data.
2. This permit is not transferable and must be reapplied for at such time as ownership,or-management-changes.
3. The designated repair area is to have no:parking,.driveways,or-other impervious material located on it. This
area is to be protected, reserved and maintenance in a natural state.
4. All subsequent owners of this property and sewage system,shall execute a contract between the owner and an
approved management entity before the operations permit is-issued. Management of the sewer system to be provided
at all times.
5. All contracts between owners;management entity(Public or Private),or Health Dept-shall be reviewed and approved
before being accepted.
6. A.properly certified Operator shall be provided as indicated:
Certified Subsurface System Operator YES
7. The issuance of this permit does not preclude the permittee from complying with any and all statutes, regulations,or
• ordinances which may be imposed by other government agencies which have jurisdiction,or any other permits issued by
this department.
•
8. This wastewater-system.shall be installed by a contractor:authorized in writingby the manufacturer,.who-shall
coordinate the installation with the designer and:the manufacturer's field representative.
9. For sites requiring evaluation by a certified soil-scientist or professional geologist,said soil scientist/geologist shall be
present and supervise any site modifications,and crii cal- hases of-the wastewater system installation.
'10. This authorization shall be valid for monthSfrom"the-dal of issue. The authorization shall become invalid if the
information submitted in the application was falsified or changed,if the permit was based on inaccurate or incomplete
information,or if the designated site is altered,or expiration of this-authorization,:a new application shall be submitted to
the BCHD with updated information,as may-be applicable orrequested.
11. '*A PERMANENT BARRIER-SHALL BE'PROVIDED AND IN PLACE AROUNDTHE SYSTEM/REPAIR AREA BEFORE
THE OPERATIONS PERMIT IS ISSUED:
12. ALL APPLICABLE SETBACKS SHALL-BE MAINTAINED, NO IRRAGATION SYSTEMS, STORM WATER PONDS/
BASINS, SURFACE/SUBSURFACE DRAINAGE SHALL BE LOCATED IN"THE AREA OF THE.WASTEWATER
permit.aut 2
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. SYSTEM OR ITS REQUIRED SETBACKS.
INSTALLATION REQUIREMENTS
1. The installer shall be currently registered with this department.
2. A pre-installation conference is to be held on the site prior to beoinnina any 'site modification or construction of the
proposed structure or the sewage collection,treatment,and disposal system. Attending these conferences shall be
representatives of the State&/or Local Health Department; project engineer or designer;contractor; builder;proposed '
system operatorfinstaller,and the owner orhis authorized agent
3. •The contractor:shall be responsible for'notification of the engineer and the BCHD for system inspection in stages as
required and.prior to backfilling any portion of the system. No portion of the system shall be backfilled or placed into
use without prior approval of the BCHD. ,
4. The system shall be installed in accordance with the approved set of plans and specifications. Any deviation in site
modifications,plans,specification,layout,materials or other system component shall be approved by the design
engineer and the Brunswick County Health.Department prior to installation of the system. Failure to do so may result in
delay or refusal of final-approval of the system, and may render the Permit null and void.
5. The system shall be installed in a timely manner and staged so as to avoid unnecessary exposure to weather.
6. The location and identification of all property lines,easements,water lines,and other appropriate utilities shall be the •
responsibility of theinstaller. • .
7. Other:
• OPERATION PERMIT REQUIREMENTS
1. An Operation Permit shall be issued by the BCHD prior to placing the system into use,or making any connections to the
system. •
2. Prior to issuance of the Operation Permit:
• - the system shall be completed,installed,and tested in accordance with the approved design, including proper
abandonment of tanks existing wells,-and other components.The certified subsurface system operator for the
system:shall be present forthe testing.and startup of the.installation.
- final landscaping,water diversion devices,and vegetative cover requirements and pressure adjustment shall be
completed,
'the Engineer,-Designer or applicable responsible parties shall submit as-built plans to the BCHD,the plans shall
reflect-any.changes or alterations-from the as-approved plans.The final pump delivery rate for the installation shall
• also be determined and provided to:BCHD as part of the final certification.
'3. For-sites that required evaluation bya'certified.soil scientist orprofessional,geologist,a written certification shall be
submitted that the site/system installation-was/.is in accordance with their specified site/iinstallation requirements.
4. For systems thathave been engineered or designed by a private consultant,the designer or engineer(as applicable)
_shall certify in writing to the Brunswick County Health Department,that he has inspected the installation and that it has
been installed according to:the.approved.plans and specifications.
- Any necessary easements,-plats,or other documents shall-be recorded with the Register of-Deeds and-copies
:subm itted ao:the"BCHD,
The owner and a Public Management Entity/Subsurface System Certified Operator-shall-execute a contract which
• -addresses all of the requirementsfor maintenance,-monitoring,and reporting in Section:1961 and the
requirements of:the'Schedule.of Operation;and-Maintenance to_be a part of the Operation Permit for.tie facility.
Provisions of said contract.shall be-in effect•for-as Ion -as' -system-is in use.
'NOTE OF EXPRATION-IHS AUTHORIZA' EXPi ;- �; ;lc i'FROti9 DATE OFiSI:IE.-F EXPRATION
;THE OLIENTSHALLCOMPLY1MTHALL�ti11A LEREGULATIONS,Lis►WS; ASPECTS,
ETC.,THATMAYBE EFFECTIVE _(3H S MAY A NALPREPARATiON;MORE COMPLEX
WASTEWATE1SVRTEMS.OP:MATIONAND MAINTENANCE ,'PRE TREATMENT;ETC.'T iS COULD RESULT iN
LESSPJiEA FORTHE HOME,PARKINa LOIAIERI ATTBRUSAMAND RIRTHER DRIELOPMENiI'I.11iAffATIOio9S.
pennitaut
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. ' BRUNSWICK COUNTY HEALTH DEPARTMENT ALTERNATIVE SYSTEM
Authorization For Wastewater System Construction Permit J
BCHD# + 4/3 /,o
Plan review 'DATE /id �/ ) //-3/i I •
E
—�v
Site evaluation by.D'•P:I v I s`k- -Wr1�jgitTE
Site modifications,completed and inspected by q/. 4 DATE
AUTHORIZATION TO cONSTRUCT ISSUED THIS :Z1 DAY-
OF /f ? -)
BRUNSWICK COUNTY HEALTH DEPARTMENT
A ` ' R.S. ENVIRONMENTAL HEALTH DNISION
*"*Iliequired
Pre-construction conference for site by: .
Date:
Present -for conference (list) :
•
Pre-construction conference for construction of system by:
Date:
•
Present for conference (list).:
, Fi• 4d,Diftrt
-Ret2c. 26 .D?4,1e_filft) 71)k7
cz.701
•
permit.aut 4
5/97 .

