BC_15-01_Jennings

Brunswick County BC15.01
Local Government Permit Number
DEVELOPMENTCAMA
MINOR
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 Statutes, "Coastal Area Management'
Issued to Douglas and Suzanne Jennings, authorizing development in the Estuarine Shoreline (AEC) at 1765 Village
Point Road SIN, in Shallotle NC 28470, as requested in the permittee's application, dated 29-Jan-15. This permit,
issued on 16-Mar-15 is subject to compliance with the application and site drawing (where consistent with the permit),
all applicable regulations and special conditions and notes set forth below. Any violation of these terms may subject
permittee to a fine, imprisonment or civil action, or may cause the permit to be null and void.
This permit authorizes: Fill Dirt
(1) All proposed development and associated construction must be done in accordance with the permitted work plat
drawings(s) dated received on 02-Mar-15.
(2) All construction must conform to the N.C. Building Code requirements and all other local, State and Federal regulations,
applicable local ordinances and FEMA Flood Regulations.
(3) Any change or changes in the plans for development, construction, or land use activities will require a re-evaluation and
modification of this permit.
(4) A copy of this permit shall be posted or available on site. Contact this office at 910.253.2034 for a final inspection at
completion of work.
(Additional Permit Conditions on Paget) DCIMWILMINGTON,NC
MAR 1 8 2615
This permit action may be appealed by the permiltee 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
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, 2018
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.
t Vw-
Connie Marlowe
CAMA LOCAL PERMIT OFFICIAL
PO Box 249
Bolivia NC 28422
PERMITTEE
(Signature required if conditions above apply to permit)

n�+ZI ` o Brunswick County Planning and
Community Development
P.O. Box 249
zy�xcnso��a�'•� 75 Courthouse Drive N.E., Bldg I
Bolivia NC 28422
16-Mar-15
Douglas and Suzanne Jennings
803 E. Main Street
Bennettsville SC 29512
RE: CAMA MINOR PERMIT— BC15.01
PROJECT ADDRESS/LOCATION —1765 Village Point Road SW, Shallotte NC 28470
Dear Mr. and Mrs. Jennings:
The enclosed permit constitutes authorization under the Coastal Area Management Act for you to proceed with your
project proposal. Please sign both the original (buff -colored form) and the °white copy". Return the copy to this office
in the enclosed envelope. Signing the permit and proceeding means you have waived your right of appeal described
below. Please retain the original (buff -colored form), as it must be available on site when the project is inspected for
compliance.
If you object to the permit or any of the conditions, you may request a hearing pursuant to NCGS 113A-121.1 or 113-
229. Your petition for a hearing must be filed in accordance with NCGS Chapter 150E with the Office of
Administrative Hearings, 6714 Mail Service Center, Raleigh, NC 27611-6714, [phone] within twenty (20)
days of this decision on your permit. You should also be aware that if another qualified party submits a valid
objection to the issuance of this permit within twenty (20) days, the matter must be resolved prior to work initiation.
The Coastal Resources Commission makes the final decision on any appeal.
The project plan is subject to those conditions appearing on the permit form. Otherwise, all work must be carried out
in accordance with your application. Modifications, time extensions, and future maintenance require additional
approval. Please read your permit carefully prior to starting work and review all project plans, as approved. If you are
having the work done by a contractor, it is to your benefit to be sure that he fully understands all permit requirements.
From time to time, staff will visit the site to monitor the project. However, if questions arise concerning permit
conditions, environmental safeguards, or problem areas, you may contact me at any time for assistance at
910.253.2034. By working in accordance with the permit, you will be helping to protect our vitally important coastal
resources.
Sincerely,
Co��
nnie Madowe, LPO
Brunswick County
PO Box 249
Bolivia NC 28422
cc: Halley Snider, Wilmington Office
Greg Miller, Agent
RECEIVED
DCM WILMINGTON, NO
TELEPHONE [phone] • [phone] • FAX (910) 253,2437
MAR 1 8 2055

