PN_20-02_ Fischer

Issued by WiRO PN20-02
Pender County Permit Number
CAMA
MINOR DEVELOPMENT •
PERMIT
I•
NORTH CAROLINA
as authorized by the State of North Carolina, Department of Environmental Quality Environmental Quality
and the Coastal Resources Commission for development in an area of environment
concern pursuant to Section 113A-118 of the General Statutes, "Coastal Area
Management"
Issued to Tim Fischer authorizing development in the Estuarine Shoreline (AECs) at 107 Anna Ct., in Hampstead,
Pender County as requested in the permittee's application, dated January 30, 2020, and received complete by DCM on
January 30, 2020. This permit, issued on February 19, 2020, is subject to compliance with the application and drawing
dated and received by DCM on January 30, 2020 (where consistent with the permit), all applicable regulations and
special conditions and notes set forth below. Any violation of these terms may subject the permittee to a fine,
imprisonment or civil action, or may cause the permit to be null and void.
This permit authorizes: Installation of a swimming pool.
(1) All proposed development and associated construction must be done in accordance with the permitted site drawing,
received by DCM on January 30, 2020.
(2) All construction shall 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, and/or land use activities will require re-evaluation and
modification of this permit.
(4) A copy of this permit shall be posted or available on site throughout the construction process. Contact this office at(910)
766-7221 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 0
within twenty (20)days of the issuing date. This permit must be on the project Z
site and accessible to the permit officer when the project is inspected for Jason Dail o Z
compliance. Any maintenance work or project modification not covered under 0 CA LOCAL PERMIT OFFICIKthis permit,require further written permit approval.All work must cease when this
permit expires on: 127 Cardinal Drive Extension• z
December 31,2023 Wilmington, NC 28405-3845j g eq
m
UJ
In issuing this permit it is agreed that this project is consistent with the local Land
Use Plan and all applicable ordinances. This permit may not be transferred to
another party without the written approval of the Division of Coastal RMITTEE 0
Management.
(Signature required if conditions above apply to permit)

Name: Tim Fischer
Minor Permit#PN20.02
Date: February 19, 2020
Page 2 of 2
(5) This permit does not authorize the excavation or filling of any wetlands or open water area(s).
(6) 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.
(7) This permit does not authorize any development activities within 30 feet of the normal/mean high water line.
(8) Pursuant to 15A NCAC, Subchapter 7J.0406(b), this permit may not be assigned, transferred, sold or otherwise
disposed of to a third-party.
(9) All construction shall conform to the N.C. Building Code requirements and all other local, State and Federal
Regulations, applicable local ordinances and FEMA Flood Regulations.
SIGNATURE: DATE: Ce1 a 20 20
PERMITTEE
RECEIVED
DCM WILMINGTON, NC
FEB 2 6 2020

ROY COOPER
I'MOtt
4 r • MICHAEL S. REGAN
BRAXTON DAVIS
Director
February 19, 2020
Tim Fischer
107 Anna Court
Hampstead, NC 28443
Dear Mr. Fischer,
Attached is CAMA Minor Development Permit PN 20-02 for work to be done at 107 Anna Court,
Hampstead in Pender County. An electronic copy has been sent to the Pender County Inspections
Department and to your Agent.
To validate this permit, please sign both copies as indicated for our records. Retain the orange copy for
your files, and return the white copy 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.
Sincer 'ly,
r
.,V14qm
Tanya K. Pietila
__Permit Support Technician
N.C. Division of Coastal Management
Enclosures
Cc: WiRO files
PN Inspection Dept.
Ocean Blue Pools&Spas—Agent
State of North Carolina I Environmental Quality I Coastal Management
127 Cardinal Drive Ext.,Wilmington,NC 28405
919 796 7215

