SC_19-27_ Chancy

v .
Issued by WiRO SC19-27
Surf City 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 Laurie Chancy authorizing development in the Estuarine Shoreline (AEC) at 115 Bland Drive, in Surf City,
Pender County as requested in the permittee's application, dated June 4, 2019, and received by DCM on June 7, 2019.
This permit, issued on June 26, 2019, is subject to compliance with the application and drawing dated and received by
DCM on June 7, 2019 (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: Proposed addition to dwelling, newl decking and steps.
(1) All proposed development and associated construction must be done in accordance with the permitted site drawing dated
received by DCM on June 7, 2019.
(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.
RECEIVED
(Additional Permit Conditions on Page 2)
DCM WILMINGT©N
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 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
December31,2022
In issuing this permit it is agreed that this project is consistent with the local Land ^ `u, 460kar
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.

Name: Laurie Chancy
Minor Permit#SC19-27
Date: June 26, 2019
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) 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.
(7) This permit does not authorize the excavation or filling of wetlands or open water areas, even temporarily.
(8) This permit authorizes the construction of 28 square feet of decking with the 30-foot coastal shoreline buffer. No
additional decking within the 30-foot buffer is authorized.
(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: IVCPB ")4• DATE: 4 26i?
PERMITTEE

V "` V,� - r 'iQ t,0 S V I C1 / 1Y OTHER PERMITS MAY BE REQUIRED:The activity you are planning may require permits other than the CAMA
I-rality Permit Number /�+�I 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,FIA
Ocean Hazard Estuarine Shoreline ORW Shoreline Public Trust Shoreline Other Certification,Sand Dune,Sediment Control,Subdivision Approval,Mobile Home Park Approval,Highway Connection,and
(For official use only) others.Check with your Local Permit Officer for more information.
GENERAL INFORMATION STATEMENT OF OWNERSHIP:
I,the undersigned,an applicant for a CAMA minor development permit,being either the owner of property in an AEC or a
LAND OWNER person authorized to act as an agent for purposes of applying for a CAMA minor development permit,certify that the person
Name Laurie Chancy listed as landowner on this application has a significant interest in the real property described therein.This interest can be
described as:(check one)
Address 1131 Timothy Road 4641
nan owner or record title,Title is vested in Fee Simple ,see Deed Book
City Dunn State NC Zip 28334 Phone [phone] page 182 in the Pender County Registry of Deeds.
Email [e-mail]
nan owner by virtue of inheritance.Applicant is an heir to the estate of ,
AUTHORIZED AGENT probate was in County.
Name Charles F.Riggs&Associates,Inc. of other interest,such as written contract or lease,explain below or use a separate sheet&attach to this application.
Address P.O.Box 1570 NOTIFICATION OF ADJACENT PROPERTY OWNERS:
City Jacksonville State NC Zip 28541 Phone [phone] I furthermore certify that the following persons are 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.
Email [e-mail]
(Name) (Address)
(i) Ms.Lynn C.Faulk,4949 North Highway Al A,Unit 143,Fort Pierce,FL 34949
LOCATION OF PROJECT:(Address,street name and/or directions to site.If not oceanfront,what is the name of the
adjacent waterbody.)115 Bland Drive,Surf City,Pender County (2) Mr.Robert H.Hilker,11817 Norwood Road,Raleigh,NC 27613
(3) Wilkinson Family Trust,P 0 Box 1088,Sanford,NC 27331
DESCRIPTION OF PROJECT:(List all proposed construction and land disturbance.) Proposed Addition (4)
One Story on Piling Open Below and Uncovered Deck and Steps
SIZE OF LOT/PARCEL: 13,986 square feet 0.321 acres ACKNOWLEDGEMENTS:
I,the undersigned,acknowledge that the land owner is aware that the proposed development is planned for an area which
PROPOSED USE:Residential 2 (Single-family El Multi-family❑) Commercial/Industrial 0 Other D 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-
COMPLETE EITHER(1)OR(2)BELOW(Contact your Local Permit Officer if you are not sure which AEC applies lion and floodproofing techniques.
to your property):
I furthermore certify that I am authorized to grant,and do in fact grant,permission to Division of Coastal Management staff,
(1) OCEAN HAZARD AECs:TOTAL FLOOR AREA OF PROPOSED STRUCTURE:Nis square feet(includes the Local Permit Officer and their agents to enter on the aforementioned lands in connection with evaluating information
air conditioned living space,parking elevated above ground level,non-conditioned space elevated above ground level but related to this it application.
excluding non-load-bearing attic space) P PP
(2) COASTAL SHORELINE AECs:SIZE OF BUILDING FOOTPRINT AND OTHER IMPERVIOUS OR BUILT 2/ This the 4r11 day of�LJA/4ss ,20 l9
UPON SURFACES:1.123 square feet(includes the area of the roof/drip line of all buildings,driveways,covered decks,
concrete or masonry patios,etc.that are within the applicable AEC.Attach your calculations with the project drawing.) �.ntforof filinga CAMApermit application
Landowner or person authorized to act as hi purpose
STATE STORMWATER MANAGEMENT PERMIT:Is the project located in an area subject to a State Stormwater /
Management Permit issued by the NC Division of Water Quality? This application includes:general inform , this form),a site drawing as described on the back of this application,the
YES= NCI ✓ I ownership statement,the Ocean Hazard A .,otice where necessary,a check for S100.00 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 sources are
If yes,list the total built upon area/impervious surface allowed for your lot or parcel: square feet. 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 AEC without permit is subject to civil,criminal and administrative action.
RECEIVED
JUN 0 7 2019
DCM WILMINGTON, NC ,

