PN16-15

Issued by WiRO PN 16-15
For Pender Co. Permit Number
CAMA
MINOR DEVELOPMENT
PERMIT Coastal Management
ENVIRONMENTAL QUALITY
as authorized by the State of North Carolina, Department of Environmental Quality
and the Coastal Resources Commission for development in an area of
environmental concern pursuant to Section 113A-118 of the General Statutes,
"Coastal Area Management"
Issued to Joseph Kimel authorizing development in the Estuarine Shoreline (ORW)Areas of Environmental Concern
(AECs) at Lot 28, Long Point Estates, in Hampstead, Pender County as requested in the permittee's application
package, dated November 1, 2016 and received by DCM on November 7, 2016. This permit, issued on November 23,
2016, is subject to compliance with the application and site drawing (where consistent with the permit), all applicable
regulations and special conditions and notes set forth below. Any violation of these terms may subject permittee to a fine,
imprisonment or civil action, or may cause the permit to be null and void.
This permit authorizes: Placement of fill material on-site as well as grading.
(1) All proposed development and associated construction must be done in accordance with the permitted work plat drawings(s)
dated received by the Division of Coastal Management on November 7, 2016.
(2) All construction must conform to the N.C. Building Code requirements and all other local, State and Federal regulations,
applicable local ordinances and FEMA Flood Regulations.
(3) Any change or changes in the plans for development, construction, or land use activities will require a re-evaluation and
modification of this permit.
(4) A copy of this permit shall be posted or available on site. Contact this office at [phone] for a final inspection at
completion of work.
(Additional Permit Conditions on Page 2)
This permit action may be appealed by the permittee or other qualified persons j
within twenty (20) days of the issuing date. This permit must be on the project
site and accessible to the permit officer when the project is inspected for
compliance. Any maintenance work or project modification not covered under Jason Dail
this permit,require further written permit approval.All work must cease when this Acting CAMA LOCAL PERMIT • 1q���
permit expires on: 127 Cardinal Driv- -1', Ir3
December 31,2019 • Wilmington, NC :'S, -3845
In issuing this permit it is agreed that this project is consistent with the local Land 7.)°‘A-41) -
Use Plan and all applicable ordinances. This permit may not be transferred to PERMITTEE
another party without the written approval of the Division of Coastal
Management. (Signatury‘quired if conditions above apply to permit)

Joseph Kimel
Minor Permit#PN16-15
November 23, 2016
Page 2
(5) All unconsolidated material resulting from associated grading and landscaping shall be retained on site by effective
sedimentation and erosion control measures. Disturbed areas shall be vegetated and stabilized (planted and
mulched)within 14 days of construction completion.
(6) Any proposed for grading within the 30' buffer from the Normal High Water level must be contoured to prevent
additional stormwater runoff to the adjacent marsh and/or canal. This area shall be immediately vegetatively
stabilized, and must remain in a vegetated state.
(7) No structures shall be located within the 30' Coastal Shoreline buffer, including but not limited to concrete slabs,
stepping stones, roof covers, accessory buildings, swimming pools,stormwater drains, pump houses,etc.
(8) This permit does not authorize the excavation or filling of any wetlands or open water areas.
(9) Pursuant to 15A NCAC, Subchapter 7J.0406(b), this permit may not be assigned, transferred, sold or otherwise
disposed of to a third-party.
SIGNATURE'' `— � 'f' "' DATE1 s �' )�
PERMITTEE
RECEIVED
IDCM WILMINGTON N :.

PAT MCCRORY
Governor
lirliZ
DONALD R. VAN DER VAART
Secretary
BRAXTON DAVIS
Coastal Management Director
ENVIRONMENTAL QUALITY
November 28, 2016
Mr. Joseph Kimel
1703 Washington Acres Rd.
Hampstead, NC 28443
Dear Mr. Kimel:
Attached is CAMA Minor Development Permit# PN 16-15 for work to be done at Lot 28
Washington Acres Rd., in Pender County. An electronic copy of the permit has been sent to the
Pender County Inspections Department.
In order to validate this permit, please sign both copies of the permit as indicated for our
records. Please retain the orange copy for your files, sign both pages of the white copy, and
return to us within 20 days of receipt, in the enclosed, self-addressed envelope.
This is not a valid permit until it is signed and returned to our office.
Thank you for your prompt attention to this matter.
Sincerely,
/4444-1----- <," ";1.-----i
Shaun K. Simpson
Permit Support Technician
Enclosures
Cc: WiRO files
Pender Co. Inspection Dept.
State of North Carolina I Environmental Quality I Coastal Management
127 Cardinal Drive Ext.,Wilmington,NC 28405
919 796 7215