Issued by WiRO PN20-02
Pender County Permit Number
CAMA
MINOR DEVELOPMENT
PERMIT „5.
NORTH CAROLINA
as authorized by the State of North Carolina, Department of Environmental Quality Environmental Quality
and the Coastal Resources Commission for development in an area of environment
concern pursuant to Section 113A-118 of the General Statutes, "Coastal Area
Management"
Issued to Tim Fischer authorizing development in the Estuarine Shoreline (AECs) at 107 Anna Ct, in Hampstead,
Pender County as requested in the permittee's application, dated January 30, 2020, and received complete by DCM on •
January 30, 2020. This permit, issued on February 19, 2020, is subject to compliance with the application and drawing
dated and received by DCM on January 30, 2020 (where consistent with the permit), all applicable regulations and
special conditions and notes set forth below. Any violation of these terms may subject the permittee to a fine,
imprisonment or civil action, or may cause the permit to be null and void.
This permit authorizes: Installation of a swimming pool.
(1) All proposed development and associated construction must be done in accordance with the permitted site drawing,
received by DCM on January 30, 2020.
(2) All construction shall 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, and/or land use activities will require re-evaluation and
modification of this permit.
(4) A copy of this permit shall be posted or available on site throughout the construction process. Contact this office at(910)
766-7221 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
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 Jason Dail
compliance. Any maintenance work or project modification not covered under CAMA OCAL PERMIT OFFICIAL
this permit,require further written permit approval.All work must cease when this
permit expires on: 127 Cardinal Drive Extension
December 31,2023 Wilmington, NC 28405-3845
In issuing this permit it is agreed that this project is consistent with the local Land
Use Plan and all applicable ordinances. This permit may not be transferred to
another party without the written approval of the Division of Coastal PERMITTEE
Management.
(Signature required if conditions above apply to permit)

Name: Tim Fischer
Minor Permit# PN20-02
Date: February 19, 2020
Page 2 of 2
(5) This permit does not authorize the excavation or filling of any wetlands or open water area(s).
(6) 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.
(7) This permit does not authorize any development activities within 30 feet of the normal/mean high water line.
(8) Pursuant to 15A NCAC, Subchapter 7J.0406(b), this permit may not be assigned, transferred, sold or otherwise
disposed of to a third-party.
(9) All construction shall conform to the N.C. Building Code requirements and all other local, State and Federal
Regulations, applicable local ordinances and FEMA Flood Regulations.
SIGNATURE: DATE:
PERMITTEE

Z
Locality A/el- � v Permit Number
. Ocean Hazard Estuarine Shoreline ORW Shoreline Public Trust Shoreline Other
(For official use only)
GENERAL INFORMATION
LAND OWNER- MAILING ADDRESS
Address t.__ b [ 14Q '�,��` c
City ` I _ State i Vc_ Zip Zi 3 Phone 1/ * en —i,'J
• Email 7 v,it!i DTI
AUTHORIZED AGENT
Name Neer.K POb& Wid Sp vtS
Address 3D awlAre., g ^17c
City bf State AA Zip l4? Phone /0- 7f�022_
Email Gnu`''1.4teeo&4)
LOCATION OF PROJECT: (Address,street name and/or directions to site;name of the adjacent waterbody.)
/0 7 4u c"
14nO s/i A/L 7- /,J
DESCRIPTION OF PROJECT: (List all proposed construction and land disturbance.) _4 —AA,
in y ) �sG<rfl s t'
SIZE OF LOT/PARCEL: 1 i ware feet 0 • 1 8 acres
PROPOSED USE: Residential ❑ (Single-family, Multi-family ❑ ) Commercial/Industrial ❑ Other ❑
COMPLETE EITHER(I)OR(2) BELOW(Contact your Local Permit Officer jfyou are no!sure which AEC applies
to your property):
(I) OCEAN IiAZARU 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:J?3::,7 square feet(includes the area of the foundation of all buildings,driveways,covered decks,t
concrete or masonry patios,etc. that are within the applicable AEC.Attach your calculations with the project drawipg.)Z
LL7I Z _
STATE STORM WATER MANAGEMENT PERMIT: Is the project located in an area subject to a State j Q _o
Stonnwatcr Management Permit issued by the NC Division of Energy,Mineral and Land Resources(DEMLR)? W Z
YES NO X U c�
If yes, list the total built upon area/impervious surface allowed for your lot or parcel: square ,eti
CC z
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a