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.
PHYSICAL DIMENSIONS C 4/ APPLICATION FOR
R
SOF Label roads CAMA MINOR
abel highways right-of-ways S
Label local stback lines " DEVELOPMENT
Label any and all structures and driveways currently existing on property
Label adjacent waterbody
PHYSICAL CHARACTERISTICS )C 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 state's sounds and oceanfront.Along with requiring special care by those who
I'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.
Adentify 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
/S how the roof overhang as a dotted line around the structure locality in which you plan to build to be certain that you understand what information he
)raw and label landward limit of AEC or she needs before you apply.
pr/ aw and label all wetland lines(contact LPO for assistance)
"'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
_uraw and label all proposed structures certain that your application is complete and signed,that your drawing meets the
// w and label areas that will be disturbed and/or landscaped specifications given inside and that your application fee is attached.
Draw
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
how 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 in a 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? c
• completed an AEC Hazard Notice,if necessary?(Must be signed by the property owner)
FOR STAFF USE (
Site Notice Posted_Final Inspection Fee Received vs~
tl
Site Inspections ❑t
Zr
❑C
Date of Action:Issued^E I V C Exempted Denied Appeal Deadline(20 days from permit action)REDCM Form EB1952-2010/Revised April 2010
JUNN 072019

ROY COOPER
Governor
te
J r ig
MICHAEL S. REGAN
Secretary
NORTH CAROLINA BRAXTON DAVIS
Environmental!totality Director
June 26, 2019
Laurie Chancy
1131 Timothy Road
Dunn, NC 28334
Dear Ms. Chancy,
Attached is CAMA Minor Development Permit SC 19-27 for work to be done at 115 Bland Drive, in Surf
City, Pender. An electronic copy has been sent to the Surf City Inspections Department and your Agent.
To validate this permit, please sign both copies as indicated for our records. Retain the orange copy for
your files, and - - - 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.
:rely,
/ A I LC 1
4111$%. K. IR a
Permit Support Technician
N.C. Division of Coastal Management
Enclosures
Cc:WIRO files
SC Inspection Dept
Charles Riggs—Agent
State of North Carolina I Environmental Quality I Coastal Management
127 Cardinal Drive Ext.,Wilmington,NC 28405
010 10K 711 f

CHARLES F. RIGGS & ASSOCIATES, INC.
Land Surveyors
Charles F.Riggs,P.L.S.L-2981 Corporate License(C-730) James A.Lewis,P.L.S.L-4562
502 New Bridge Street 502 New Bridge Street Landfall Executive Suites
Jacksonville,North Carolina 28540 P.O.Box 1570 1213 Culbreth Drive
[phone] Jacksonville,North Carolina 28541 Wilmington,North Carolina 28405
[e-mail] [phone] [phone]
[e-mail]
June 5,2019
To: Mr.Jason Dail
Division of Coastal Management
North Carolina Department of Environmental Quality
127 Cardinal Drive
Wilmington,North Carolina 28405
Re: Laurie Chancy Submittal for Minor CAMA Permit
Dear Mr. Dail:
On behalf of Ms. Laurie Chancy,Charles F. Riggs&Associates,Inc. submits for your review the
enclosed application for a Minor CAMA permit for the property at 115 Bland Drive, Surf City,Pender
County,North Carolina.
Res ectfully,
James L.Riggs
RECEIVED
JUN 0 7 2019
C

