BC_03-10_Coleman

JD
BrunswickEF
03-10
Local Government ��� rj 2003 Permit Number
DIVISION OF
COASTAL MANAGEMENT CAMA
MINOR DEVELOPMENT
PERMIT
as authorized by the State of North Carolina, Department of Environment,
and Natural Resources and the Coastal Resources Commission for development
in an area of environment concern pursuant to Section 113A-118 of the
General Statues, "Coastal Area Management"
Issued to Elliott Wade Coleman, authorizing development in Estuarine Shoreline at 1224 Riverbend Drive SW,
Lot 4 Riverbend Subdivision, Supply NC 28462 requested in the permittee's application, dated 12-Nov-03.
This permit, issued on 01-Dec-03, is subject to compliance with the application and site drawing (where
consistent with the permit), all applicable regulations and special conditions and notes set forth below. Any
violation of these terms may subject permittee to a fine, imprisonment or civil action, or may cause the
permit to be null and void.
2hispermit authorizes
(1) A silt fence or natural buffer must be positioned between any land disturbance and adjacent waters or
wetlands. In no case, shall erosion of disturbed areas result in deposition of this material into adjacent
waters or wetlands.
(2) All proposed development and associated construction must be done in accordance with the permitted
work plat drawings(s) [Single Family Residence/Swimming Pool with Decking/Covered Porch and
Deck] submitted on 12-Nov-03.
(3) All construction must conform to the N.C. Building Code requirements and all other local, State and
Federal regulations, applicable local ordinances and FEMA Flood Regulations.
(4) Any change or changes in the plans for development, construction, or land use activities will require a
re-evaluation and modification of this permit.
Conditions continued on second page
This permit action may be appealed by the permittee or other
qualified persons within twenty (20) days of the issuing date. From
the date of an appeal, any work conducted under this permit must
cease until the appeal is resolved.
This permit must be on the project site and accessible to the permit
officer when the project is inspected for compliance.
Any maintenance work or project modification not covered under
this permit, require further written permit approval.
All work must cease when this permit expires on December 31,
20D6.
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 Management.
Cam. k a4y.,
Local Permit Official (signature)
Connie Marlowe
CAMA Local Permit Official
PO Box 249
Bolivia NC 28422
Permittee (signature required if conditions above apply to permit)

Elliott Wade Coleman
Minor Permit #03-10
01-Dec-03
(5) All development projects, proposals, and designs shall limit the construction of
impervious surfaces and areas not allowing natural drainage to only so much as
is necessary to adequately service the major purpose or use for which the lot is to be
developed. Impervious surface areas shall not exceed 30% of the lot area within the
75 feet Area of Environmental Concern. However, no construction of a single-family
dwelling shall occur within 30 feet of normal water level.
(6) No impermeable surfaces shall be allowed over any functional part of the septic tank
system.
(7) All unconsolidated material resulting from associated grading and landscaping shall be
retained on site by effective sedimentation and erosion control measures.
(8) All disturbed areas shall be vegetatively planted and mulched within fourteen days
of construction completion.
(9) The first floor elevation must be in compliance with Federal Flood Insurance Rate
Map Elevations.
(10) Pursuant to 15 NCAC, Subchapter 7J.0406(b), this permit may not be assigned,
transferred, sold or otherwise disposed of to a third -party unless done so by the Director
of the Division of Coastal Management.
(11) A building permit and zoning compliance must be obtained prior to any construction.
JLd O E H v
ED
Dci, 00 3 2003
DIVISION OF
COASTAL MANAGEMENT