7
OTHER PERMITS MAY BE REQUIRED:The activity you arc 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, RA
Certification,Sand Dune,Sediment Control,Subdivision Approval,Mobile Home Park Approval,Highway Connection,and
others. Check with your Local Permit Officer for more information.
STATEMENT OF OWNERSHIP:
1,the undersigned,an applicant for a CAMA minor development permit,being either the owner of property in an AEC 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 1 iO J • Sc 1\.(2,�
see Deed Book 3 j&5 c a21 3SJ6S page 35/(yy in the P4r1[,(2,g_ 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:
1 fiirthennore 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) Car y/t i/0,/1 l Ote Ane,z
(2) ----
(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-
tion 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 301'4` day of j(w\ .,20 Z0
Landowner or per on authorized to act as his/her agent for purpose of filing a CAMA permit application
This application ulc/lnles:general information(this form), a site drawing as described on the back of this application, the
ownership statement, the Ocean Hazard AEC Notice where necessary; a check for S100.00 made parable to the locality,and
any information as may be provided orally by the applicant. The details of the application as described by these sources are
incorporated without reference in any permit which may he issued. Deviation from these details will constitute a violation of
any permit.Any person developing in an AEC without permit is subject to civil, criminal and administrativ e. a6 E t V E D
GCM WILMINGTON, NC
JAN 3 0 2020

PENDER COUNTY HEALTH DEPARTMENT 'N C•PEN]
ENVIRONMENTAL HEALTH SECTION
S7 t Iiii1i 17,
EXISTING SYSTEM
AUTHORIZATION PERM) I
EN5A-ao9-,2oi9 107 Anna (M-396- 1139
PERMIT# ADDRESS PHONE
Tim Fischer Lan Po,'rtf Es/ides 3
OWNER/APPLICANT SUBDIVISION/MOBILE HOME PARK
STRUCTURE TYPE
MOBILE HOME HOUSE COMMERCIAL
3013f x ) 3 I , ingrotinc.g pool
OTHER J
***This permit is valid for one year***
At the time of inspection, no visible signs of malfunction were evident. However,since this is a
subsurface sewage disposal system, it is impossible for this office to determine if any
unauthorized modifications or misuse has occurred. No warranty or guarantee is implied or
expressed and future performance of this system is not assured by the Pender County Health
Department. Failing to maintain a properly operating septic tank system is considered a public
health hazard and a violation of the North Carolina State Laws and Rules Governing Sanitary
Sewage Collection,Treatment and Disposal (Article 11 NC General Statues Chapter 130A).
Should the system malfunction or fall in the future, it shall be the responsibility of the owner to
apply for an Improvement Permit for the repair of the system.
NUMBER OF BEDROOMS
PERMIT ISSUED FOR
Install as permited
REMARKS
I L!L 12/3119
ENVIRONMENTAL HEALTH SPECIALIST DATE
803 S.WALKER STREET BURGAW, NC
28425(910)259-1233 RECEIVED
15060 US HWY 17 HAMPSTEAD, NC DCM WILMINGTON, NC
28443(910)270-5000
JAN 3 0 2020

