PN_20-14_ Brock

Issued by WiRO PN20.14
Pender County Permit Number
CAMA
MINOR DEVELOPMENT
PERMIT
NORTH CAROLINA
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 environment
concern pursuant to Section 113A-118 of the General Statutes, "Coastal Area
Management"
Issued to Tim and Terry Brock authorizing development in the Estuarine Shoreline (AEC) at 33 Long Point Lane (Lot
R6B), in Hampstead, Pender County as requested in the permittee's application, dated July 12, 2020, and received by
DCM on July 20, 2020. This permit, issued on August 11, 2020, is subject to compliance with the application and
drawing dated and received by DCM on July 20, 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: Single-family residence with amenities.
(1) All proposed development and associated construction must be done in accordance with the permitted site drawing dated
received by DCM on July 20,2020.
(2) Any change or changes in the plans for development, construction, and/or land use activities will require re-evaluation and
modification of this permit.
(3) 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)
w
This permit action may be appealed by the permittee or other qualified persons /4‘./e
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 CAM OCAL PERMIT OFFICIAL
this permit,require further written permit approval.All work must cease when this
permit expires on: 127 Cardinal Drive Extension
Wilmington, NC 28405-3845
December 31,2023
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)

A s
Name: Tim and Terry Brock
Minor Permit#PN20.14
Date: August 11, 2020
Page 2 of 2
(4) 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.
(5) Any proposed for grading within the 30' Coastal Shoreline buffer (as measured 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 vegetated and stabilized and must remain in a vegetated state.
(6) This permit does not authorize the excavation or filling of any wetlands,even temporarily.
(7) No impervious coverage/built upon area, including but not limited to the house (including eaves), foundation pad,
covered decking,etc. shall extend into the 30-foot coastal shoreline buffer.
(8) The amount of impervious surface/coverage on this property shall not exceed 25% within 575 feet of the Normal
High Water line.
(9) All structures shall comply with the NC Building Code, including the Coastal and Flood Plain Construction Standards
of the N. C. Building Code, and the Local Flood Damage Prevention Ordinance as required by the National Flood
Insurance Program. If any provisions of the building code or a flood damage prevention ordinance are inconsistent
with any of the following AEC standards, the more restrictive provision shall control.
(10)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: DATE:
PERMITTEE

ROY COOPER
Gaverwr
4 Zir
,a>f MICHAEL S. REGAN
fp. .Secretary
BRAXTON DAVIS
I iirector
August 12, 2020
Tim &Terry Brock
33 Long Point Lane
Hampstead, NC 28443
Dear Tim and Terry,
Attached is CAMA Minor Development Permit PN 20-14 for work to be done at 33 Long Point Lane,
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 blue 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.
incerely,
anya K Pietila
Permit Support Technician
N.C. Division of Coastal Management
Enclosures
Cc:WiRO files
PN Inspection Dept.
Jeff Morris-Agent
State of North Carolina I Environmental Quality I Coastal Management
127 Cardinal Drive Ext.,Wilmington,NC 28405
919 796 7215