CAMA PERMIT NOTICE
Pursuant to NCGS 113A-119(b), Bruns-
wick County, a locality authorized to issue
CAMA permits in the areas of environ-
mental concern, hereby gives NOTICE that
on November 12, 2003, Elliott W. Coleman
applied for a CAMA minor development
permit to construct a single family resi-
denee/swimming pool with decking/cov.
ered porch and deck at 1224 Riverbend
Drive SW, Lot 4, Riverbend Subdivision, in
Supply, NC 29462.
The application may be inspected at the
below address. Public comments received
by November 28, 2W3 will be considered.
Later comments will be accepted and con-
sidered up to the time of permit decision.
Project modifications may occur based on
further review and comments. Notice of
the permit decision in this matter will be
provided upon written request.
Counts Marlowe
CAMA Local Permit
Officer for Brunswick County
P.O. Box 249
Bolivia, N.C. 29422
910-253-2025
Nov 20
lip
SO S.X%
CO
Brujawdc Lucy
03-10
STATE OF NORTH CAROLINA
COUNTY OF BRUNSWICK
AFFIDAVIT OF PUBLICATION
Before the undersigned, a Notary Public of said County and State,
duly commissioned, qualified, and authorized by law to administer
oaths, personally appeared
Scott R. Harrell
who, being first duly sworn, deposes and says: that he is
Publisher
(Owner, partner, publisher, or other officer or employee
authorized to make this affidavit)
of The Brunswick Beacon, a newspaper published, issued, and en-
tered as periodical mail in the Town of Shallotte in the said County
and State; that he is authorized to make this affidavit and sworn state-
ment; that the notice or other legal advertisement, a true copy of
which is attached hereto, was published in The Brunswick Beacon on
the following date(s):
November 20, 2003
and that the said newspaper in which such notice, paper document or
legal advertisement was published, was at the time of each and every
such publication, a newspaper meeting all the requirements and qual-
ifications of Section 1-597 of the General Statutes of North Carolina
and was a qualified newspaper within the meaning of Section 1-597
of the General Statutes of North Carolina.
This the 20th day of November, 2003.
............................
(Signature of person making affidavit)
Sworn to and subscribed before me this 20th day of �'' Q� Hy
..... ',
November, 2003. ' "' 'L '
�0T.gny `.22
Y
(Notary Public) " nnnun
My commission expires: December 29, 2004.

Locality BraAS IC'k CoUYtiy Permit Number 03'1D
Ocean Hazard Estuarine Shoreliney ORW Shoreline Public Trust Shoreline _Other
(For official use only)
GENERAL INFORMATION
LAND OWNER
Name WADG eoleA"RH
Address ISO �%0%i o5f. S5'w
Ciry��o/v State /Y Zip -,Fl6z Phone
AUTHORIZED AGENT �9 (`j
Name
Address
City
State
Zip
ION OF
LOCATION OF PROJECT. (Address, street name and/or directions to site. If not oceanfront, what is the name of
the adjacen//tl!waterbody?) A-2,211 Avelz ��n� PRi-c - locAlal . v �/;P11oh% /orri%
f2a�p e RVA&
DESCRIPTION OF PROJECT. (List all proposed construction and land disturbance.)
SIZE OF LOTMARCEL: a35';2 S. 3 square feet • S� acres
PROPOSED USE: Residential ✓ (Single-family 1!!!�_ Multi -family _) Commerical/Industrial
Other
TOTAL ENCLOSED FLOOR AREA OF A BUILDING IN THE OCEAN HAZARD AREA OF ENVI-
RONMENTAL CONCERN (AEC):
square feet (includes all floors and roof -covered decks)
SIZE OF BUILDING FOOTPRINT AND OTHER IMPERVIOUS OR BUILT -UPON ITRFACES IN
THE COASTAL SHORELINE AREA OF ENVIRONMENTAL CONCERN (AEC): zl_ZO sq. ft.
(Calculations include 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.)
Choose the AEC area that applies to your property:
(1) within 75 feet of Normal High Water for the Estuarine Shoreline AEC
(2) within 575 feet of Normal High Water for the Estuarine Shoreline AEC, adjacent to Outstanding
Resource Waters
(3) within 30 feet of the Public Trust Shoreline AEC
(Contact your Local Permit Officer if you are not sure which AEC applies to your property.)
STATE STORMWATER MANAGEMENT PERMIT: Is the project located in an area subject to a
State Stormwater Manage t Permit issued by the N.C. Division of Water Quality?
YES_ NO
If yes, list the total built -upon area/impervious surface allowed for your lot or parcel. square feet.