N()TI (117
J
_.„\dc
CAMA PERMIT
A#PremPove trees and grade at Lot #28
PROJECT:
VVasi a - _ • - _ _ k, in
my
Hampstead, Pender County
N/A
COMMENTS ACCEPTED THROUGH
APPLICANT: FOR MORE DETAILS CONTACT
THE LOCAL PERMIT OFFICER BELOW:
Joseph Kimel NC Div. of Coastal Management
1 703 Washington Acres Rd. 127 Cardinal Dr. Extension
Hampstead, NC 28443 Wilmington, NC 28405
Jason Dail, Field Representative
910-796-7221

Locality Permit Number-
. Ocean I Lazard Estuarine Shoreline ORW Shoreline Public Trust Shoreline_ Other
(For official use only)
GENERAL INFORMATION
LAND OWNER-MAILING ADDRESS
Name
Address 196� j,.�9}Sftf ..� Acres. t o
CityNninpu'eAo(_ State JUC, Zile. Phone ,Z3I 33/q
Ismail ca/ F_RiMe qt/iNt30 ehrr
AUTHORIZED AGENT
Name — ---
i
Address
City State _ Zip Phone
Email
LOCATION OE PROJECT: (Address,street name and/or directions to site;name of the adjacent watcrbody.)
•
J of teat AJc. 3
k Cce .( ft -
(s----4442-j)
DESCRIPTION OF PROJECT: (List all proposed construction and land disturbance.)
Ibt y-c)01
SIZE OF LOT/PARCEL: a5) J 1 square feet ,(o acres
PROPOSED USE: Residential [El/ (Single-family[] Multi-family [] ) Commercial/Industrial Other []
COMPLETE EITHER(I)OR(2) BELOW(Contact you•Local Permit Officer if you are not sure which ALC applies
to your property):
(1) OCEAN HAZARD AECs:TOTAL FLOOR AREA OF PROPOSED STRUCTURE: square feet(includes
air conditioned living space,parking elevated above ground level,non-conditioned space elevated above ground level but
excluding non-load-bearing attic space)
(2) COASTAL SHORELINE AECs: SIZE OF BUILDING FOOTPRINT AND OTHER IMPERVIOUS OR BUILT
UPON SURFACES:WM square feet(includes the area of the foundation of all buildings,driveways,covered decks,
concrete or masonry patios,etc.that arc within the applicable AEC.Attach your calOCM WREGEINGTOroject.drawing.)
To 6� RtAeAtez
STATE STORMWATER MANAGEMENT PERMIT: Is the project located in an area subj htate
Stormwater Management Permit issued by the NC Division of Energy,Mineral and Land Res tt!"ceMMLR)'?
YES NO
If yes,list the total built upon area/impervious surface allowed for your lot or parcel: square feet.

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OTHER PERMITS MAY BE REQUIRED:The activity you are planning may require permits other than the CAMA
minor development permit,including,but not limited to: Drinking Water Well,Septic Tank(or other sanitary waste
treatment system),Building, Electrical, Plumbing, Heating and Air Conditioning, insulation and Energy Conservation, EtA
Certification,Sand Dune,Sediment Control,Subdivision Approval,Mobile i tome Park Approval,I lighway Connection,and
• others.Check with your Local Permit Officer for more information.
STATEMENT OF OWNERSHIP:
iI,the undersigned,an applicant for a CAMA minor development permit,being either the of : ;est�a„a EL'or a
person authorized to act as an agent for purposes of applying for a CAMA minor development permit,certify that the person
listed as landowner on this application has a significant interest in the real property described therein.This interest can be
described as:(check one)•
�— an owner or record title,Title is vested in name of i epl P k's - mef ,
teed Book MR9 iStyek 3(Q page Lfr1 in the Pe"oPT" County Registry of Deeds.
an owner by virtue of inheritance.Applicant is an heir to the estate of
;probate was in County.
___._if other interest,such as written contract or lease,explain below or use a separate sheet&attach to this application.
NOTIFICATION OF ADJACENT RIPARIAN PROPERTY OWNERS:
I furthermore certify that the following persons arc owners of properties adjoining this property. I affirm that I have given
ACTUAL NOTICE to each of them concerning my intent to develop this property and to apply for a CAMA permit.
(Name) (Address)
(I) ko�es Cirookf 153?. Dea\ ode Dr— rks.Aet_s1-- a NC 66r/
(2) --_- 1)411i a Pn kv csej 13.13_._tohskeski4 Ae_re c_u got. N psi rvc.
AMALT
(3)
(4)
ACKNOWLEDGEMENTS:
I,the undersigned,acknowledge that the land owner is aware that the proposed development is planned for an area which
may be susceptible to erosion and/or flooding. i acknowledge that the Local Permit Officer has explained to me the particu-
lar hazard problems associated with this lot.This explanation was accompanied by recommendations concerning stabiliza-
Lion and floodproofing techniques.
I furthermore certify that I am authorized to grant,and do in fact grant,permission to Division of Coastal Management staff,
the Local Permit Officer and their agents to enter on the aforementioned lands in connection with evaluating information
related to this permit application.
This the f li ii day of 1 ,20 16,
14077j
a t . .
Landowner or person au rized to act as his/her agent for purpose of filing a CAMA permit application
01
This applicalios includes:general information(this form),a site drawing as described on the back of this application, the
ownership statement, the Ocean Hamm/AEC Notice where necessaiy, a check for$100.00 made payable to the locality,and
any information as may be provided orally by the applicant. The details of the application as described by these mares are
incorporated without reference in any permit which may be issued. Deviation from these details will constitute a violation of
any permit. Any person developing in an ABC without permit is subject to civil, criminal and adnz o
DCM WILM� M
NOV 07 2016