I,MARC P.GLENN.C9RTlPY THAT THIS PROPIXTY WAS SURVEYED AND MAP DRAWN UNDER MY SUPERVISION: I
DE3CR/PT1ON AS 5l1OWN ON THE PACE OF THIS PLAT:RATIO OF PRECISION A5 CALCULATED BY COMPLIER
IS I:20.000+;THAT THE DOUNDARI NOT SURVEYED ARE 5fOWN 6Y 6ROKEN UNES PLOTTED PROM Of 1"L. t- 4
INFORMATION REFERENCED:THAT THIS PLAT WAS PREPARED IN ACCORDANCE KTTH'RUE STANDARDS OF
;1
PRACTICE FOR LAND SURVEYING IN NORTH CAROUNA':w1TNE55 MY ORIGINAL SIGNATURE.UCENSURE
NUMBER AND SEAL THIS 27771 DAY OP MARCH A.D. 2019. t t1111111111 "1 1
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I,MARC F.GLENN,CERTIFY THAT THIS PROPERTY WAS SURVEYED AND MAP DRAWN UNDER MY SUPERVISION: €
DESCRIPTION AS SHOWN ON THE FACE OF THIS PLAT;RATIO OF PRECISION AS CALCULATED BY COMPUTER `
IS 1:20,000+;THAT THE BOUNDARIES NOT SURVEYED ARE SHOWN BY BROKEN LINES PLOTTED FROM s Qp
INFORMATION REFERENCED;THAT THIS PLAT WAS PREPARED IN ACCORDANCE WITH THE STANDARDS OF
PRACTICE FOR LAND SURVEYING IN NORTH CAROLINA";WITNE55 MY ORIGINAL SIGNATURE,LICENSURE �„ t /
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PLAT BOOK 36 PAGE 47 I I I
JANUARY 17, 2020 I NHWL LINE TABLE
LINE LENGTH BEARING •
SITE PLAN FOR PROPOSED POOL PREPARED FOR L I 13.91 N39°04'09"E
Timothy J. Fischer and Monica M. Fischer L2 20.12 N51°13'O5"E U
L3 15.18 N63°29'O 1"E Z
#107 ANNA COURT L4 /9.74 N21°22'23"E
LOT 3 I R LONG POINT ESTATES L5 12.79 N30°26'45"E W 0 N
LG 15.67 N 1 O°43'47"W -.
TOPSAIL TOWNSHIP PENDER COUNTY ' f— c.�
L7 19.77 N3/31'07"W
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WILMINGTON,NC 28411 q =CENTERLINE IN ZONE AE 12 0
5 MI I910I-618-4210 =RIGHT OF WAY FIRM COMMUNITY PANEL
RAN N 37203291 J
fAX19101319-7325 ROM LICI0758 AREA BY COORDINATE METHOD DATED:2/16/2007

eo , Meertg PENDER COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH DIVISION
4� ���� 803 Walker Street,P.O.Box 1209
Burgaw,NC 28425
Phone [phone] FAX [phone]
•O; i I www.pendercountync.gov
North ClIf011111 PubYc Haft
b.r.ee,k frond*& rests
WASTEWATER SYSTEM CONSTRUCTION AUTHORIZATION
Parcel PIN: 3291-06-5800-0000 Permit#: 101972
Application Date: 11/01/13 Associated IP#: 101972
Applicant: Carol Ivey Owner Hamilton Wells
Address: 6422 Chalfont Cr. Address: 6211 Wrightsville Ave Unit 161
Wilmington,NC 28405 Wilmington,NC 28403
Phone: [phone] Phone: [phone]
Property Address: Anna Court Lot Size(Acres):
Property Description: Long Point Estates Lot 31 Facility Type: Single Family Dwelling
Permit Type: Residential Revision Water Supply: Private Well
INITIAL SYSTEM REPAIR SYSTEM
Design Flow: 480gpd System Type: Brunswick Bed&FIB System Type: Peat Type A
No.of Bedrooms:4 System Class:me System Class: y
Septic Tank: 1000gal(min) Nitrification:3'x 304' Nitrification:(2)8'x 22.5'
Pump Tank: N/A Max Trench Depth: is,' Max Trench Depth:See Site Plan
noriz Trench Separation: 3 feet Horiz Trench Separation: Bed
Conditions/Comments:
-NOT DESIGNED FOR GARBAGE DISPOSAL.
-Brunswick Bed&Fill (16 lines Q 19'long) (24'x 38'Bed)
-Excavate 30"and backfill with clean group 1 sand.
-Install bed 18"from natural soil surface.
-On site pre construction meeting required before installation.
-IF GRAVITY FLOW CANNOT BE MAINTAINED A PUMP TANK WILL BE REQUIRED.
ZONING#132404
REFER TO THE ATTACHED SITE PLAN SHOWING THE SYSTEM AND FACILITY LOCATIONS AND OTHER SYSTEM SPECIFICATIONS.
THIS AUTHORIZATION SHALL BECOME INVALID AND MAY BE REVOKED IF THE INFORMATION SUBMITTED ON THE APPLICATION V
OR SITE PLAN IS INCORRECT,FALISIFIED,OR CHANGES OR IF THE SITE IS ALTERED OR IF THE SYSTEM INSTALLATION IS NOT Z
COMPLETED BEFORE THE EXPIRATION DATE. THE SYSTEM SHALL BE INSTALLED IN ACCORDANCE WITH:
0-1NORTH CAROLINA ADMINISTRATIVE CODE TITLE ISA.1900, O o
APPLICABLE SYSTEM APPROVALS, W
-PENDER COUNTY HEALTH DEPARTMENT POLICIES. \ F— N
ISSUED:3-11-14 �,/ �"~'f EXPIRES:02/05/16
Registered Environmental Health Specialist LI
[� 1