OTHER PERMITS MAY BE REQUIRED: The activity you are planning may require permits other than dte CAMA minor
development permit. As a service we have compiled a list of the kinds of permits that might be required. We suggest you check over the list
with your LPO to determine if any of these apply to your project: Zoning, Drinking Water Well, Septic Tank (or other sanitary waste
treatment system), Burning, Electrical, Plumbing, Heating and Air Conditioning, Insulation and Energy Conservation, FIA Certification,
Sand Dune, Sediment Control, Subdivision Approval, Mobile Home Park Approval, Highway, Connection, and others.
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
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 F%loll Xgooe�Awy % e4lem 4W , see Deed Book V
page 55 in the .QQ-,)irw,cA 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
NOTIFICATION OF ADJACENT PROPERTY OWNERS: I DIVISION OF
COASTAL MANAGEMENT
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.
(1)
(2)
(3)
(4)
FOR DEVELOPERS IN OCEAN HAZARD AND ESTUARINE HAZARD AREAS:
I 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 particular hazard problems associ-
ated with this lot. This explanation was accompanied by recommendations concerning stabilization and floodproofing tech-
niques.
PERMISSION TO ENTER ON LAND:
I furthermore certify that I am authorized to grant and do in fact grant permission to the local permit officer and his agents to
enter on the aforementioned lands in connection with evaluating information related to this permit application.
This application includes: general information (this form), a site drawing as described on the back of this application, the
ownership statement, the AEC hazard notice where necessary, a check for $100.00 made payable to the locality, and any infor-
mation 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 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 Th' e_day of 20_
NOV 12 2003 �•
Landowner or person authorized to act as his agent for purpose of filing a CAMA permit application.

Brunswick County—Regist:er of Deeds
Robert J. Robinson
Inst #167305 Book 1786Page 355
07/16/2003 04:46:22pn Rec#
ls36o9
07/17/2003 RET t TOTAL 1 RE' � TC# —
T
$432.00 30 CK AMA - O CKt��
REC# ® //,,'' ''
—REF BY{-
NHA (EY—A'� Real Estate NORTH CAROLINA ASH
Excise Tax
GENERAL WARRANTY DEED
Excise Tax: $ 432.00
Tax Map No.
Recording Time, Book and Page
Parcel Identifier No. 214 OA 004
Mail after recording to: Christian S. Mathis 10239-2 Beach Dr. SW Calabash, NC 28467
This instrument was prepared by: The Law Office of Christian S. Mathis
THIS DEED made this 09 day of July , 2003 by and between
GRANTOR
James M. Drucker and wife, J L'Y NOV 1 31003
Amfe S. Drucker L V
GRANTEE COASTAL MANAGEMENT
Elliott Wade Coleman and wife, TS
Tracy T. Coleman
130 Violet Street SW
Supply, NC 28462
The designation Grantor and Grantee as used herein shall include said parties, their heirs, successors, and assigns, and shall
include singular, plural, masculine, feminine or neuter as required by context.
WITNESSETH, that the Grantor, for a valuable consideration paid by the Grantee, the receipt of which is hereby
acknowledged, has and by these presents does grant, bargain, sell and convey unto the Grantee in fee simple, all that certain
lot or parcel of land and more particularly described as follows:
Being all of Lot 4 of River Bend Estates Subdivision, Shallotte Township, Brunswick County, North Carolina as shown on a
plat recorded in Map Cabinet K, Page 272, Brunswick County Registry to which reference is hereby made for a more full
and complete description.

ppppp�
Inst tt 167305 Book 1786Page: 356
All or a portion of the property hereinabove described was acquired by Grantor by instrument recorded in Book 1491 , Page
771 , Brunswick County Registry.
A map showing the above described property is recorded in Plat Book K , Page 272 , and referenced within this
instrument.
TO HAVE AND TO HOLD the aforesaid lot or parcel of land and all privileges and appurtenances thereto belonging to the
Grantee in fee simple.
And the Grantor covenants with the Grantee, that Grantor is seized of the premises in fee simple, has the right to convey the
same in fee simple, that title is marketable and free and clear of all encumbrances, and that Grantor will warrant and defend
the title against the lawful claims of all persons whomsoever except for the exceptions hereinafter stated.
Title to the property hereinabove described is subject to the following exceptions:
Restrictive Covennats in Book 432 at Page 408, Brunswick Registry.
IN WITNESS WHEREOF, the Grantor has hereunto set his hand and seal, or if corporate, has caused this
instrument to be signed in its corporate name by its duly authorized officer(s), the day nd year first above
written.
_(SEAL)
(ENTITY NAME) mes((-�M. Drucke
By: (,� y� ����(SEAL)
Amin S. Drucker
By:,
0"OFFICIAL SEAL"
Notary Public, North Carolina (SEAL)
'' Coun of Brunswick SEAL
�'�, .q P Christian Mathis
MY Commission Ea ire$1Q/30/2005
NORTIH,,CAROLINA Brunswick COUNTY
I, L.Y `✓Ia Notary Public of the County and State aforesaid, certify James M. Drucker and
aihL
Arnie S. Drucker , Grantor(s), personally appeared before me this day and acknowledge{) the execution of the foregoing
instrument. Witness my hand and official stamp or seal, this the day of 74 Z�
STATE OF NORTH CAROLINA
COUNTY OF BRUNSWICK
The Foregoing (or annexed) Certificate(s)
Notary(ies) Public is (are) Certified to be Correct.
This Instrument was filed for Registration on this 16th Day of July 2003
in the Book and page shown on the First Page hereof.`
ROE J. RO N, Register of Deeds