PHYSICAL SURVEY
I
0 tt�o
il
I 14-
006
r 1
I� 9%� d eg
d
Lot 5 a. �4s Site
Ia J Washington Acres Q°
Section 7 •
\ I I! ,Q� MB 10 Pg 29 VICINITY MAP N.T.S.
o a0 Legend:
\ o 0 Existing Iron Pipe
4� P%it �— ------N 35'22'00" E 0 Existing Najumentl
` e in Existing Drive 110.00' —
\ ` �a.sz --.. `70 1 —
8.75 15'OAK
15'OAK y44 2"OAK��
e-1- \ 8.22 ' 9\\ 1 1
/ 22"OAK
I I' ` 0 Lot 28 4,
8.ao 25,417 s.f. -5 oAK `G
sO I&38 12"OAK-2
io 124"OAK 8.09
1"- 4I (�15"0A
24'OAK 7.90 i9 I 7.6 7.69
CD �.71 24"OAK N. 15'OAK/ \v 15"O
7.50
15"OAK 7.72 89 // \12'OAK O
7.7 15" / 20 0AK\ 7. 5 H
AO \ 18�0 " _
Q ��'97.21 1
^, \ 18'OAK 8'8.24 , / 11,
PL.' r ��\ 15'OAK /�'8 lA Lot 29
/ I �) 7 54 C!// 8-1 3� N N Long Point Estates
/ 1J 20"O,K 15"OAK 8.710 ai Section 3
/ Co
l .(7) 1 7.12 // &2E
) 24"OAK .- Id MB 36 Pg 47
O �18"OAK/ ® �15"OAK 01
'• h \\ 8.57 O
/ �- / 7.67 \OAK_ MI
/
I /�20 0AK O'OAK9.02 In
(D 01 2 ,K' 8"OAK d-
\ \ ~ -
70 co. in
h \\ ` U)
Note:
v \ 6.77� `��,_ - _ 7, 1) Vertical Datum referenced to
K \ 24"OAK _=]^ -./ NAVD 88.
m I \ I 631,6.79 2) Any and all developmental
c+ I \ 20'°AK z' • restrictions (Federal, State,
-g_ 1 - Local, P.O.A., H.O.A., Deed, Etc.)
6.03 ) must be verified with the
20%1
w _ parties responsible for enforcing
N Z ` 2 0AK\` those restrictions prior to any
/ a1 10 ) design or construction.
/ ` tJ
1 Co W Wo .eWalkway
ay In , — —
(,+ell & Walkway
V \ C
O Tie Lines 4
` 104.84
1 *t: - 25 7 45' E
nneted 'Safer*"
Scale: 1"= 40' \
ch°MB 36 pg 47
mow
RECE VED
40' 20' 0' 40' tor
DCM WILMINGTON,
SURVEY FOR: dOSee, f. 14.l04e-N I, Paul D. Talbot, do certify that ,,j111„,,,
this actual survey and map was .,.ESN CARO�•,��
performed and drawn under my ��c --•.,, /
Washington Acres Road supervision in accordance with 4o,.oFESS/o,.4:5y
Lot 28, Section 3 "The Standards of Practice for _ 'Q� C,►I -f
Long Point Estates Land Surveying in North Carolina SEAL 1-
Topsail Township, Pender County, NC witness my original signature, • L-4099
e At
license number and seal. .r :
Date: August 16, 2010 Revised: October 2, 2012 ''.,�Aq Z ��o`�
-. ',1,44.0 O.1 u""`.
Survey Reference: Paul D. Talbot, P.L.S. L-4099
Deed Book 3775
Ai
Map Book Pagea51 Talbot Land Surveying, P.C.
This property is located 16747 U.S. Hwy 17, Suite 106
within o Flood Hazard Area. Hampstead, North Carolina 28443 T
Firm license C-2722 r
Project /: 1057 Nap Name: 1057-topo.dwq Drafter: B2 Phone: [phone] Fax: [phone]