Name: Douglas and Suzanne Jennings
Minor Permit # BC15.01
Date: 16-Mar-15
Page 2
(5) The amount of impervious surface shall not exceed 30% of the lot area within 75 feet of Normal High Water
(Estuarine Shoreline Area of Environmental Concern), in this case, 0 square feet is authorized.
(6) Unless specifically allowed in 15A NCAC 07H. 0209(d)(10), and shown on the permitted plan drawing, all
development/construction shall be located a distance of 30 feet landward of Normal High Water. No portion of the
roof overhang shall encroach into the 30 ft. buffer.
(7) All unconsolidated material resulting from associated grading and landscaping shall be retained on site by effective
sedimentation and erosion control measures. Prior to any land -disturbing activities, a barrier line of filter cloth must
be installed between the land disturbing activity and the adjacent marsh or water areas, unfil such time as the area
has been properly stabilized with a vegetative cover.
(8) Any proposed grading within the 30' buffer from the Normal High Water must be contoured to prevent additional
stormwater runoff to the adjacent marsh. This area shall be immediately vegetatively stabilized, and must remain in
a vegetated state.
(9) All other disturbed areas shall be vegetatively stabilized (planted and mulched) within 14 days of construction
completion.
SIGNATURE:
PERMITTEE
DATE:
REi;1 iVEC
DCNI WI! UINGTON, NC
MAR 1 s LU 19

GENERAL INFORMATION
FW-V617i .tl+r �0 1
Name .000 Lr1S r SdZAtV/VE 7_CIVN//f4;5
Address __ 90-5 E _ /11A- /n/ SK,
City (3EJi//1/ (f enm State Zip 2.95/Z Phone 3$ h
Email I
do". 5UZa%7✓7g ,, 7;/ r^,,,, `/V 439-3od5�-J
AUTHORIZED AGENT
Name GREG M/LLE-R — bui/diy r�til`tu��cv- �rPnM;//ems f?2 �noklrhe�.
Address .J Z % Lo oP C,, vC/pi J
City LONGS State .SG Zip 2451 Phone "I/ Z5/— %2ZE
Email grggnoilLBrS/enooc%�rn 9�id/�- Com
LOCATION OF PROJECT: (Address, street name and/or directions to site. If not oceanfront, what is the name of the
adjacent waterbody.) /'765 &� e P01nk t%�OczQ�sN'7//o#e Ne rn .1he /C N/>
2 8y?o 1
DESCRIPTION OF PROJECT: (Liistt all proposed constructionand land disturbance.) /)
SIZE OFLOT/PARCEL: °Z�1 i}3� square feet acres F.410r.� GF� 2-Z3
PROPOSED USE: Residential [v� (Single-family ❑ Multi -family I] ) Commercial/Industrial Other
COMPLETE EITHER (1) OR (2) BELOW (Contact your Local Permit Officer ijyou are not sure which AEC applies
to your property):
9FrAAPi B ATCc mnm r e s: era ` ^'y 9 AC7T+rST rrrmr G square feet (includes
air conditioned living space, parking elevated above ground level, non-conditione�spaoe elevated above ground level but
excluding non -load -bearing attic space) (0 t'+<%oot' 52v�d I7 o n l7
(2) COASTAL SHORELI AE�s: 0Z OF B LD G FOOTPRINT AND OTHER IMPERVIOUS OR BUILT
UPON SURFACES: l tar %et includ�s tle rea 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.)
STATE STORIVIWATER MANAGEMENT PERMIT: Is the project located in an area subject to a State Stormwater
Management Permit issued by the NC Division of Water Quality?
YES NO
If yes, list the total built upon area/impervious surface allowed for your lot or parcel: square feet.
RECEIVED
F1ECEIVED
DCM WILMINGTON, NC
OR 0 2 2015
MAR 0 2 2015