z
ul
WAGE COLEMAN---_----- —_--- - � ' q w
T 6 W EXPENSE ACCOUNT j u-
NCDL 708092 910 842-3402 1171 cn
SUPPLY, NC 28462 bale
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Paytothe�66-1215/531
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Orderof,
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WALK '� AW cn
Dollars �
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For
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(olre, NC 28a59 -
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�:0531121521:B0002OB844u' 1y!
0117i

CAMA PERMIT NOTICE
Pursuant to NCGS 113A-119(b), Brunswick County, a locality authorized to issue
CAMA permits in areas of environmental concern, hereby gives NOTICE that on
12-Nov-03 Elliott W. Coleman applied for a CAMA minor development permit to
construct a Single Family Residence/Swimming Pool with Decking/ Covered
Porch and Deck at 1224 Riverbend Drive SW, Lot 4, Riverbend Subdivision, in
Supply NC 28462. The application may be inspected at the address below. Public
comments received by 28-Nov-03 will be considered. Later comments will be
accepted and'considered up to the time of permit decision. Project modifications
may occur based on further review and comments. Notice of the permit decision in
this matter will be provided upon written request.
Connie Marlowe
CAMA Local Permit Officer for
Brunswick County
PO Box 249
Bolivia, NC 28422
Phone [phone]
PLEASE PUBLISH ON 19-Nov-03
1 0*91,Vs
Nov 1 3 2003
DIVISION O OF
COASTAL M

13:06 PM ^o T..rq ME'a DEVELOPMENT CO. 2_.3 Seea
P.01
D1�/ISrON Or OA,CTAi M�v�rr
ADJACENT RIPApIAN PROPERTY OWNER NOTICATION
Applicant's
Address Of Prop
Street #,' Street Name, Ctry a;
Applicant's Telephone Number
I hereby certify that I own waterfront property adjacent to the above-referonced property. The
applicant has provided 03g a drawing of the the proposed development. Please' statement below if you have no objections to the applicant's proposed developm1ent.lnirla
this block it aes no corestilute a waiver of Ae rlling
equired 15'set5ec t from the rrperr;an corridor
lines.
I have no objections to this pW"posal.
���n lure
Date
PnJ-�rl�i�
0�1b�a j jper'Tsle. Sk/
Telephone Number :tli Area Cods
116 0 /I
//— 613
�0-SvE
NOV 13 2003
DIVISION OF
COASTAL MANAGEMENT
lfyou have objections to the applicant's pr000sal, do not initial or sign this form. You should
contact the Loca! CA,&LA Permit Officer list
concerns: ad below as soon as possible to register your
Telephone:

DEC-65-0212:06 FM ST.JAMES DEVELOPMENT CO. 25Z 5330e
P.01
Applicant's
Address
ISiON or cc�ACTa, ar uI.1 NT
ADJACENT RIPAWAN PROPERTY OWNER NOTI'rTCATION
Street #,' Street Name, C y as
Applicant's Telephone Number 9167 — 93�W_ 2 �W q
I hereby certify that I own waterfront property adjacent to the above-referonced property. The
applicant has or id d m-o ne of the the proposed development. please'
W the
statement below if you have no objections to the applicant's proposed development. initialling
initialling
this block dow not cortstilute a waiver of the required IS'scibackfiom the ri /an corridor
lines.
I have no objections to this prd
Signature Date
Ai 01ayir-h
Print Name and Mailing Address vur en
3/0— -IS214-0/
Telephone Number With Area Code
_Dr, S w
NOV 13 2003
pIVIS�NN EMF-W
COp,STPA- M
If you have objections to the applicant's proposal, do not initial or sign this form. you should
contact the Local CAMP permit Concerns: Officer listed below as soon as possible to register your
Telephone:

KIA•.
a
CERTIFIED MAILT.
RECEIPT
.. I
..
11ALLOTTE K 28470
SkLOTTE K 28470:� 1
A L RU f3 E'.
Postage &
Postage $ 90-27
Ceni9ed Fee $2.30 0462
Certifies Fee $2.30
0462
01 Postmark
nra m Reciept Fee $1.75 I
(Endorsement Required) Here
Return Recie t Fee
P $1.73
(Endorsement Required)
01 Postmark
Here
Reatricled Delivery Fee I
(Ergomement Required) 0•0''
Restricted Delivery Fee
(Endorsement Required) S0•0
Total Postage & Fees $ i4.42 10/28/2003 )
Total Postage & Fess .$ 14.42
10/28/2003
I
lcW_r ]
sK..A_.Q�_c1o�_------
._%lharnca�-_
So-eer, APk Mo., _
�4�-=-.....k
...
.,.anw,...w l/Y?'k•itf,v .� _ __ �
Marl
,
■ Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery is desired.
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mailpiece,
or on the front if space permits.
1.. Article Addressed to:
MS. Norma �iet.oe-f't
/A60 RivYrbrii Dr. SW
SkOL001It- / Al, C,
A. Signature r
❑ Agent
B. Received by (Printed Name)
D. Is delivery address different from item 17 U Yes
If YES, enter delivery address below: ❑ No
a-, 8 -L17 0 3. Sew a Type
I Certified Mail ❑ Express Mail
❑ Registered ❑ Return Receipt for Merchandise
❑ Insured Mail ❑ C.O.D..
4. Restricted Delivery? (Extra Fee) ❑ Yes
2. Article Number
(ram. 7002 3150 0004 0320 9071
PS FO. ugust �2001Domestic Return Receipt 102595-02-M-IW
■ Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery is desired.
■ Print your name and address on the reverse '
SO that we can return the card to you.
■ Attach this card to the back of the mailpiece,
or on the front if c.,n,o
Ylr PagrTck A.o'is'rio�
/a( RNrrby^d Qr• c, W_
Sh 10,4,1-1 1/
a-8-� 7 0
If YES, enter delivery address below:
❑ Registered ' ❑ Retum Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery! (Extra Fee) 0 v
rs
Mr, 7002 3150 0004 0320 9064
PS Form 3811, August 2001
Domestic Return Receipt
102595-02-M-1540

Brunswick County Health Department Application # 0/Slo79�i
Environmental Health Section Tax Parcel # a�cfOkOdy
Wastewater Collection, Treatment Type ��
and Subsurface Disposal System
IMPROVEMENT PERMIT
FOR WASTEWATER COLLECTION, TREATMENT, AND DISPOSAL SYSTEM
In accordance with the provisions of Article 11 of Chapter 130A, General Statutes of North Carolina, 15A NCAC 18A . 1900 at
seq., and other applicable Laws and Rules
PERMISSION IS HEREBY GRANTED TO:
Owner
Address
FOR THE
Installation of a wastewater collection, treatment, and disposal system to serve:
Residential ✓ Bedroom -O� Cammercial- Emple� Max Occupany V a
Comments/Use
pursuant to 15A NCAC 18A.1900 as amended and in conformity with the application and other supporting data subsequently filed and
approved by the DEHNR/or the Brunswick County Health Department and considered a part of this permit.
Facility to be served: Name 4)
Address/Location. /—q;)
Description ��i,nr_
The owner shall be subject to the following conditions, limitations, and construction requirements for the installation and operation of
this system:
1. This permit is effective only with respect to the specific design flow facilities, and the nature and volume of waste described in the
Permit Application, and other supporting data. Changes in the proposed use, waste flow, nature or volume of waste render this
Permit void.
2. All documents, including but not limited to site evaluation, design review plans and specifications, Triparty Agreements,
Easements, and other legal agreements will become a part of the Permit. This includes operation and maintenance procedures
and other pertinent documents relating to system operation and maintenance.
3. The designated repair area is to have no parking, driveways, or other impervious material located on it.
4. The issuance of this permit does not preclude the permittee from complying with any and all statues, regulations, or ordinances
which may be imposed by other government agencies which have jurisdiction, or any other permits issued by this department.
5. The permit shall become invalid if the information submitted in the application was falsified or changed, if the permit was based on
inaccurate or incomplete information, or if the designated site is altered.
6. Before Authorization to Construct a Wastewater Treatment and Disposal System is issued, all site modifications., plans,
specifications, draft legal paperwork must be completed and approved.
7. Sites requiring complex designs for wastewater systems, may require approval of plans and specifications before the
Improvements Permit is issued.
PERMIT ISSUED THIS _4%S DAY OF
DATE OF PERMIT EXPIRA
tl�z / a—�� R.S.
-ts= aoo��j��J��V
NT ENVIR E AL HEALTH DI_,SION�
13 20
BAN; EMEN?
G� p,gTP�
PERMIT.STA 11/10//97