Typical Setbacks Required By State Rules Unless Otherwise Specified In Writing:
1. Any private water supply sources,including any well or spring 100 feet
2.Any public water supply source 100 feet
3. Streams classified as WS-I 100 feet
4.Any other stream,canal,marsh,or other surface water 50 feet
5. Any Class I or Class II reservoir 100 feet from normal pool
elevation
6.Any permanent storm water retention pond 50 feet from flood pool
elevation
7. Any other lake or pond 50 feet from normal pool
elevation
8. Any building foundation or building footing 5 feet
9.Any property line 10 feet
10. Top of slope of embankments or cuts of 2 feet or more 15 feet
11. Any water line 10 feet
12. Drainage systems:
A) Interceptor drains,foundation drains,and storm water diversions
I)upslope from system 10 feet
II) sideslope from system 15 feet
III)downslope from system 25 feet
B)groundwater lowering ditches and devices 25 feet
13. Any swimming pool 15 feet
14. Any other nitrification field(except repair area) 20 feet
15. Drip line(outermost edge of a structure) 5 feet
Any changes to the proposed plans must be approved by the PCHD
Please do not allow any traffic,construction,excavation,utilities,material storage,or any other disturbance to take
place on the designated septic areas. These activities may void your permit.
The Owner is responsible for marking any property lines,corners,proposed house site,outbuildings,decks and
driveways. The Contractor is responsible for ensuring that the well or septic system is installed in the proper
location and that all setbacks and conditions on the permit arc met.
e
The system must be installed/repaired by a Registered Septic System Contractor
For systems with a pump,the Registered Septic Contractor is responsible for insuring the proper installation of the
electrical components. An electrical permit must be obtained and a person with a valid North Carolina SP-PH
Electrical license must provide electrical service to the pump controller and alarm.
It is the responsibility of the Registered Septic Contractor to call the PCHD to schedule the installation inspections.
R
The Registered Septic Contractor is responsible for backfiiling the system components so that no areas are subject to
the retention or ponding of surface water.
•
After the installation is completed,some settling of the backfill material may take place. The system Owner is
responsible for eliminating settled or sunken area,stabilization,and final landscaping of the ground surface.
When the Construction Authorization is issued for a Conventional or Accepted System,the Owner may choose to
substitute any Accepted System for the permitted system,provided there are no changes necessary in the specific
line locations,depths,or distribution system. When a substitution is made,verification that the Owner made the
system choice will be required prior to issuance of the Operation Permit
It is the responsibility of the Owner to ensure proper maintenance. RECEIVED
- _ I'rCM Wu MINGTON, NC
J A N 3 0 2020