Attach Certified Mail/Retum Receipt here:
September 11,2001
Lewis C.Holder
2969 Ebbtide Ln.
Vamamtown NC 28462
Dear Mr.Holder,
This letter is to inform you that I have applied for a CAMA permit on my property at 35 Varnamtown Rd.,
Lot#2 Subdivision Varnam's Landing in Brunswick County town of Varnamtown,NC and
owned by Henry Butler.I have enclosed a copy of my permit application and a copy of the drawing of my
proposed project.
If you have any comments on my proposed project,please contact the Coastal Representative listed below.
No response within ten(10)days is the same as no objection when you have been notified by Certified
Mail.
Janet M.Russell
Coastal Management Representative
127 Cardinal Dr.Extension
Wilmington NC 28405-3845
Ph: 0)395-3900
Sincerely,
Joel K1assB&J C struction
Applicant:Joel Klass/B&J Construction
Mailing Address:998 Cypress Lk. Cir. SE Bolivia
State:NC
Telephone#:[phone]

.
Attach Certified Mail/Return Receipt here:
September 11,2001
J.B.Wilkins.
33 Varnamtown Rd.
Varnamtown NC 28462
Dear Mr.Wilkins,
This letter is to inform you that I have applied for a CAMA permit on my property at 35 Varnamtown Rd.,
Lot#2 Subdivision Varnam's Landing in Brunswick County town of Varnamtown,NC and
owned by Henry Butler.I have enclosed a copy of my permit application and a copy of the drawing of my
proposed project.
If you have any comments on my proposed project,please contact the Coastal Representative listed below.
No response within ten(10)days is the same as no objection when you have been notified by Certified
Mail.
Janet M.Russell
Coastal Management Representative
127 Cardinal Dr.Extension
Wilmington NC 28405-3845
Ph: [phone]
Sincerely,
titag
oel KlassB&J Construction o,fe_
Applicant:Joel KlassB&J Construction
Mailing Address:998 Cypress Lk. Cir. SE Bolivia
State:NC (,L/
Telephone#: [phone] -I'L- —''

•
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