A---- ?1•\ C.A r6% A
Locality WalnikTPit& Permit Number 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
Ocean Hazard Estuarine Shoreline ORW Shoreline Public Trust Shoreline Other treatment system),Building,Electrical,Plumbing,Heating and Air Conditioning,Insulation and Energy Conservation,FIA
(For official use only) Certification,Sand Dune,Sediment Control,Subdivision Approval,Mobile Home Park Approval,Highway Connection,and
others.Check with your Local Permit Officer for more information.
GENERAL INFORMATION
STATEMENT OF OWNERSHIP:
LAND OWNER-MAILING ADDRESS I,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
G BroYk
Name Vol yp listed as landowner on this application has a significant interest in the real property described therein.This interest can be
33 lc,., �.' described as:(check one)
Address �/ S n>< �p.A ,�- ,/ �1 L
City 14129�d State i(/C, Zip 21i2WJ Phone f'O Z97—57 '7 Van owner or record title,Title is vested in name of Zcr4i4 Fe..bk j P,, &1,c4 ,
// ,, r; see Deed Book ftGSS page Z5Y3 in the County Registry of Deeds.
Email .'i_f2r�ec cii,..,(0.e•L,4SO/us{.S.sS,e lams,
AUTHORIZED AGENT _an owner by virtue of inheritance.Applicant is an heir to the estate of
7 ;probate was in County.
✓Name e C /Y/o ram;S
Address ,a dif
47A/ �84 if other interest,such as written contract or lease,explain below or use a separate sheet&attach to this application.
City Or/„a,. a4a, State ,T/,( Zipayiig Phone _._c'p 279-3 58 NOTIFICATION OF ADJACENT RIPARIAN PROPERTY OWNERS:
I furthermore certify that the following persons are owners of properties adjoining this property.I affirm that I have given
Email_ � 1 lg.�., ACTUAL NOTICE to each of them concerning my intent to develop this property and to apply for a CAMA permit.
e (Address)
/dress
LOCATION OF PROJECT:(Address,street (Nam
el
name and/or directions to site;name of the adjacent waterbody.) (I) ,(yj /e /e 4)415,4.+71-/ 77 /�n[lee v O P, WI4: 1.tbc tow/
35 Lt.,/ P;.,,z. 14.E / f4. s 4/ ,Iic, zs.,g3 (2) ,ems ,c/ta-tt<et / s/ Ls" Av./ ..,. , s, A/C ZRWy3
(3) b S AA./&st44-4 A 2,arc, /06 44-A�.-,.x,At6.p rl.,s,dC Zihivs
(4)
DESCRIPTION OF PROJECT:(List all proposed construction and land disturbance.) ACKNOWLEDGEMENTS:
/ I,the undersigned,acknowledge that the land owner is aware that the proposed development is planned for an area which
LL
.7%9f/e /� re�f14See/ /Z/i✓tS O✓15) - �7, r- syd"4"-) 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 stabilize-
SIZE OF LOT/PARCEL: 2Z 4/14 square feet Qt/Z. ,acres tion and floodproofing techniques.
PROPOSED USE:Residential( (Single-family❑ Multi-family❑) Commercial/Industrial❑ Other a I furthermore certify that 1 ant 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
COMPLETE EITHER(1)OR(2)BELOW(Contact your Local Permit Officer if you are not sure which AEC applies related to this permit application.
to your property):
This the day of ,20
(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 but2
excluding non-load-bearing attic space) Lan owner or tsar n hod z o act as his/her ages urpose of fir g a CA A permit application
(2) COASTAL SHORELINE AECs:SIZE OF BUILDING FOOTPRINT AND OTHER IMPERVIOUS OR BUILT
This appli lion Includes:general information(this form),a site drawing as described on the back of this application,the
UPON SURFACES: f3square feet(includes the area of the foundation of all buildings,driveways,covered decks,
a check ownership statement,the Ocean Hazard AEC Notice where necessary,
concrete or masonry patios,etc.that are within the applicable AEC.Attach your calculations with the project drawing.) for$100.00 made payable to the locality,and
any information as may he provided orally by the applicant.The details of the application as described by these sources are
STATE STORMWATER MANAGEMENT PERMIT:Is the project located in an area subject to a State incorporated without reference in any permit which may be issued.Deviation from these details will constitute a violation of
Stormwater Management Permit issued by the NC Division of Energy.Mineral and Land Resources(DEMLR)? any permit Any person developing in an AEC without permit is subject to civil,criminal and et i srrprt,geotI E D
YES ✓ NO DCM WILMINGTON NC
If yes,list the total built upon area/impervious surface allowed for your lot or parcel: 4pGd square feet.
JUL 2 0 2020