,00. Pender County Health Department
Cr ' v9�� Environmental Health Division
803 Walker Street, F.O. Box 1209
rrra,,Lr.r,ra,r;� Burgaw, NC 28425
North c is,.1,41:6.0 H..N,
r.nM.kew,fmPUY.1+ar" t. Phone:[phone] Fax: [phone]
www.pendercountync.gov
Wastewater System Operation Permit
Parcel Pin: 3291-064309 Permit Number: 100577
Property Address: Long Point Lot 28 Facility Type: Single Family Dwelling
.Owner: Susan Brandon oce 11-""-'. -``1 System Operator: Na
Address: 104 Hampstead Village REQUIRED INSPECTIONS
ORC Inspection every: N/A
System Installer: Sidbury PCUD Inspection every:NIA
System Classification: EEZ Flow(3 lines at 50 feet each)
System Type: Hug
In accordance with NCGS i3oA-n and 15A NCAC:t$A Section.s9oo,This Operation Permit is issued to:
Susan Brandon
For the operation of a 480 GPD wastewater treatment and disposal system.
Conditions
r. This permit shall be effective only with respect to the nature and volume of the waste specified.Water softener backwash is not allowed in the system.
z.This permit is transferable;however,any conditions imposed on this permit shall also transfer to the subsequent owner.
3.The system shall perform and be properly maintained and operated at all times in accordance with Rule.1g6r.
4.The owner,or other contractually responsible parry if applicable,is responsible for compliance with 15A NCAC i8A section agoo.
5. In the event of failure of the system to perform satisfactorily(as determined by the PCHD),the owner,or other responsible part if applicable,shall take
such corrective actions as required by the Department within the specified period of time.
6. No traffic,vehicles or excavations shall be allowed on the system or the repair area.
7• Appropriate permits shall be obtained from the PCHD prior to any repairs to the system or additions of flow.
8, The owner(and ORC,if applicable)shall notify the PCHD of any malfunction or necessary repairs.
9. The owner is responsible for keeping the plumbing system of the facility in good repair and eliminating leaks,drips,or excess flows as they are found.
so.A useable repair area as designated by the PCHD shall be maintained and reserved for the addition to or replacement of the initial drainfleld.
rr.Refer to the'as-built'inspection record on file at PCHD for system installation specifications.
rz.Permits for Types V and VI systems expire in 5 years.Owner must contact PCHD 6 months prior to expiration for permit renewal.
r3.The system shall be maintained and operated at all times in accordance with the Schedule of Operation and Maintenance shown on pg a of this permit.
rq..'Unless specifically allowed for on the Construction Authorization,systems are not designed For garbage disposal use.
15.See page a.for any additional conditions.
This permit may be srrs,pentled or revoked for non-compliance with any permit condition. D
AGM W� ml NGi'ON, NC
ISSUED: 07 Feb 2014 N( P 016
Registered Environme al t ealth Specialist
2