OTHER PERMITS MAY BE REQUIRED: The activity you are planning may require permits other than the CAMA
minor development permit, including, but not limited to: Drinking Water Well, Septic Tank (or other sanitary waste
treatment system), Building, Electrical, Plumbing, Heating and Air Conditioning, Insulation and Energy Conservation, FIA
Certification, Sand Dune, Sediment Control, Subdivision Approval, Mobile Home Park Approval, Highway Connection, and
others. Check with your Local Permit Officer for more information.
STATEMENT OF OWNERSHIP:
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)
%}ouy/as ,%nniny5, ur: E Suzahne C. 'TeAr,i✓71s
/ an �oqwner or record 'tle, Title is vested in &-U, t 5W Ck Cp, see Deed Book
page _L_ in the StYI County Registry of Deeds.
an owner by virtue of inheritance. Applicant is an heir to the estate of
probate was in County.
if other interest, such as written contract or lease, explain below or use a separate sheet & attach to this application.
NOTIFICATION OF ADJACENT PROPERTY OWNERS:
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 LAMA permit.
(Name) p (Address)
(1) McAkepiaot_ %FEde.11G�rnar }507 Ci»e.sfvtu(' In�ilv..�.�a-f tfC2B4o1
(2)4fl4tewfGre"er Clark , Zt q5 Dan;el pap (cRun_ Da"iaj CAA 3oo19
(3)
(4)
ACKNOWLEDGEMENTS:
I, the undersigned, acknowledge that the land owner is aware that the proposed development is planned for an area which
may be susceptible to erosion and/or flooding. I acknowledge that the Local Permit Officer has explained to me the particu-
lar hazard problems associated with this lot. This explanation was accompanied by recommendations concerning stabiliza-
tion and floodproofing techniques.
I furthermore certify that I am authorized to grant, and do in fact grant, permission to Division of Coastal Management staff,
the Local Permit Officer and their agents to enter on the aforementioned lands in connection with evaluating information
related to this permit application.
This the Z q day of , 20 IS
Landowner or person aAhoriz& to act aslis/ifer agent for purpose of filing a CAMA permit application
This application includes., general information (this form), a site drawing as described on the back of this application, the
ownership statement, the Ocean Hazard AEC Notice where necessary, a checkfor $100.00 made payable to the locality, and
any information as may be provided orally by the applicant. The details of the application as described by these sources are
incorporated without reference in any permit which .may be issued Deviation from these details w' ntstiluuttea violation of
any permit Any person developing in an AEC without permit is subject to civil,' criminal and pdr bX riia&)doF D
RECEIVED - ,M WILMINGTON, NC
MAR 0 2 2015 MAR 0 2 2015

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03/021201 S 15:54 Brunsco EH Dept.
ffAX)9102535952 P.0011002
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Brunswick County Health Department
Environmental Health Section
Wastewater Collection, Treatment
and Subsurface Disposal System
OPERATION PERMIT
BCHD 498-50492
In accordance with the provisions of Article I I of Chapter 130A, General Statutes of
North Carolina 15A NCAC 18A.1900 et seq., and other applicable Laws and Rules as amended,
PERMISSION IS HEREBY GRANTED TO:
Owner SAM THOMASSON_ Phone [phone]_
Address 4021 BARRET DR., RALEIGH, NC. 27609
FOR TBE
operation of a 480_ GPD wastewater collection, treatment and disposal system
WHICH SHALL SERVE: 1 UNIT 4 BEDROOMS, PRMTE SINGLE FAMILY
RESIDENCE
LOCATED: _ pRIVITE TRACT vIL AGE RD PROM 179 SHALLOTTE AREA
Tax Map Reference 06 230 OA 028A1
GIS Location 1765 VILLAGE RD. SW.
with no discharge of wastes to the ground surface or surface waters p to 15A NCAC I SA section.
19000 et seq. -Laws and Rules for Sanitary Sewage Collection Treatment, and Disposal
[Hereinafter "Laws and Rules"] and in conformity with the project plans, specifications, and other
supporting data subsequently filed and approved by the Department of Environment, Health, and
Natural Resources and/or the Brunswick County Health Department (BCHD) and considered part
of this permit
The wastewater collection treatment, and disposal system ["the system" or "the facility'l as
described in the Improvements Permit and accompanying data.
The system is classified as a TYPE 3B Wastewater Treatment and Disposal System in
accordance with 15 NCAC 18A.1961.
The Owner shall be subject to the following conditions and limitations:
I. GENERAL CONDITIONS
1. This permit is effective only with respect to the specific design flow facilities, and
connections and the nature and volume of waste described in the Permit Application,
and other supporting data. Changes in the facilities, connections, nature or volume of
waste render this permit void.
2. Ownership or management changes shall be provided to the BC1-1D within 90 4M of such
changes.
3. All documents, including but not limited to site evaluation, design review plans and
specifications, Triparty Agreements, Easements, and other legal agreements mttD
of the Permit. This includes operation and maintenance procedwes an ILMINGTON, NC
documents relating to system operation and maintenance.
MAR 0 2 2015