OCEAN HAZARD AEC NOTICE
Project is in an: Ocean Erodible Area High Hazard Flood Area Inlet Hazard Area
Property Owner:
Laurie Chancy
Property Address: 115 Bland Drive, Surf City, Pender County
Date Lot Was Platted: November 1985
This notice is intended to make you.the applicant.aware of the SPECIAL NOTE: This hazard notice is required for
special risks and conditions associated with development in this development in areas subject to sudden and massive storms and
area.which is subject to natural hazards such as storms.erosion erosion. Permits issued for development in this area expire on
and currents. The rules of the Coastal Resources Commission December 31 of the third year following the year in which the
require that you receive an AEC Hazard Notice and permit was issued. Shortly before work begins on the project
acknowledge that notice in writing before a permit for site,the Local Permit Officer must be contacted to determine the
development can be issued. vegetation line and setback distance at your site. If the property
has seen little change since the time of permit issuance,and the
The Commission's rules on building standards, oceanfront proposed development can still meet the setback requirement.
setbacks and dune alterations are designed to minimize, but not the LPO will inform you that you may begin work. Substantial
eliminate. property loss from hazards. By granting permits, the progress on the project must be made within 60 days of this
Coastal Resources Commission does not guarantee the safety of setback determination,or the setback must be re-measured.Also.
the development and assumes no liability for future damage to the occurrence of a major shoreline change as the result of a
the development. Permits issued in the Ocean Hazard Area of storm within the 60-day period will necessitate re-measurement
Environmental Concern include the condition that structures be of the setback. It is important that you check with the LPO
relocated or dismantled if they become imminently threatened before the permit expires for official approval to continue the
by changes in shoreline configuration. The structure(s) must be work after the permit has expired. Generally. if foundation
relocated or dismantled within two (2) years of becoming pilings have been placed and substantial progress is continuing,
imminently threatened, and in any case upon its collapse or permit renewal can be authorized. It is unlawful to continue
subsidence. work after permit expiration.
The best available information,as accepted by the Coastal For more information.corneal:
Resources Commission, indicates that the annual long-term
average ocean erosion rate for the area where your property is
located is feet per year.
Local Permit Officer
The rate was established by careful analysis of aerial
photographs of the coastline taken over the past 50 years.
Studies also indicate that the shoreline could move as much as Address
feet landward in a major storm.
The flood waters in a major storm are predicted to be about
feet deep in this area. Locality
Preferred oceanfront protection measures are beach nourishment
and relocation of threatened structures. Hard erosion control
structures such as bulkheads,seawalls.revetments,groins.jetties Phone,Number
and breakwaters are prohibited. Temporary sand bags may be
authorized under certain conditions.
The applicant must acknowledge this information and
requirements by signing this notice in the space below.Without
the proper signature,the application will not be complete.
` 1512aq
Prop rty Owner Signature Date
Revised May 2010
RECEIVED
JUN 0 7 2019

CHARLES F. RIGGS &ASSOCIATES, INC.
Land Surveyors
Charles F.Riggs,P.L.S.L-2981 Corporate License(C-730) James A.Lewis,P.L.S.L-4562
502 New Bridge Street 502 New Bridge Street Landfall Executive Suites
Jacksonville.North Carolina 28540 P.O.Box 1570 1213 Culbreth Drive
[phone] Jacksonville,North Carolina 28541 Wilmington.North Carolina 28405
[e-mail] [phone] [phone]
[e-mail]
AGENT AUTHORIZATION FORM
Date: May 3,2019
Name of Property Owner Applying for Permit:
Laurie Chancy
Mailing Address:
//3/ -17/ra-1119 Rd.
DCAnn / C. aA33
I certify that l have authorized Charles F. Riggs&Associates, Inc. to act on my behalf, for the purpose
of applying for and obtaining all CAMA Permits necessary to install or construct proposed addition for property
at 115 Bland Drive, Surf City,Pender County,North Carolina,and I grant permission to the Division of Coastal
Management to access the property to mark/flag:
The First Line of Stable Natural Vegetation
X The Coastal Wetlands
X The Normal High Water Line
This authorization is valid thru May 3, 2020
May 3.2019
Prop Owner Signature Date
RECEIVED
JUN 0 7 2019