I►EZflow
MIILTMTO�
FIVE YEAR LIMITED WARRANTY
NORTH CAROLINA
STANDARD WARRANTY
EZflow,L.P.("EZflow")hereby extends the following FIVE(5)YEAR Limited Warranty to the original purchaser of a new EZJIor drainfield system
installed by an authorized!2,/bar installer. The EZJIoa•drainfield system is warranted to be free from defects in material and workmanship under
normal use,subject to the terms and conditions herein.
WARRANTY ELIGIBILITY:
The system owner is eligible for this Limited Warranty provided all of the terms and conditions of this Limited Warranty have been met. The terms
of this Limited Warranty shall extend to the original purchaser/homeowner and to each subsequent owner of the home during the term of this Limited
Warranty. This Limited Warranty covers only the performance of the EZJIoa•drainfield system as manufactured and installed in accordance with the
manufacturer's design specifications and applicable state rules and regulations.
OWNER'S OBLIGATIONS AND MAINTENANCE
1. The system owner must retain evidence that septic tank solids(digested sludge)have been properly removed once every thirty-six(36)
months. -'p
2.The system owner must not landscape over the!Z%r drainfield system with trees or shrubbery nor erect any structures or place heavy items
over the drainfield.
3. The system owner must retain this Limited Warranty signed by an authorized EZtoa'drainfield system installer and a properly issued
Operation Permit.
WHAT IS WARRANTED AND FOR HOW LONG:
The!ZJ/oa.prefabricated drainfield system is warranted for FIVE(5)YEARS from the date installation of the system is completed,to be free from
defects in material or workmanship.During the warranty period,iEZflow,L.P.shall,at its option,repair or replace any defective system components at
no charge for labor or materials.REPAIR OR REPLACEMENT OF THE DEFECTIVE PRODUCT IS THE EXCLUSIVE REMEDY UNDER THIS
LIMITED WARRANTY. Any replacement or repair parts are warranted for the remainder of the warranty period or ninety(90)days,whichever is
longer.Under this Limited Warranty,EZflow,L.P.will provide only for replacement and installation of defective EZf/ordrainfield system parts.Owner
shall be responsible for any other costs,including but not limited to re-sodding and any permits required for installation.
WHAT IS NOT COVERED BY THIS LiMITED WARRANTY:
1. The septic tank,filters,effluent distribution box(es)or other system components.
2.Improper design or installation,including but not limited to repairs/replacements necessitated due to improper or inaccurate soils analysis,the
use of incorrect application rates or inadequate sizing criteria.
3. Landscaping or re-sodding costs.
4. Repair work performed without EZflow authorization.
5. Damage caused by unauthorized or improper attachment,alterations or modifications,including but not limited to the use of geotextiles or
plastic pipe.
6. Damage caused by flood,earthquake or other natural disaster.
7. Damage or failure due to improper maintenance or lack of proper maintenance.
8. Failure due to excessive water usage,improper grease disposal or other excessive or improper use.
9. Failure caused by placing structures or plant material over the drainfield or by stresses or vehicular traffic greater than that prescribed in the
installation or operation instructions.
CONDITIONS OF LIMITED WARRANTY:
1.The design and installation of the EZflow drainfield system is performed according to the rules and regulations of the North Carolina Depart-
ment of Environment and Natural Resources and the Commission for Health Services.
2. The!XI/Oa'drainfield system is subject to use permitted by applicable state or local rules and regulations for on-site wastewater systems..
.� 3. Installation of the EZfloa,drainfield system is performed only by an authorized EZflow installer.
NOTICE OF WARRANTY CLAIM:
` To obtain warranty service under this Limited Warranty,the system owner must notify EZflow,L.P.within ninety(90)days after discovery of any defect
NI
and obtain an authorization number for investigation,repair,or replacement service. Notice should be sent to: EZflow,L.P.,6 Business Park Road,
Old Saybrook,CT 06475,Toll Free Phone:[phone]. EZflow will not pay for any costs,repairs,or replacements for which prior authorization
has not been obtained.
DISCLAIMER OF AND LIMITATION ON WARRANTIES:
OTHER THAN THE EXCLUSIVE WARRANTY SPECIFICALLY SET FORTH HEREIN,NO OTHER EXPRESS OR IMPLIED WARRANTIES
HAVE BEEN MADE OR WILL BE MADE BY OR ON BEHALF OF EZFLOW,L.P. EZFLOW HEREBY DISCLAIMS AND EXCLUDES ANY
y IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE. THE WARRANTIES AND REMEDIES
t; CONTAINED HEREIN ARE EXCLUSIVE AND DO NOT INCLUDE INCIDENTAL,CONSEQUENTIAL OR SPECIAL DAMAGES,LOSS OF
`C! USE,INCONVENIENCE,OR LOSS OR DAMAGE TO PERSONAL PROPERTY,WHETHER DIRECT OR INDIRECT,WHETHER ARISING IN
CONTRACT OR IN TORT.
THIS LIMITED WARRANTY GIVES YOU SPECIFIC LEGAL RIGHTS. FEDERAL OR STATE LAW MAY GiVE YOU CERTAIN OTHER
RIGHTS THAT ARE NOT CONTAINED HEREIN.
4se p1-- Li,mt.\ ZS
Print Purchaser/Homeownereo.t /
Name H eowner's Address
C:dSignatureXI/14 .4C-At /0 C.-Z•Ci II,
INSTALLER CERTIFICATION /
"I certify that the EZfloa•drainfield system has been installed properly and in accordance with the Infiltratorinstallation procedures,adE EIED
North Carolina wastewater laws and regulations and all health department permits." DCM W I LM I NGTON,NC
AC,.5' �-L-c f � NOV 0 7 �016
t By:
I st lei Business Name Tit try I-''>`{-a+�
Date: 2 7 /t/
This warranty is provided in triplicate. One copy shall go to EZflow,L.P.,one to the local health department,and one to the system owner.
a4ar /6O5 77 Ez591 G-6