Locality Permit Number 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
Ocean Hazard Estuarine Shoreline ORW Shoreline Public Trust Shoreline Other treatment system),Building,Electrical Plumbing,Heating and Air Conditioning,insulation and Energy Conservation,FIA
(For official use only) Certification,Sand Dune,Sediment Control,Subdivision Approval,Mobile Home Park Approval,Highway Connection,and
others.Check with your Local Permit Officer for more information.
GENERAL INFORMATION
STATEMENT OF OWNERSHIP:
LAND OWNER-MAILING ADDRESS 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
Name 7701 e $rDct listed as landowner on this application has a significant interest in the real property described therein.This interest can be
Address 33 1.01 described as:(check one)
.S n,l �4,x'
City w.0-94VL✓ State 4,' Zip Z1?f45"Phone PO Z97-57r7 Wean owner or record title,Title is vested in name of Zr i�i iet'le4 jar it,,i4 �4 .i / ch
Email Tt�. e ,/,"/<:(�J1�G,4SO4u1ry rS ,co see Deed Book S$ page Z3`><aj in the /�irGL�r County Registry of Deeds.
AUTHORIZED AGENT an owner by virtue of inheritance.Applicant is an heir to the estate of
;probate was in County.
Name JJe..p:' h2,re•S
if other interest,such as written contract or lease,explain below or use a separate sheet&attach to this application.
Address /RO, aomr Sap 5J
City 0+41 4. State il/.(, Zip Phone 9/p 279-y53$ NOTIFICATION OF ADJACENT RIPARIAN PROPERTY OWNERS:
1 furthermore certify that the following persons are owners of properties adjoining this property.I affirm that I have given
Email a %!�„l 99 ,y�,�la..-, ACTUAL NOTICE to each of them concerning my intent to develop this property and to apply for a CAMA permit.
(Name (Address)
LOCATION OF PROJECT:(Address,street name and/or directions to site;name of the adjacent waterbody.) (I) ,4,d r; /ers/G 60415.ts,41-/ 775/$.t glee/#4%4c ,ZJIi,Y'41 4/C esll/
33 ZPv J i ,4 24.$r-/A6AJ64d r A/C, Z S'/'3 (2) a S...4 .f�l.YAt6R� / s� 2a3 Av./l��,e/Ar61, ,' AlC ZcW3
•� (3) I,i, 40,7./e s✓s4-4. Aead,X;ic, /OG 4***£wr,e/41. ,L1tn/.f/G l}?iki
(4)
DESCRIPTION OF PROJECT:(List all proposed construction and land disturbance.) ACKNOWLEDGEMENTS:
/ _ / i,the undersigned,acknowledge that the land owner is aware that the proposed development is planned for an area which
5,Vie-FI r/, J�'SJC&eei n/i'.,�i �15 f�C I p i4C f9'l u"i may be susceptible to erosion and/or flooding.l 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-
SIZE OF LOT/PARCEL: 2Zig54 square feet 6,,11 Z acres tion and floodproofing techniques.
PROPOSED USE:Residential Eir (Single-family❑ Multi-family❑) Commercial/Industrial 0 Other 0 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
COMPLETE EITHER(1)OR(2)BELOW(Contact your Local Permit Officer if you are not sure which AEC applies related to this permit application.
to your property):
This the -ir day of ', ,20 20
(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 /chterj
excluding non-load-bearing attic space) Landowner or person authorized to act as his/her agent for purpose of filing a CAMA permit application
(2) COASTAL SHORELINE AECs:SIZE OF BUILDING FOOTPRINT AND OTHER IMPERVIOUS OR BUILT This application includes:general information(this form),a sire drawing as described on the back of this application,the
UPON SURFACES: square feet(includes the area of the foundation of all buildings,driveways,covered dicks, ownership statement,the Ocean Hazard AEC Notice where necessary,a check for$100.00 made payable to the locality,and
concrete or masonry patios,etc.that are within the applicable AEC.Attach your calculations with the project drawing.)
any information as may be provided oral!y by the applicant.The details of the application as described by these sources are
STATE STORMWATER MANAGEMENT PERMIT:Is the project located in an area subject to a State incorporated without reference in any permit which may be issued.Deviation from these details will constitute a violation of
Stormwater Management Permit issued by the NC Division of Energy.Mineral and Land Resources(DEMLR)? any permit.Any person developing in an AEC without permit is subject to civil,criminal and administrative action.
YES ✓ NO RECEIVED
If yes,list the total built upon area/impervious surface allowed for your lot or parcel: 4011e2 square feet. DCM W I LM I NGTON m NC
JUL 2 0 2020