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner: Laurie Chancy
Address of Property: 115 Bland Drive, Surf City, Pender County
(Lot or Street#, Street or Road, City &County)
Agent's Name#: Charles F. Riggs & Assoc. Mailing Address: P. O. Box 1570
Agent's phone#: [phone] Jacksonville, NC 28541
I hereby certify that I own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing the development
they are proposing. A description or drawing, with dimensions, must be provided with this letter.
1 have no objections to this proposal. I have objections to this proposal.
If you have objections to what is being proposed,you must notify the Division of Coastal Management
(DCM) in writing within 10 days of receipt of this notice. Contact information for DCM offices is
available at www.nccoastalmanagementnet/contact dcm.htm or by calling 1-888-4RCOAST. No
response is considered the same as no objection if you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pi , ck, mooring pilings, breakwater, boathous , or groin must be set
back a minimum distance of m my area of riparian acc niess waived by me. (If you
wish to waive the setback, you must i • . the ap e blank below.)
I do wish to waiv ' setback requir ` t.
not wish to waive the 15' setback requirement.
(Prope a Inf on) (Adjacent Property Owner Information)
Signature Signature
Charles F. Riggs, t for application
Print or Type Name Print or Type Name
P. O. Box 1570
Mailing Address Mailing Address
Jacksonville, NC 28541
City/State/Zip City/State/Zip RECEIVED
[phone]
Telephone Number Telephone Number J U N 0 7 2019
/%4 J 9 DCM WILMINGTON, NC
Date Date
Revised 6/18/2012

CHARLES F. RIGGS & ASSOCIATES, INC.
Land Surveyors
•
Charles F.Riggs,P.L.S.L-2981 Corporate License(C-730) James A.Lewis,P.L.S.L-4562
502 New Bridge Street 502 New Bridge Street Landfall Executive Suites
Jacksonville,North Carolina 28540 P.O. Box 1570 1213 Culbreth Drive
[phone] Jacksonville,North Carolina 28541 Wilmington,North Carolina 28405
[e-mail] [phone] [phone]
[e-mail]
June 5,2019
Wilkinson Family Trust
P. O. Box 1088
Sanford,NC 27331
Re: Laurie Chancy Submittal for Minor CAMA Permit
To whom it may concern:
On behalf of Laurie Chancy,Charles F. Riggs&Associates, Inc. is submitting to the Division of
Coastal Management, North Carolina Department of Environmental Quality the enclosed application for a
CAMA permit for the property located at 115 Bland Drive, Surf City, Pender County,North Carolina.
Laurie Chancy is planning to construct an addition: one story on pilings open below with an uncovered
deck and steps on their property. We are required to notify the adjoiners of this submittal. Please review
the package and sign,address and date the form provided and place a check and your initials
beside whether you have objections or no objections to this. If you have no objections,please return
the form to us in the self-addressed stamped envelope provided. If you have objections,please send the
form along with your comments to Mr. Jason Dail, Division of Coastal Management,N.C. Department of
Environmental Quality, 127 Cardinal Drive, Wilmington,NC 28405 within 10 days of receipt of this
notice.
Respectfully,
AU.S. Postal Service..
CERTIFIED MAIL' RECEIPT
Domestic Mail Only
ames L. Riggs rr
For delivery information,visit our website at www.usps.com
SA AM:;
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Extra Services&Fees(check box,add fee pate)
❑Return Receipt(herdcopy) $ •rll'' '. .'
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RECEIVED �1B1'�- r�,!\J� ��3
PS Form 3800,April 2015 PSN 753o-o2-uvu rv4, See Reverse for Instructions
jUN 0 7 2019