SYSTEM TYPE In7 P ER COUNTY:HEALTH DEPARTMENT MAP*
• P.O.BOX 1209,BURGAW,NC 28425
PAGE / OF 2 PHONE:[phone] RECORD#
IMPROVEMENT PERMIT I CONSTRUCTION AUTHORIZATION
OPERATIOgERMIT
�L- k* 0- o
OWNER/AGENT ,.5,f4,0 giaticA Y1.. DATE b PERMIT# /a05 7 J
ADDRESS /0 V /i�6 9f f C i/ g'// 7 , ( #7'2./74 PHONE 7 - /'/
SITE LOCATION f /7 S /4 t J i i affrA, ire( P-c� /o , f 1, , 4A f'
Gel -A; 114/e , /4 dot /o F /
SUBDIVISION Lo74 6 /,7" (/1w'7 , • LOT# 2? SECTION/BLOCK
HOUSE[✓JMOBILP HOME[ ] { #Bdrni. } y BUSINESS [ ] {#EMPLOYEES/MEMBERS/SEATS} /"/''4
WATER SUPPLY:PUBLIC r ]WELL[* (OTHER DESIGNATED WETLANDS:YES[4 NO[c-}-
BASEMENT/LOWER LE PLUMBING YES[ ]NO[L-1 .SYSI F.M MINIMUM REVIEW FREQUENCY
DAILY DESIGN FLOW .1( U DOMESTIC WASTEWATER [ INDUSTRIAL WASTEWATER [ I
LTAR gpd/ft TANK.SI7F: ' /a0O Gallons NITRIFICATION FIELD 660 Square Feet
NUMBER OF LINES 3 LENGTH tti 7 Feet -DEPTH 2•2 Inches 4L1,J 17.1/7 3 / /
BED SYSTEM SWF_iv X
•
********IF GARBAGE DISPOSAL UNIT.IS TO BE USED AN EFFLUENT FILTER SHALL BE INSTALLED********
************* *********************************************************************************************
SEE),AYOUT OR ATTACHED PLOT PLAN
NO CHANGE IN SEPTIC SYSTEM OR ITS LOCATION WITHOUT PRIOR APPROVAL
FROM TIM FENDER COUNTY HEALTH DEPARTMENT.
THIS PERMIT IS SUBJECT TO REVOCATION IF THE SITE PLAN,PLAT OR INTENDED USE OF THIS SITE CHANGES,
G.S. 130A-335(f)
MINIMUM HORIZONTAL SEPARATION OF SEPTIC SYSTEM {See Section.1950 a-c}
/T ISSUE DATE (- 3 U - Us-
5 YEAR IMPROVEMENT PERMIT: �'r � �f�� f f
IMPROVEMENT PERMIT,NO EXP • TION DAM,: /WI
ISSUE DATE
CONDITIONS/ADDITIONAL INFORMATION:
/r 4.l 441 = 2/ 7 fr 3� 67 lit-3 ' �:
�' > 4 �ll /O 6� T �y J
���f�� �P � c�; C?xp;r� �� orb �� �� px� � c�7 1"3 QH� d �'�
ifirii 44r (if VDel.
RECEIVED
NOV 07 205

Statement (DATE 2 Lit TERMS
TO (re_ wt.(ja___
° 3 t/3"41;46-it--0-71 • 44_1
,UCL._ ZE:
IN ACCOUNT WITH ai. SIDBURY CONSTRUCTiC .
130 BROADVIEW LN.
HAMPSTEAD, NC 28443
SEPTIC INSTALLATION
910-270-3221
44t-ILLIL /COO
4- 3 -7.0
64:44„&i- b/Mr
„i2.44-S-04( ( 1 Ei 16rIt Fc20417:
t- ,2-71r ere,
__-
CURRENT OVER 30 DAYS OVER 60 DAYS
TOTAL AMOUNT
fradamr DC5812 01-11
RECEIVED
DCM WILMINGTON,NO
NOV 07 2016