SITE PLAN / LOCATION MAP \
SOT
WILT)
LONG POINT ESTATES ,� ��S 4' OA, / R HIGHWAY 17
SECTION 5, LOT R6B ¢� /' , N N\ t FSRo S, �3 CENTER DR.
TOPSAIL TOWNSHIP, PENDER COUNTY, NORTH CAROLINA p''? / ./.
\ 44�w\ q0 Z
DATE: JULY 9, 2020 .FISIF JOME VT v.. / / N N �c LONG POINTER
OM / / N. \
IMPERVIOUS SURFACE CALCULADONS / \ \ S. /
DRIVES\PORCHES 7 S-F 2,248 SF , // \ \
0 / / \ \
MAX ALLOMED 8,000 SF(PER CM-NAMES RP' A / / \ \ I
RECORDED AT BOOK 3129 PAGE 14) ® / \1
ir / \N. I
4` x� � / \ I as
/ I
riot: / I
/ All n\1 WHISNANT401' I
OT SBR I
,Q' "1k
/ ,� LONG POINTS ESTATES I
p$� / // II 11111. MB 4B PG 142 I
c CO+r� G\ / I
ME I
mE..a f�QO'`4 �. 1
000
\ yvs / / �. ,G
iJ DOKo1ErE / D' I1 \ 1
\ '�fl' i \\\ / •'44SED ^/'4 i \� /
cosnrk TOR SEPlIC
\\/ / \/ / N \\ RAW AM9tl1091 FIY)TN.tM1UUu/ / /\ nvn OWV X•77 to TB An MW uIery'I /�
/ \ PLATFORM / v\ y7 /
/ \ �Ae
\ \\ g /
\ / \ RY' /
0171.TOY' V+ \\ 1 °Nil \ �/ //
/ e
n\T NORMAN . \ / //
LOT R79 \\ c� / (s'/ a
Q LONG POINTE ESTATES ,�j
LEGEND MB 48 PG 1I6 0\ / ///A Btp�u51 ARG
+24.1 - SPOT ELEVADON T \\/ 5 WALL S A� LLIRVr N4TOADI 23.59'I N 52.22"58'1 ElC" 27.S9pG 1
E.I.P. - EXISTING IRON PIPE 1 1 / \ // C1
El. - COSTING IRON �' C ///vVV/ h, \moo. _��.4 4
E.C.M.- EXISTING CONCRETE MONUMENT G C m ..OT' \s
004
R\W - RIGHT OF WAY \�I^ ///
C.P. - COMPUTED POINT n \`r /� 4 MEAN NIGH WATER LINE
\- J/ 4 FLAGGED BY JASON DNL
\' / 4
zm \
a4:.aEsslp-,4L9s IV < \ // 20' 10' 0 20'
N Nom
E ;a SEAL ..' 0 s
i L-3391 ; E' G 7 SCALE Y FTET
„°,,ANlu,,`d„ z
OPEN SPACE THIS MAP IS NOT FOR RECORDATION
LONG POINTE ESTATES
I CERTIFY THAT THIS MAP WAS DRAWN UNDER MY SUPERVISION FROM AN ACTUAL 1p MB 44 PG 59 HANOVER DESIGN SERVICES, P.A.
SURVEY 1MADE UNDER MY SUPERVISION(DEED DESCRIPTION RECORDED IN BOOK b // LAND SURVEYORS,ENGINEERS&LAND PLANNERS
PAGE=OR OTHER REFERENCE SOURCE AV ):THAT THE BOUNDARIES NOT
SURVEYED ARE INDICATED AS DRAWN FROM INFORMATION IN BOOK=,PAGE ,14
OR OTHER REFERENCE SOURCE N\A •THAT THE RA710 OF PRECISION OR -_ // 1123 FLORAL PARKWAY
POSITIONAL ACCURACY IS 2O. 4+ •AND THAT THIS,OUP MEETS THE REQUIREMENTS ,. - / WIL.MINGTON,N.C. 28403
OF THE STANDARDS OF PRACTICE FOR LAND SURVEYING IN NORTH CAROIJNA(2INCAC _._,/ PHONE: al
THIS DAY OF(l!y' 2020. vAN ` ------
---- LICENSE#C-0597
JONATHAN L.WAYNE PLS 3391 15276 Long Pont Wt.plan-JLW

SITE DRAWING/APPLICATION CHECKLIST
Please make sure your site drawing includes the following information required for a CAMA minor development permit.
The Local Permit Officer will help you,if requested. t-.
PHYSICAL DIMENSIONS N
APPLICATION FOR
Label roads Z
CAMA MINOR z
Label highways right-of-ways
Label local setback lines DEVELOPMENT
Label any and all structures and driveways currently existing on property Coastal Management
_Label adjacent waterbody
ENVIRONMENTAL QUALITY
PHYSICAL CHARACTERISTICS PERMIT
Draw and label normal high water line(contact LPO for assistance) In 1974,the North Carolina General Assembly passed the Coastal Area Management Act
Draw location of on-site wastewater system
(CAMA)and set the stage for guiding development in fragile and productive areas that
If you will be working in the ocean hazard area: border the slate's sounds and oceanfront.Along with requiring special care by those who
_Draw and label dune ridges(include spot elevations) build and develop,the General Assembly directed the Coastal Resources Commission
_Draw and label toe of dunes \ (CRC)to implement clear regulations that minimize the burden on the applicant.
_Identify and locate first line of stable vegetation(contact LPO for assistance)
_Draw and label erosion setback line(contact LPO for assistance) / This application for a minor development permit under CAMA is part of the
Draw and label topographical features(optional) Commission's effort to meet the spirit and intent of the General Assembly.It has been
designed to be straightforward and require no more time or effort than necessary from
If you will be working in a coastal shoreline area: the applicant.Please go over this folder with the Local Permit Officer(LPO)for the
Show the roof overhang as a dotted line around.he structure locality in which you plan to build to be certain that you understand what information he Qt-.
Draw and label landward limit of AEC or she needs before you apply. "
_Draw and label all wetland lines(contact LPO for assistance) r
Draw and label the 30-foot buffer line
Under CAMA regulations,the minor permit is to be issued within 25 days once a
DEVELOPMENT PLANS complete application is in hand.Often less time is needed if the project is simple.The
process generally takes about 18 days.You can speed the approval process by making
Draw and label all proposed structures certain that your application is complete and signed,that your drawing meets the
_Draw and label areas that will be disturbed and/or landscaped specifications given inside and that your application fee is attached.
Note size of piling and depth to be placed in ground
_Draw and label all areas to be paved or graveled Other permits are sometimes required for development in the coastal area.While these
_Show all areas to be disturbed are not CAMA-related,we urge you to check with the Local Permit Officer to determine
Show landscaping which of these you may need.A list is included on page two of this folder.
NOTE TO APPLICANT
We appreciate your cooperation with the North Carolina Coastal Management Program
Have you: and your willingness to build ins way that protects the resources of our beautiful and
• completed all blanks and/or indicated if not applicable? productive coast.
• notified and listed adjacent property owners?
• included your site drawing? Coastal Resources Commission
• signed and dated the application? Division of Coastal Management
• enclosed the$100.00 fee? rn
• completed an AEC Hazard Notice,if necessary?(Must be signed by the property owner) .rn
i3 FOR STAFF USE
.<n
tnt- q
Site Notice Posted__Fir2nsction Fee Received ----- ❑m rn
Site Inspections C__. SS
tt'rri
f t— 0 0 5m ❑z 2
Date of Action:Issue_,.—, %E,pted Denied Appeal Deadline(20 days from permit action), CK'.
.�
IV ` M Form 1iB195?-2a15/Rcvised
t" O m
z0
Z
0