CHARLES F. RIGGS & ASSOCIATES, INC.
Land Surveyors
Charles F.Riggs,P.L.S.L-2981 Corporate License(C-730) James A.Lewis,P.L.S.L-4562
502 New Bridge Street 502 New Bridge Street Landfall Executive Suites
Jacksonville,North Carolina 28540 P.O.Box 1570 1213 Culbreth Drive
[phone] Jacksonville,North Carolina 28541 Wilmington,North Carolina 28405
[e-mail] [phone] [phone]
[e-mail]
June 5,2019
Ms. Lynn C. Faulk
4949 North Highway A 1 A, Unit 143
Fort Pierce, FL 34949
Re: Laurie Chancy Submittal for Minor CAMA Permit
Dear Ms. Faulk:
On behalf of Laurie Chancy,Charles F. Riggs&Associates, Inc. is submitting to the Division of
Coastal Management, North Carolina Department of Environmental Quality the enclosed application for a
CAMA permit for the property located at 115 Bland Drive, Surf City, Pender County, North Carolina.
Laurie Chancy is planning to construct an addition: one story on pilings open below with an uncovered
deck and steps on their property. We are required to notify the adjoiners of this submittal. Please review
the package and sign,address and date the form provided and place a check and your initials
beside whether you have objections or no objections,to this. If you have no objections, please return
the form to us in the self-addressed stamped envelope provided. If you have objections, please send the
form along with your comments to Mr.Jason Dail, Division of Coastal Management,N.C. Department of
Environmental Quality, 127 Cardinal Drive, Wilmington, NC 28405 within 10 days of receipt of this
notice.
Re .ectfully,
,��� U.S. Postal Service''
4 // I9 Q CERTIFIED MAILS RECEIPT
Domestic Mail Only
ames L. Riggs
For delivery information,visit our website at www.usps.com
"'
FO PR >' FI�134f4�
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IIIN 47 2019

CHARLES F. RIGGS & ASSOCIATES, INC.
Land Surveyors
•
Charles F.Riggs,P.L.S.L-2981 Corporate License(C-730) James A.Lewis,P.L.S.L-4562
502 New Bridge Street 502 New Bridge Street Landfall Executive Suites
Jacksonville,North Carolina 28540 P.O.Box 1570 1213 Culbreth Drive
[phone] Jacksonville,North Carolina 28541 Wilmington,North Carolina 28405
[e-mail] [phone] [phone]
[e-mail]
June 5,2019
Mr. Robert H. Hilker
11817 Norwood Road
Raleigh,NC 27613
Re: Laurie Chancy Submittal for Minor CAMA Permit
Dear Mr. Hilker:
On behalf of Laurie Chancy,Charles F. Riggs& Associates, Inc. is submitting to the Division of
Coastal Management,North Carolina Department of Environmental Quality the enclosed application for a
CAMA permit for the property located at 115 Bland Drive, Surf City, Pender County,North Carolina.
Laurie Chancy is planning to construct an addition: one story on pilings open below with an uncovered
deck and steps on their property. We are required to notify the adjoiners of this submittal. Please review
the package and sign,address and date the form provided and place a check and your initials
beside whether you have objections or no objections to this. If you have no objections, please return
the form to us in the self-addressed stamped envelope provided. If you have objections, please send the
form along with your comments to Mr. Jason Dail, Division of Coastal Management,N.C. Department of
Environmental Quality, 127 Cardinal Drive, Wilmington,NC 28405 within 10 days of receipt of this
notice.
Res ectfully,
U.S. Postal Service
/
rn CERTIFIED MAIL® RECEIPT
Domestic Mail Only
rr
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James L. Riggs
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1{ 1i\I n 7 0nfn