Fender County Health Department
• NC. r- Environmental Health Division
803 Walker Street, P.O. Box 1209
. .: Burgaw,NC 28425
Phone:[phone] Fax:9io-259-1404
www.pendercountync.gov
Wastewater System Operation Permit
Parcel Pin: 3291-06-58(10 Permit Number: 101972
Property Address: Anna Court Facility Type: Single Family Dwelling
Property Description:Long Point Lot 31
Owner: Carol Ivey System Operator: n/a
Address: 6422 Chalfont Circle REQUIRED INSPECTIONS
Wilmington,NC ORC Inspection every:
System Installer: RSC PCHD Inspection every:
System Classification: Pump to Brunswick Bed
System Type: IIIbc
In accordance with NCGS i3oA-u and 15A NCAC i8A Section.1900,This Operation Permit is issued to:
Carol Ivey
For the operation of a 480 GPD wastewater treatment and disposal system.
Conditions
L 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.
a.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.1.961.
4.The owner,or other contractually responsible party if applicable,is responsible for compliance with 15A NCAC i8A section.t9oo.
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 drainfield.
n.Refer to the'as-built'inspection record on file at PCHD for system installation specifications.
ia.Permits for Types V and VI systems expire in 5 years.Owner must contact PCHD 6 months prior to expiration for permit renewal.
13.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.
14.Unless specifically allowed for on the Construction Authorization,systems are not designed for garbage disposal use.
1.5.See page a for any additional conditions.
This permit may be suspended or revoked for non-compliance with any permit condition.
RECEIVED
DCM WILMINGTON, NC
ISSUED: 09 March 15 JAN 3 0 2020
Registered En " ental Health Specialist

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DCM WILMINGTON, NC
PEN COUNTY HEALTH DEPE
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Receipts for
Certified Mail
,i. (Staple Here)
011 LA P-
ovine-of_
rv�'pa N 3
City,State,Zip Code
Dear Adjacent Property:
This letter is to inform you that 1, --t; SC have applied for a CAMA Minor
Owner
Permit on my Properly at 1D7 4 n,nta r D g f i f :n COUNTYProperty Address
County. As required by CAMA regulations,;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 9 .4 . ,or by mail at the address listed below. if you wish tc
Appii.:. ' elephohe
file written comments or objections with the LOCAL GOVERNMENT CAMA Minor Permit Program,you may submit
them t:
L.°O NAME
Local Permit Officer for LOCAL GOVERNMENT
LOCAL GOVERNMENT ADDRESS
CITY,STATE,ZIP CODE
Sincerely,
.o, er
Mailing Address
,2.1y41
City,State,tip Code
RECEIVED
DCM WILMINGTON, NC
JAN 3 0 2020

ADJACENT RIPARIAN PROPERTY OWNER
STATEMENT FOR CAMA MINOR PERMITS
1 hereby certify that 1 own property adjacent to I v� r o S�L
(Na., Property Owner)
property located at 67 , ,-w1
'�
Address,Lot,Block,R d,etc.)
on :12/r c6A5-71a G^�4cd� ,N.C.
(Waterbody) Town#id/or County)
He has described to me as shown in the attached application and project drawing(s),the development
he is proposing at that location,and, have no objections to his proposal.
(APPLICATION AND DRAWING OF PROPOSED DEVELOPMENT ATTACHED)
czutitr
Signature
Print or iype Name
COD Z-iu i `d1L
Telephone Number
j2iJLf/ 201C1
Date
RECEIVED
DCM WILMINGTON, NC
JAN 3 0 2020