Brunswick County Health Department Application #Of/5(o7y(,
Environmental Health Section Tax Parcel # a 9o400Al
Wastewater Collection, Treatment Type -Z77:rj
and Subsurface Disposal System
AUTHORIZATION TO CONSTRUCT
FOR
WASTEWATER COLLECTION, TREATMENT, AND DISPOSAL SYSTEM
In accordance with the provisions of Article 11 of Chapter 130A, General Statutes of North Carolina as amended,
AND other applicable Laws and Rules
PERMISSION IS HEREBY GRANTED TO
Owner
Address
Phone
to construct, install a sewage treatment and disposal system as described below:
To Serve: Residential # Bedrooms I/ Commercial — #Employees = Max. Occupany t2d
Comments, Des ribtion: /o�91
SUBDIVISION BLOCK — SECTION __
ADDRESS/LOCATION: 1 Q� if \\� pj
The system components consists of: Type system NOV 13 2003
Design Flow ''eo
Description // 'tta, DIVISION OF
1. COLLECTION SYSTEM: CONVENTIONAL PLUMBING COASTAL MANAGEMENT
(MUST COMPLY WITH ALL APPLI ABLE STATE AND LOCAL PLUMBING CODES)
� ¢
II. TANKAGE: A. GREASE TRAP /4 GALLONS CAPACITY
B. SEPTIC TANK(S) O O GALLONS CAPACITY
C. PUMP TANK CD GALLONS CAPACITY
D. OTHER:
ALL TANKS, FORCE MAINS, PRESSURE LINES TO BE LEAK TESTED AND CERTIFIED BY APPROPREIATE
PARTIES.
ACCESS RISERS REQUIRED ON ALL INSPECTIONS & SERVICE HATCHES ON TANKS -RISERS TO EXTEND 4-6"
ABOVE FINISHED GRADE
III. PUMP CHAMBER/DOSING TANK:
A. DOSING PUMP(S): SIZE, MAKE, MODEL M
NUMBER OF PUMPS REQUIRED:
B. DISCHARGE PIPING: SIZE: INCH MATERIAL: SCH 40 PVC GATE VALVES: YES, INTERNAL
CHECK VALVE: YES UN-ION/DISCONNECT: YES(PVC) LIFT CHAIN OR ROPE: YES NON -CORROSIVE
ANTISIPON HOLE: YES (3/161N.) H-CONNECTION:
C. DOSE VOLUME: DRAW DOWN DEPTH: INCHES
IV. DOSING MAIN: SIZE: INCH MATERIAL: SCH 40 PVC VALVING:
"H" CONNECTION:_ AIR RELEASE VALVE:_ CLEANOUTS:
V. CONTROL PANEL:: TYPE:
TO INCLUDE: NEMA 4X ENCLOSURE, MANUAL DISCONNECTS/BREAKERS FOR PUMP AND
ALARM( PARATE CIRCUITS FOR PUMP AND ALARM), H-O-A SWITCH, ALARM (AUDIBLE AND VISIBLE)
SIMPLEXUPL,EX_ WITH ALTERNATOR AND ELASPED TIME COUNTERS / EVENT COUNTERS
FLOATS: ON V OFF ./ ALARM_✓ LAG
(MUST COMPLY WITH ALL APPLICABLE STATE AND LOCAL ELECTRICAL CODES)
VI. DISPOSAL FIELD: /4,) LTAR /, D TRENCH DEPTH
A. CONVENTIONAL: SIZE:!SQ. FT.) #FIELDS:1 #LINES:3
permit.aut 1
5/97