U.S. DEPARTMENT OF HOMELAND SECURITY OMB No. 1660-0008
Federal Emergency Management Agency Expiration Date: November 30, 2018
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:
LAURIE CHANCEY
A2. Building Street Address(including Apt., Unit, Suite, and/or Bldg. No.)or P.O. Route and Company NAIC Number
Box No.
115 BLAND DRIVE
City State ZIP Code
SURF CITY North Carolina 28445
A3. Property Description (Lot and Block Numbers,Tax Parcel Number, Legal Description, etc.)
LOT 6, JOHN T. BLAND AND ELAINE S. BLAND SUBDIVISION
A4. Building Use(e.g., Residential, Non-Residential,Addition,Accessory, etc.) ADDITION
A5. Latitude/Longitude: Lat.34d23'48"N Long.77d35'30"W Horizontal Datum: ❑ NAD 1927 ❑x 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) 184.00 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 576.00 sq in
d) Engineered flood openings? ❑Yes ❑x No
A9. For a building with an attached garage:
a) Square footage of attached garage 0.00 sq ft
b) Number of permanent flood openings in the attached garage within 1.0 foot above adjacent grade 0
c) Total net area of flood openings in A9.b 0.00 sq in
d) Engineered flood openings? ❑ Yes ❑x No
SECTION B—FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
B1. NFIP Community Name&Community Number B2. County Name B3. State
TOWN OF SURF CITY 370186 PENDER 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
3720422300 J 02-16-2007 02-16-2007 AE 8.0'
B10. Indicate the source of the Base Flood Elevation(BFE) data or base flood depth entered in Item B9:
n AS Profile ❑ FIRM ❑ Community Determined ❑ Other/Source:
B11. Indicate elevation datum used for BFE in Item B9: [] NGVD 1929 ❑x NAVD 1988 ❑ Other/Source:
B12. Is the building located in a Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area(OPA)? ❑ Yes DI No
Designation Date: ❑ CBRS ❑ OPA RECEIVED
JUid 0 7 2019 4/z30/
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OMB No. 1660-0008
ELEVATION CERTIFICATE Expiration Date: November 30, 2018
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:
115 BLAND DRIVE
City State ZIP Code Company NAIC Number
SURF CITY North Carolina 28445
SECTION C—BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
C1. Building elevations are based on: ❑x 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: NC CORS Vertical Datum: NAVD 1988
Indicate elevation datum used for the elevations in items a)through h)below.
❑ NGVD 1929 ❑x 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) 3.40 ❑x feet ❑ meters
b) Top of the next higher floor 13.30 x❑ feet ❑ meters
c) Bottom of the lowest horizontal structural member(V Zones only) N/A ❑ feet ❑ meters
d) Attached garage(top of slab) N/A ❑ feet ❑ meters
e) Lowest elevation of machinery or equipment servicing the building 7.70 ❑x feet ❑ meters
(Describe type of equipment and location in Comments)
f) Lowest adjacent(finished)grade next to building (LAG) 3.10 ❑x feet ❑ meters
g) Highest adjacent(finished)grade next to building (HAG) 3.30 ❑x feet ❑ meters
h) Lowest adjacent grade at lowest elevation of deck or stairs, including N/A ❑ feet ❑ meters
structural support
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. 1 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? Cii Yes ❑No ❑Check here if attachments.
Certifier's Name License Number
JAMES A. LEWIS L 4562 \.,0 N,CAfiQr///,
Title ;•OQ'.•• SS/ • `4,:
PROJECT MANAGER p�
Company Name _ Z•a�0 SEAL .:
CHARLES F. RIGGS&ASSOCIATES, INC. _ SE
L-4562 cr i _-
Address �, -�0 •
502 NEW BRIDGE STREET
City State ZIP Code //, FS A L '\\\\
JACKSONVILLE North Carolina 28540 �'�i r,i i i i i ti Z3//9
Signature Date Telephone Ext. //
/9 1e.--"-z,--- Z3 /9 [phone] 41
Copy all p es 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)
EXISTING DWELLING IS ONE STORY ON PILINGS. PARTIALLY ENCLOSED BELOW.
EXISTING BOTTOM OF METER BOX=7.7'; EXISTING BOTTOM OF HVAC=9.2'
PROPOSED ADDITION TO DWELLING WILL BE ONE STORY ON PILINGS, OPEN BELOW. PROPOSED ADDITION WILL HAVE A
FINISH FLOOR ELEVATION OF 13.3' RECEIVED
- . • JUN 0 7 2019 Form Paae 2 of 6

BUILDING PHOTOGRAPHS OMB No. 1660-0008
ELEVATION CERTIFICATE See Instructions for Item A6. Expiration Date: November 30,2018
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:
115 BLAND DRIVE
City State ZIP Code Company NAIC Number
SURF CITY North Carolina 28445
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.
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BUILDING PHOTOGRAPHS OMB No. 1660-0008
ELEVATION CERTIFICATE Continuation Page Expiration Date: November 30,2018
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:
115 BLAND DRIVE
City State ZIP Code Company NAIC Number
SURF CITY North Carolina 28445
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.
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Photo Three
Photo Three Caption LEFT VIEW Clear Photo Three
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Photo Four Caption NON-ENGINEERED FLOOD VENT t' Clear Photo Four
r-r-..A n 00 P7/1 cN Rcnlanoc all nrovini is erlitinns_ J U N 0 7 LO 19 Form Page 6 of 6

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Please retain receipt for your records as proof of payment for permit issued.
Signature of Agent or Applicant: Date:
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late Date Check From Name of Vendor Check Check Permit Rct. #
.eived Deposited Permit Holder Number amount Number/Comments
/2019 Charles F. Riggs Laurie Chancy First 16121 $100.00 minor fee, 115 Bland Drive,Surf JD rct.
and Associates Inc. Citizens City PnCo 8242
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