U.S. DEPARTMENT OF HOMELAND SECURITY OMB No. 1660-0008
Federal Emergency Management Agency Expiration Date: November 30,2022
National Flood Insurance Program
ELEVATION CERTIFICATE
Important: Follow the instructions on pages 1-9.
Copy all pages of this Elevation Certificate and all attachments for(1)community official, (2)insurance agent/company,and(3)building owner.
SECTION A-PROPERTY INFORMATION FOR INSURANCE COMPANY USE
Al. Building Owner's Name Policy Number:
Tim&Terry Brock
A2. Building Street Address(including Apt., Unit,Suite,and/or Bldg. No.)or P.O. Route and Company NAIC Number:
Box No.
33 Long Point Lane
City State ZIP Code
Hampstead North Carolina 28443
A3. Property Description(Lot and Block Numbers,Tax Parcel Number, Legal Description,etc.)
Lot R6B, Section 5, Long Point Estates, Map Book 48 Page 142
A4. Building Use(e.g., Residential, Non-Residential,Addition,Accessory,etc.) Residential
A5. Latitude/Longitude: Lat.34.33716 Long.-77.70724 Horizontal Datum: ❑ NAD 1927 Q NAD 1983
A6. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance.
A7. Building Diagram Number 6
A8. For a building with a crawlspace or enclosure(s):
a) Square footage of crawlspace or enclosure(s) 300.00 sq ft
b) Number of permanent flood openings in the crawlspace or enclosure(s)within 1.0 foot above adjacent grade 2
c) Total net area of flood openings in A8.b 400.00 sq in
d) Engineered flood openings? X❑Yes ❑ No
A9. For a building with an attached garage:
a) Square footage of attached garage 1290.00 sq ft
b) Number of permanent flood openings in the attached garage within 1.0 foot above adjacent grade 7
c) Total net area of flood openings in A9.b 1400.00 sq in
d) Engineered flood openings? Q Yes ❑ No
SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
B1. NFIP Community Name&Community Number B2.County Name B3. State
Pender County 370344 Pender County North Carolina
B4.Map/Panel B5.Suffix B6. FIRM Index B7. FIRM Panel B8. Flood B9. Base Flood Elevation(s)
Number Date Effective/ Zone(s) (Zone AO, use Base Flood Depth)
Revised Date
3720/3291 J 02-16-2007 02-16-2007 VE 14.0
B10. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in Item B9:
❑ FIS Profile © FIRM ❑Community Determined ❑ Other/Source:
B11. Indicate elevation datum used for BFE in Item B9: ❑ NGVD 1929 Q NAVD 1988 0 Other/Source:
B12. Is the building located in a Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area(Olpf)Eti
Designation Date: ❑ CBRS ❑ OPA DCM WILMINGTON, NC
JUL 2 0 2020
FEMA Form 086-0-33(12/19) Replaces all previous editions. Form Page 1 of 6