LENGTH OF LINES:S RENCH WIDT 3
DISTRIBUTION BOX/FLOW DIVIDERRES URE HEAD
PRESSURE MANIFOLD: SIZE:_ TA SIZE:TSCH 80 PVC: -addle taps)
CLEANOUTS:_ SCH 40 ORUC:_ (Glued Fitting)
B. LOW PRESSURE PIPE: SIZE:—sq. ft. #FIELDS:_ #LATERALS:
SIZE MANIFOLD:_ SCH 40 _ SC 80 _ TRENCH WIDTH: jr�j�
HOLE SPACING: �) ^ E Hf�
SIZE HOLES:_ CLEANO,LR A MG:_ PRESSURE HEAD:
SIZE LATERAL PIPES: SCH 40 SCH 80 _ SDR NOV 1 3 2003
ADDITIONAL COMMENTS:
VII. APPURTENANCES TO SYSTEMS: DIVISION O F
INSTAL
A. SUBSURFACE DRAINAGE: TYPE: DEPTH:
DEPTH: ASTAL MANAGEMENT
B. AREA FILL: FILL DEPTH:_ MATERIAL:
SIZE OF BASAL AREA:_ WIDE x _(LONG)
C. LANDSCAPE EACH SITE AS NEEDED. ALL SITES SHALL BE LANDSCAPED SUFFICIENT TO PROVIDE
SURFACE RUNOFF AND TO PREVENT PONDING OF RAIN OR OTHER SURFACE WATERS.
D. COMMENTS, SITE MODIFICATIONS, ETC.,
The Owner shall be subject to the following conditions, limitations, and construction requirements for the installation of
this system:
1. This authorization is effective only with respect to the specific design flow and facilities, and the nature and volume of
waste described in the Permit Application, and other supporting data.
2. This permit is not transferable and must be reapplied for at such time as ownership, or management changes.
3. The designated repair area is to have no parking, driveways, or other impervious material located on it. This
area is to be protected, reserved and maintenance in a natural state.
4. All subsequent owners of this property and sewage system, shall execute a contract between the owner and an
approved management entity before the operations permit is issued. Management of the sewer system to be
provided at all times.
5. All contracts between owners, management entity (Public or Private), or Health Dept. shall be reviewed and approved
before being accepted.
6. A properly certified Operator shall be provided as indicated:
Wastewater Treatment System Operator
Certified Subsurface System Operator
Collection System Operator
7. The issuance of this permit does not preclude the permittee from complying with any and all statutes, regulations, or
ordinances which may be imposed by other government agencies which have jurisdiction, or any other permits issued
by this department.
8. This authorization shall be valid for 60 months from the date of issue. The authorization shall become invalid if the
information submitted in the application was falsified or changed, if the permit was based on inaccurate or incomplete
information, or if the designated site is altered, or expiration of this authorization, a new application shall be submitted
to the BCHD with updated information, as may be applicable or requested.
9. " A PERMANENT BARRIER SHALL BE PROVIDED AND IN PLACE AROUNDTHE SYSTEM/REPAIR AREA
BEFORE THE OPERATIONS PERMIT IS ISSUED.
10. ALL APPLICABLE SETBACKS SHALL BE MAINTAINED, NO IRRAGATION SYSTEMS, STORM WATER PONDS I
BASINS, SURFACE/SUBSURFACE DRAINAGE SHALL BE LOCATED IN THE AREA OF THE WASTEWATER
SYSTEM OR ITS REQUIRED SETBACKS.
INSTALLATION REQUIREMENTS
1. The installer shall be currently registered with this department.
2. A pre -installation conference is to be held on the site prior to beginning any site modification or construction of the
proposed structure or the sewage collection treatment, and disposal system. Attending these conferences shall be
pennit.aut
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representatives of the State of Local Health Department; project engineer or designer; contractor; builder; proposed
system operator/installer; and the owner or his authorized agent.
3. The contractor shall be responsible for notification of the engineer and the BCHD for system inspection in stages as
required and prior to backfilling any portion of the system. No portion of the system shall be backfilled or placed into
use without prior approval of the BCHD.