Receipts for
Certified Mail
(Staple Here)��O� I aC`o
Date
Rohe rt 8rivkc-
Adjqcfp1PropertyOwner
Mailipa Address
I(1})to l'Ak A L ;.710G7
City,State, Code
Dear Adjacent Property:
This letter is to inform you that I, - 4— Kw>Propertyhave applied for a CAMA Minor
Ownerl
Permit on my property at hot * o) 44n� 1$s.1.i rfe.J A!e-s ,in A/ P�ct
Property Address 3 City/Town
In Pender County. As required by CAMA regulations, I have enclosed a copy of my permit application and
project drawing(s)as notification of my proposed project. No action is required from you or you may sign and return
the enclosed no objection form. If you have any questions or comments about my proposed project,please
contact me at 3lt „).31 3 3 f(1 ,or by mail at the address listed below. If you wish to
Applicant's Telephone
file written comments or objections with the CAMA Minor Permit Program,you may submit them to:
Jason Dail,DCM Field Representative
LPO,County of Pender
NC DEQ/DCM
127 Cardinal Drive Ext.
'` Wilmington, NC 28405
yet AL---
Prop Owner
/90'-i i..)1/4 Ski\iti\/ /k.r; kdk
Mailing Address
/111-mpSfVICO1/4- hie- D.Vig3
City,State,Zip Code
RECEIVED
DCM VW1LMtNGTON,NC
NOV . 1201b

• 1
CERTIFIED MAIL° RECEIPT
3 Domestic Mail Only
T
rFor delivery information,visit our website at www.usps.com".
RAL 4
GI ,u 1 z.: f.'q
0 CertifiedMall Fee f3.30 `�} 43
9 Extra Services&Fees(check box,add fee lQ >,! R LM I N G�f
❑Return Receipt(hardcopY) $ e!;- WILMINGTOPI! 1C
J '}
❑Return Receipt(electronic) $ :�1 Vd Postmark
3 ❑Certified Mail Restricted Delivery $ ♦rr f�A I\� V I l� 7 F� ��
3 ❑Adult Signature Required $- 7II.�V l �r
❑Adult Signature Restricted Delivery$
3 Postage
T $ $0.47
i Total ostage and Fees 11/1013/2016
$ / oberfi si3flogc
1 Sent� l
3 Waxti_'Or
3 Street andApt.No.,or Pb Box No.
1 ;_� 0C �7�Or�
C ity,Sta e, +4 `�'"

Vfl C F/r vWwcO%IIG IVIfVV1r1I Iy MCI ICI1LJ.
i A receipt(this portion of the Certified Mail label). for an electronic return receipt,see a retail
I A unique identifier for your mailpiece. associate for assistance.To receive a duplicate
Electronic verification of delivery or attempted return receipt for no additional fee,present this
delivery. USPS®-postmarked Certified Mail receipt to the
A record of delivery(including the recipient's retail associate.
signature)that is retained by the Postal Service'" -Restricted delivery service,which provides
fora specified period. delivery to the addressee specified by name,or
to the addressee's authorized agent.
rnportant Reminders: -Adult signature service,which requires the
You may purchase Certified Mail service with signee to be at least 21 years of age(not
First-Class Mail',First-Class Package Service®, available at retail).
or Priority Mar service. -Adutt signature restricted delivery service,whicl
Certified Mail service is not available for requires the signee to be at least 21 years of ag
international mail. and provides delivery to the addressee specifier
Insurance coverage is not available for purchase by name,or to the addressee's authorized agent
with Certified Mail service.However,the purchase (not available at retail).
of Certified Mail service does not change the •To ensure that your Certified Mail receipt is
insurance coverage automatically included with accepted as legal proof of mailing,it should bear r
certain Priority Mail items. USPS postmark.If you would like a postmark on
For an additional fee,and with a proper this Certified Mail receipt,please present your
endorsement on the mailpiece,you may request Certified Mail item at a Post Office"for
the following services: postmarking.If you don't need a postmark on this
-Return receipt service,which provides a record Certified Mail receipt,detach the barcoded portion
of delivery(including the recipient's signature). of this label,affix it to the mailpiece,apply
You can request a hardcopy return receipt or an appropriate postage,and deposit the mailpiece.
electronic version.Fora hardcopy return receipt,
complete PS Form 3811,Domestic Return
Receipt;attach PS Form 3811 to your mailpiece; IMPORTANT:Save this receipt for your records.
s Form 3800.Aorii 201S PSN 7sa0-02-e00-0047