OMB No. 1660-0008
ELEVATION CERTIFICATE Expiration Date: November 30,2022
IMPORTANT: In these spaces,copy the corresponding information from Section A. FOR INSURANCE COMPANY USE
Building Street Address(including Apt., Unit, Suite, and/or Bldg. No.)or P.O. Route and Box No. Policy Number:
33 Long Point Lane
City State ZIP Code Company NAIC Number
Hampstead North Carolina 28443
SECTION C—BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
C1. Building elevations are based on: © Construction Drawings* ❑ Building Under Construction* ❑ Finished Construction
*A new Elevation Certificate will be required when construction of the building is complete.
C2. Elevations—Zones A1—A30,AE,AH,A(with BFE),VE,V1—V30,V(with BFE),AR,AR/A,AR/AE,AR/A1—A30,AR/AH,AR/AO.
Complete Items C2.a—h below according to the building diagram specified in Item A7. In Puerto Rico only,enter meters.
Benchmark Utilized: HDS Vertical Datum:NAVD 1988
Indicate elevation datum used for the elevations in items a)through h)below.
❑ NGVD 1929 © NAVD 1988 ❑Other/Source:
Datum used for building elevations must be the same as that used for the BFE.
Check the measurement used.
a) Top of bottom floor(including basement,crawlspace,or enclosure floor) 9.5 ❑X feet ❑ meters
b) Top of the next higher floor 19.4 © feet ❑ meters
c) Bottom of the lowest horizontal structural member(V Zones only) 16.0 E feet ❑meters
d) Attached garage(top of slab) 9.5 0 feet ❑ meters
e) Lowest elevation of machinery or equipment servicing the building
(Describe type of equipment and location in Comments) 16.0 ® feet ❑ meters
f) Lowest adjacent(finished)grade next to building(LAG) 9.5 Q feet ❑ meters
g) Highest adjacent(finished)grade next to building(HAG) 9.4 © feet ❑ meters
h) Lowest adjacent grade at lowest elevation of deck or stairs, including
structural support 9.5 0 feet ❑ meters
SECTION D—SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION
This certification is to be signed and sealed by a land surveyor,engineer, or architect authorized by law to certify elevation information.
I certify that the information on this Certificate represents my best efforts to interpret the data available. I understand that any false
statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001.
Were latitude and longitude in Section A provided by a licensed land surveyor? ©Yes ❑No ❑Check here if attachments.
Certifier's Name License Number ��.��'`��- CAR%.,,
Jonathan L.Wayne PLS 3391 N O.-ESg_.
Title ' ;;0 - sCiF /0-•�/
Q ti
Professional Land Surveyor �%2 9<•�'=
Company Name = • _
Hanover Design Services, P.A. - , _
Address = `O 94, ,' e
1123 Floral Parkway •> -.. (J _ C.�=�
City State ZIP Code ,�l',%fhan L `Na N��`
Wilmignton North Carolina 28403 ..,""""",,,,,``
Signatur Date Telephone Ext.
.4-,'-a2----- 07-16-2020 [phone] n\a
Copy all ages of this Elevation Certificate and all attachments for(1)community official,(2)insurance agent/company, and(3)building owner.
Comments(including type of equipment and location, per C2(e), if applicable)
Flood Vent data based on using smart vents. RECEIVE(]
DCM WILMINGTON, NC
JUL 2 0 2020
FEMA Form 086-0-33(12/19) Replaces all previous editions. Form Page 2 of 6

OMB No. 1660-0008
ELEVATION CERTIFICATE Expiration Date: November 30,2022
IMPORTANT: In these spaces,copy the corresponding information from Section A. FOR INSURANCE COMPANY USE
Building Street Address(including Apt, Unit,Suite, and/or Bldg. No.)or P.O. Route and Box No. Policy Number:
33 Long Point Lane
City State ZIP Code Company NAIC Number
Hampstead North Carolina 28443
SECTION E—BUILDING ELEVATION INFORMATION(SURVEY NOT REQUIRED)
FOR ZONE AO AND ZONE A(WITHOUT BFE)
For Zones AO and A(without BFE),complete Items El—E5. If the Certificate is intended to support a LOMA or LOMR-F request,
complete Sections A, B,and C. For Items El—E4, use natural grade, if available.Check the measurement used. In Puerto Rico only,
enter meters.
El. Provide elevation information for the following and check the appropriate boxes to show whether the elevation is above or below
the highest adjacent grade(HAG)and the lowest adjacent grade(LAG).
a) Top of bottom floor(including basement,
crawlspace, or enclosure)is ❑feet ❑meters 0 above or ❑below the HAG.
b) Top of bottom floor(including basement,
crawlspace, or enclosure)is ❑feet ❑meters ❑above or ❑below the LAG.
E2. For Building Diagrams 6-9 with permanent flood openings provided in Section A Items 8 and/or 9(see pages 1-2 of Instructions),
the next higher floor(elevation C2.b in
the diagrams)of the building is ❑feet ❑meters ❑above or ❑below the HAG.
E3. Attached garage(top of slab)is ❑feet ❑meters ❑above or ❑below the HAG.
E4. Top of platform of machinery and/or equipment
servicing the building is ❑feet ❑meters ❑above or ❑below the HAG.
E5. Zone AO only: If no flood depth number is available, is the top of the bottom floor elevated in accordance with the community's
floodplain management ordinance? ❑ Yes ❑ No ❑ Unknown. The local official must certify this information in Section G.
SECTION F—PROPERTY OWNER(OR OWNER'S REPRESENTATIVE)CERTIFICATION
The property owner or owner's authorized representative who completes Sections A, B,and E for Zone A(without a FEMA-issued or
community-issued BFE)or Zone AO must sign here.The statements in Sections A, B, and E are correct to the best of my knowledge.
Property Owner or Owner's Authorized Representative's Name
Address City State ZIP Code
Signature Date Telephone
Comments
RECEIVED
DCM WILMINGTON, NC
JUL 2 0 2020
❑Check here if attachments.
FEMA Form 086-0-33(12/19) Replaces all previous editions. Form Page 3 of 6