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0EA$ $Lut
30 COVIL AVENUE
0-r; WILMINGTON, NC 28403 US
-` (910) 7993022
POOLS&SPAS [e-mail]
www.oceanbluepoolsandspas.com
ADDRESS SHIP TO Estimate 2784
Tim Fischer Tim Fischer
107 Anna Ct '07 Anna Ct
Hampstead, NC 28443 Hampstead, NC 28443 DATE 09'26/2019
POOL TYPE SALES REP
Leisure Riviera 30 Derek
DATE ACTIVITY QTY RATE AMOUNT
09/26/2019 Inground Pools:Leisure Pool Riviera 1 37,703.00 37,703.00
30
Building and Electrical Permits
Excavation and Installation
Backfill excavation area
Plumbing of pool
Hayward Variable Speed Pump
2 LED Lights with remote
Hayward Sand Filter
Hayward Salt Generator
Electrical hook up for pump and salt
generator
Skimmer,2 returns and 2 main drains
Handrail, Cleaning pole and brushes
and Equipment pad
Startup chemicals
Leisure Start Up Kit
Freeze Protection Timer
1st Pool Cleaning
Zinc Anode
Warranty
4 of broom finished concrete on three
sides and 10 on shallow end=Approx.
549 SF
All estimates includes standard Boom
Crane for install - all larger crane will
have an additional fee based on site
survey or site changes since site
survey
RECEIVED
DCM WILMINGTON, NC
JAN 3 0 2020

;tx= ACTIVITY QTY RATE AMOUNT
09/26/2019 Concrete 1 -4,666.50 -4,666.50
credit back for unused concrete
approx 549 SF
09/26/2019 24x12 Ivory/Silver Travertine 1 1,260.00 1,260.00
Coping Ivory/Silver Travertine per
Piece Installed approx 40.pieces
09/26/2019 Travertine Decking 1 14,964.00 14,964.00
approx 516 SF of travertine
10/01/2019 Travertine Decking 10,440.00 10,440.00
additional travertine for pathway to
customer provided outdoor shower
and for under sunroom area in
octagon shape approx 360 SF total -
final numbers to be confirmed upon
installation
10/02/2019 Landscaping:Dec k Jets 3 300.00 900.00
Deck Jets/Water Spouts
If larger crane is required that is additional cost
If we hit uncontrollable water that requires a dewatering system
that is additional cost
Homeowner responsible for moving electrical and plumbing
lines for well and geo thermal system
Homeowner responsible for making fence pool code
-OTAl. $60,600.50
Accepted By Accepted Date
RECEIVED
DCM WILMINGTON, NC
JAN 3 0 2020

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Suitability and adaptability are the words that are most often
used to describe our Riviera'" pool. This is a swimming pool GENEROUS SAFETY LEDGE AROUND
ENTRYJEXIT
ea: �" PERIMETER OF POOL
., ., design that seems to blend perfectly with any home style and STEPS
-�+W TUTUREO FlW9q „..•`'''.. .we". .....
any home site. Its beautiful flowing lines and free form design ✓~ w,
'.- -4--0--,.. ,. area delight to landscape. '-- ''
You can choose a tropical setting or combine the pool with rock
landscaping and waterfalls,or use feature timber or even more DEEP END STEP
&swIMQUT
formal paved areas. It doesn't seem to matter as The Riviera'
always seems to be the perfect centerpiece for any LARGE ' -_ --'-,- `' - +
landscape design. NCPED PE
RENCN SEAT •
Good looks is not the only feature of The Riviera'"as this style is SHALLOW END BEEP END
- truly a great pool for the family. The large, wrap-around bench ,_ _
at the shallow end is agreat feature. Not play
only is it a la area �� .`� _.__....�.___
. for the kids but it's just perfect for adult seating as well. The -----,
Y ' t'
- . "j. -..' ` `------�
wide steps give access to the bench area and also to the floor "— - .._..
of the pool. The main body of water is generous in size and
ideal for playing games and swimming.
The Riviera"' is one ar ,,, r:,FraenTf{
** "" a'4 \ combines landscaping
of versatilityourmost withpopul a functipoolsonality thatbecause willit 4,'.'
- suit any family. {
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Date Date Check From Name of Vendor Check Check Permit Rct. #
Received Deposited Permit Holder Number amount Number/Comments
2/3/2020 Ocean Blue Pools Tim Fisher First 100352 $100.00 minor fee, 107 Anna Ct, JD rct.
and Spas of NC Citizens Hampstead PnCo 10955
Bank