4. The system shall be installed in accordance with the approved set of plans and specifications. Any deviation in site
modifications, plans, specification, layout, materials or other system component shall be approved by the design
engineer and the Brunswick County Health Department prior to installation of the system. Failure to do so may result
in delay or refusal of final approval of the system, and may render the Permit null and void.
5. The system shall be installed in a timely manner and staged so as to avoid unnecamsary gxgpsy� to weat
6. The location and identification of all property lines, easements, water lines, and o e a n t ti ti s I t
responsibility of the installer.
7. Omer. NOV 13 2003
OPERATION PERMIT REQUIREMENTS
1. An Operation Permit shall be issued by the BCHD prior to placing the system into use, or Bakld $WWc iFections to
the system. COASTAL MANAGEMENT
2. Prior to issuance of the Operation Permit:
- the system shall be completed, installed, and tested in accordance with the approved design, including proper
abandonment of tanks existing wells, and other components,
- final landscaping, water diversion devices, and vegetative cover requirements and pressure adjustment shall be
completed,
- the engineer or applicable responsible parties shall submit as -built plans to the BCHD, the plans shall reflect any
changes or alterations from the as -approved plans.
3. For systems that have been engineered, the design engineer shall certify in writing to the Brunswick County Health
Department, that he has inspected the installation and that it has been installed according to the approved plans and
specifications.
- Any necessary easements, plats, or documents shall be recorded with the Register of Deeds and copies
submitted to the BCHD,
- The owner and a Public Management Entity/Subsurface System Certified Operator shall execute a contract which
addresses all of the requirements for maintenance, monitoring, and reporting in Section .1961 and the
requirements of the Schedule of Operation and Maintenance to be a part of the Operation Permit for the facility.
Provisions of said contract shall be in effect for as long as the system is in use.
NOTICE OF EXPRATION-THIS AUTHORIZATION EXPIRES 5YEARS (60 MONTHS) FROM DATE OF ISSUE. IF EJWF2ATION
OCCURS, THE CLIENTHA SLL COMPLY WITH ALL CHANGES INAPPLICABLE REGULATIONS, LAWS, TECHNICAL ASPECTS,
ETC.,THATMAYBEEFFECTNEATTHATTI E.(M MAYREQUIRE ADDITIONAL PREPARATION, MORE COMPLEX
WASTEWATER SYSTEMS. OPERATION AND MAINTENANCE REQUIREMENTS, PRE-TREATMENT, ETC. THIS COULD RESULT
IN LESS AREA FOR THE HOME, PARKING, LOWER WATER USAGE AND FURTHER DEVELOPMENT LIMITATIONS.
BRUNSWICK COUNTY HEALTH DEPARTMENT ALTERNATIVE SYSTEM IMPROVEMENTS
PERMIT/OPERATION PERMIT BCHD # D 5
Plan review b DATE Site evaluation byyZe, DATE/1
Site modifications, cl5impleted and inspected by
AUTHO IZATION TO CONSTRUCT ISSUED THIS DAY
OF 45_�
permit.aut a001 3
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1, Samuel T. Inman . Profeealonaf Land Surveyor, certify that the ratio of precitlon
to h 7500 . ; and that We mop milli the minimum rlondardi of practice for land surveying In
N o'rlh Car ollna
Yflln.ss my hood and teal this 301h day at July 2001
U4on 2,TYf
dl fI.6
Legend:
-O— E,ablloif ton or Yon pipe
—0- Now Yon pipe set
--V'Ealsling corner lyps noted
Re6nnres:
Deed Book 715 Page 288
Map Cabinet , K Page 272
Nater;
A. Aria determined by DMD.
2. FEMA Flood Map Idanlifles parcel
as being In FIRM ZONE A10027,
Communlly Penal 370295 0330 E,
4/2/91.
Tax Map Parcal No. - 214OA004
-,ry
PLS No.
LOCATION MAP
HOLDEN ROAD
Lf778 -AL
L-2778
o7G
pi
�1/
4y,.f/
LOT 3
Survey of
LOT 4 - RIVER BEND SUBD.iV-tj;I0N
"Wade and Tracy Coleman"
Shollolla Township Bronselch Calmly, N.C.
July 30, 2001 0 20 40 60 80 Scale 1" • 40'
BOBBY M. LONO, PLS,& ASSOC.
P.O..BeK HIT
Shollalls, NC Z6409
.e
a