OMB No. 1660-0008
ELEVATION CERTIFICATE Expiration Date: November 30,2022
IMPORTANT: In these spaces,copy the corresponding information from Section A. FOR INSURANCE COMPANY USE
Building Street Address(including Apt., Unit, Suite, and/or Bldg. No.)or P.O. Route and Box No. Policy Number:
33 Long Point Lane
City State ZIP Code Company NAIC Number
Hampstead North Carolina 28443
SECTION G—COMMUNITY INFORMATION(OPTIONAL)
The local official who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete
Sections A, B, C(or E), and G of this Elevation Certificate.Complete the applicable item(s)and sign below.Check the measurement
used in Items G8—G10. In Puerto Rico only,enter meters.
Gi. ❑ The information in Section C was taken from other documentation that has been signed and sealed by a licensed surveyor,
engineer,or architect who is authorized by law to certify elevation information. (Indicate the source and date of the elevation
data in the Comments area below.)
G2 ❑ A community official completed Section E for a building located in Zone A(without a FEMA-issued or community-issued BFE)
or Zone AO.
G3. 0 The following information(Items G4—G10)is provided for community floodplain management purposes.
G4. Permit Number G5. Date Permit Issued G6. Date Certificate of
Compliance/Occupancy Issued
G7. This permit has been issued for: a New Construction ❑ Substantial Improvement
G8. Elevation of as-built lowest floor(including basement)of the building: a feet ❑ meters Datum
G9. BFE or(in Zone AO)depth of flooding at the building site: ❑feet ❑ meters Datum
G10. Community's design flood elevation: a feet ❑ meters Datum
Local Official's Name Title
Community Name Telephone
Signature Date
Comments(including type of equipment and location, per C2(e), if applicable)
RECEIVED
DCM WILMINGTON, NC
J U L 2 0 2020
❑ Check here if attachments.
FEMA Form 086-0-33(12/19) Replaces all previous editions. Form Page 4 of 6

BUILDING PHOTOGRAPHS OMB No. 1660-0008
ELEVATION CERTIFICATE See Instructions for Item A6. Expiration Date: November 30, 2022
IMPORTANT:In these spaces,copy the corresponding information from Section A. FOR INSURANCE COMPANY USE
Building Street Address(including Apt., Unit, Suite,and/or Bldg. No.)or P.O. Route and Box No. Policy Number:
33 Long Point Lane
City State ZIP Code Company NAIC Number
Hampstead North Carolina 28443
If using the Elevation Certificate to obtain NFIP flood insurance, affix at least 2 building photographs below according to the
instructions for Item A6. Identify all photographs with date taken; "Front View"and"Rear View"; and, if required, "Right Side View"and
"Left Side View." When applicable, photographs must show the foundation with representative examples of the flood openings or
vents,as indicated in Section A8. If submitting more photographs than will fit on this page, use the Continuation Page.
Photo One
Photo One
Photo One Caption Clear Photo One
Photo Two
RECEIVED
DCM WILMINGTON, NC
J U L 2 0 2020
Photo Two
Photo Two Caption Clear Photo Two
FEMA Form 086-0-33(12/19) Replaces all previous editions. Form Page 5 of 6

BUILDING PHOTOGRAPHS OMB No. 1660-0008
ELEVATION CERTIFICATE Continuation Page Expiration Date: November 30,2022
IMPORTANT: In these spaces,copy the corresponding information from Section A. FOR INSURANCE COMPANY USE
Building Street Address(including Apt., Unit, Suite, and/or Bldg. No.)or P.O. Route and Box No. Policy Number:
33 Long Point Lane
City State ZIP Code Company NAIC Number
Hampstead North Carolina 28443
If submitting more photographs than will fit on the preceding page, affix the additional photographs below. Identify all photographs
with: date taken; "Front View" and "Rear View"; and, if required, "Right Side View" and "Left Side View." When applicable,
photographs must show the foundation with representative examples of the flood openings or vents,as indicated in Section A8.
Photo Three
Photo Three
Photo Three Caption Clear Photo Three
Photo Four
RECEIVED
DCM WILMINGTON, NC
JUL 2 0 2020
Photo Four
Photo Four Caption Clear Photo Four
FEMA Form 086-0-33(12/19) Replaces all previous editions. Form Page 6 of 6