Receipts for
Certified Mail
(Staple Here)
i
Date
t'AL i)i m
Adja ent Property Owner
ll�l`�3 td-) sti,sfok, Azrcf
Ma ilinig4Address
4eik5 t 1 ,4X L4LF3
City,State,Zip Code
Dear Adjacent Property:
This letter is to inform you that I, 9041,1— have applied for a CAMA Minor
Property Owner Le P i r<f �/
1 In / � si`rock
Permit on myproperty at �U f dt K IN_ / ret is .
P P Y - -- Cit�!Town
Property Address Y
in Pender County. As required by CAMA regulations, I have enclosed a copy of my permit application and
project drawing(s)as notification of my proposed project.No action is required from you or you may sign and return
the enclosed no objection form. If you have any questions or comments about my proposed project,please Q
contact me at 11 Q 0L3 ) 33 i q ,or by mail at the address listed below. If you wish to
Applicant's Telephone
file written comments or objections with the CAMA Minor Permit Program,you may submit them to:
Jason Dail,DCM Field Representative
LPO,County of Pender
NC DEQ I DCM
127 Cardinal Drive Ext.
d Wilmington,NC 28405
Proper*UPI—
wnef
96 g Ott Sim sk J /'acre s` Zck
Mailing Address
144rnp5it Ill ,V'y1-43 RECEIVED
City,State,Zip Code DCM WILMINGTON, NC
NOV 0 7 2016

.. , - • . - r -
CERTIFIED MAIL° RECEIPT
Domestic Mail Only
For delivery information,visit our website at www.usps.com".
HAtflr 04 4443
Certified Mail Fee
$ $3.30 0443
Extra Services&Fees(check box,add fee � �:. RECEIVE 05
❑Return Receipt(hardcop» $ r1. WILMINGTON, NC
❑Return Receipt(electronic) $ so 00 Postmark
3 El Certified Mail Restricted Adult Signature Required livery $ !I., as N10 1� 7 i 6
p
❑Adult Signature Restricted Delivery$ $0.00
Postage V V
$ $0.47
Total Postage and Fees 11/03/2016
s (APi ir4n1 -)
sert4o,?3 II a � Act cs 1 ,
3 t and Apt.No.,or P Hox-No.
fit State, P+48�a �C- A 443

A receipt(this portion of the Certified Mail label). for an electronic return receipt,see a retail
A unique identifier for your mailpiece. associate for assistance.To receive a duplicate
Electronic verification of delivery or attempted return receipt for no additional fee,present this
delivery. USPS®-postmarked Certified Mail receipt to thr
A record of delivery(including the recipient's retail associate.
signature)that is retained by the Postal Service'" -Restricted delivery service,which provides
for a specified period. delivery to the addressee specified by name,or
to the-addressee's authorized agent.
important Reminders: -Adult signature service,which requires the
You may purchase Certified Mail service with signee to be at least 21 years of age(not
First-Class Mail",First-Class Package Service0, available at retail).
or Priority Mail'°service. -Adult signature restricted delivery service,whicl
Certified Mail service is not available for requires the signee to be at least 21 years of at
international mail. and provides delivery to the addressee specifier
Insurance coverage is not available for purchase by name,or to the addressee's authorized agen
with Certified Mail service.However,the purchase (not available at retail).
of Certified Mail service does not change the •To ensure that your Certified Mail receipt is
insurance coverage automatically included with accepted as legal proof of mailing,it should bear
certain Priority Mail items. LISPS postmark.If you would like a postmark on
For an additional fee,and with a proper this Certified Mail receipt,please present your
endorsement-on the mailpiece,you may request Certified Mail item at a Post Office'"for
the following services: postmarking.If you don't need a postmark on this
-Return receipt service,which provides a record Certified Mail receipt,detach the barcoded portior
of delivery(including the recipient's signature). of this label,affix it to the mailpiece,apply
You can request a hardcopy return receipt or an appropriate postage,and deposit the mailpiece.
electronic version.For a hardcopy return receipt,
complete PS Form 3811,Domestic Return
Receipt;attach PS Form 3811 to your mailpiece; IMPORTANT:Save this receipt for your records.
'S Form 3800.Aoril 2015/Reversel PSN 7530-02-000-9047

Payment Proccessing Confirmation
Date Received 11/7/2016
Check From (Name) Joseph F. Kimel
Name of Permit Holder Joseph Kimel
Vendor Resource Management Account UBS
Check Number 983
Check amount $100.00
Multiple Permits No
Major/Minor Minor
Permit Number/Comments minor fee/Lot 28 Long Point Washington Acres Rd, Hampstead,
Pen
Receipt or Refund/Reallocated JD/2799D