ADJACENT RIPARIAN PROPERTY OWNER
STATEMENT FOR CAM MINOR PERMITS
///
hereby certify that 1 awn property adjacent to „ I VA " :s
(Name of Property Owner)
property located at 07- a6 IA/
Addreem,Lot,Block,Road,etc.)
an in N C.
(Waterbody) (Town and/or County)
He has described to me as snown in the attached application and project drawing(s).the development
Pia is proposing at that location. and, I have no objections to his proposal.
APPLICATION AND DRAWING OF PROPOSED DEVELOPMENT ATTACHEDI
Signature
Ant P re4.4ts,L9A.N.,1-
ss,1'4 r
Print or Type Name
tO
Telephone Number
Otos 1
Date
RECEIVED
DCM WILMINGTON, NC
JUL 2 0 2020

a TY OWNER i ADJACENT IPA�,R AN PROPER
G
S T EN FOR CA NIA. MINOR PERMITS
H ni
�` e�„"�i.bf' 3LE'�'��{4 ws'��"t p�,1�i���,p�^!. S°r+wu � -�.,�,'4.�.1,...�,.,,,,,,.. c .w..+.v..,.,.,r+-..,....-.....,......„�.».,,,.....�.... ...,,.._...<.,..
fi f
(Warne of Property Owner)
, ,..
tr'-4,,,*. * 1 /
"--:'''' '"--"t4'-a' '-7.--.), i_ C,4P'"-42.5....1,..*-Att: ,---4,>*--.
Address. v Block,lid,ate,;
1� � (Towna €to County;
Y has ractti:te'y its ate as?,�^iown i;' e j,ta,t.t.---01E`t: ata, t w y%f,
ttiP is r 5 Midi i ?3 a i S have no v is itr'",S' v 1.
u
Priest cr Type Nail e
�^y} «y}
Telephone Nurnceer
y! :,.%,0%, ,.-,,,a;*„:,.,, '-.L,*k,2 ,.,":,;
Date
i .4:4444
taa"' a'',Ztt*Z. 4?,',4z';','1,:„ :''''40:'::',;'-:''',1:'''''''l ', ' , ',4'i,
/ tat
s / a%�j 4�/ �� lir r/ /% r// /ta/
i,' ,� r /a r /j/ / r. - ri % ,
:x i r P7, ;
/ / /✓ r
T
r/ R :CEI VET)
DOM WILIVIII:\IGTON,.,,NC
//ter
' ?to/at �o

image0.lpeg 7/17/20,10:45 AM
r',r�,, / tf y h
ADJACENT RIPARIAN PROPERTYOWNER ° ,
, STATEMENT FOR v% I �,
yr
3 hereby cortf that 1 ewn property ad�^acent to r 4 r, '
., `
(Name of Property Owner)
property late at 3 3 Ire,, ;-- t-, .._� .._
Address,Lot,Block,Road,etc.)
or l� ;n >4"% N
////////�/%j % (Waterbody) (Town andtor County) _
I
He has described to me as shown In the attached application and project araw,ng(s),the development
e is prqaosing at that locatw0 ana,i have no objections to his pr sal
i
cAPPL1CATION ANC?DRAWING OF PROPOSED t? \tELOPME 3 ATTACHED)
0
Signature
Print or type Name
1i . 1.13
Telephone Number
13a�
/,, c 1 TI'v0N NC
/ �� // // JUL 2020,, ,
/�
about:blank Page 1 of 1

Iii::: NC Division of Coastal Management 10 812
Cashier's Official Receipt A B
Ei
7i0
Date: 20
Received From: J e-f(-— A V 6 O
Permit No.: `, d ) 6 Check No.: _ �' „a
fi //� i
Applicant's Name: 1 �e vY— Cou y: I Lv,_ -
Project Address: f15
Please retain receipt for your records as proof of payment for permit issued.
Signature of Agent or Applicant. Date: ` ()
Signature of Field Represents Date:

Date Date Check From Name of Vendor Check Check Permit Rct. #
Received Deposited Permit Holder Number amount Number/Comments
7/20/2020 Old Fort LLC 55� � Wells 6840 $100.00 minor fee, 33 Long Pt Lane, JD rct.
-1m 41 'Fargo Hamptead PNCO 10812
-c� (/t"
j