03/02/2015
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PE CEIVED
DCM NILMINGTON, NC
MAR 0 2 2015

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Dear Adjacent Property: N r
This letter is to inform you that I, e+ dS —Q4&W C/� eve applied for a CAMA Minor
Property y Ownerf� '
Permit on my property at 1,1/, 140 ksp f %' W4, fit EfWO in COUNTY
Property Addr6ss
county., As{equired by CAMA regulations, I have enclosed a copy of my permit application and project
drawing(s) as notification of my proposed project. No action is required from you or you may sign and return
the enclosed no ob'ection form. If you have any questions or comments about my proposed project, please
contact at Yj S* -;7-zZ or by mail at the address listed below. If you wish to
AtiplicarifsTelephone
file written comments or objections with the LOCAL GOVERNMENT CAMA Minor Permit Program, you may submit
them to:
LPO NAME
Local Permit Officer for LOCAL GOVERNMENT
LOCAL GOVERNMENT ADDRESS
CITY, STATE, ZIP CODE
Since
Property gWner U
8b3 E [/:y 'f-
Mailing Address
City, State, Zip Code
RECEIVED
DCM WILMINGTON, NC
MAR 0 2 2015

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Dear Adjacent Property:
This letter is to inform you that I, have applied for a CAMA Minor
{P�ropert(y�O/Iwner ���I�' !!��� r
Permit on my property at i9b 5 V #doe Paij1Pd�'fe1 AILI . , 1V e in COUNTY aP
— 0 Property ss —�
County. As required by CAMA regulations, I have enclosed a copy of my permit application and project
drawing(s) as notification of my proposed project. No action is required from you or you may sign and return
the enclosed no objection form. If you have any questions or comments about my proposed project, please
contact me at 943 ` $4ILl — 32 2 2 ,or by mail at the address listed below. If you wish to
Applicant's Telephone
file written comments orobjections with the LOCAL GOVERNMENT CAMA Minor Permit Program, you may submit
Dim, 1103
LPO NAME
Local Permit Officer for LOCAL GOVERNMENT
LOCAL GOVERNMENT ADDRESS
CITY, STATE, ZIP CODE
Sincerely,
Prope2�'
X3 E jo�6-;h .sl,
Mailing Address
l,:G•,cHBF/Sti�,l .�� ifs/2-
City, State, Zip Code
RIECEIVED
DCM WILMINGTON, NC
MAR 0 2 2015

■ 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:
tvitLrifv t �12�C4 2v� tC�r
X ❑ Agent
_./CSYAddressee
B. ved,,by (Printed Name) C. Dat of Delivery
D. Is delivery address different from Item 1? ' ❑ Yes
If YES, enter delivery address below: ❑ No
3. ServI Type
ertified Mail ❑ Express Mail
❑ Registered ❑ Return Receipt for Merchandise
❑ Insured Mail ❑ G.O.D.
4. Restricted Delivery? (Extra Fee) ❑ Yes
2. Article Number 7003 1680 0005 4753 0506
(transfer from servlc„ .....,,,,
PS Form 3811, February 2004 Domestic Return Receipt
'vV Li'ViliNG'TON, NC
MAR o % 2015
0 Complete Items 1, 2, and 3. Also complete
item 4 if Restricted Delivery is desired.
13 Print your name and address on the reverse
so that we can return the card to you.
N Attach this card to the back of the mailpiece,
or on the front if space permits.
1. Article Addressed to:
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Signature
8 Received by (P 'bted Name}\ C! Jate
D. Is delivery addkss different from item 1? ❑ Yes
If YES, enter delivery address below: ❑ No
3, Sery Type
Certified Mail ❑ Express Mail
❑ Registered ❑ Return Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee) ❑ Yes
2. Article Number 7003 1680 0005 4753 0513 II
(transfer from service label)
PS Form 3811, February 2004 Domestic Return Receipt

Aa®
NC®ENR
North Carolina Department of Environment and Natural Resources
Pat McCrory Donald R. van der Vaart
Governor Secretary
AGENT AUTHORIZATION FORM
Date: 2.24 -15
Name of Property Owner Applying for Permit: Name of Authorized Agent for this project:
�jour�las� St.t�tnnz. rnni��s C�-e� M �j let -
Owner's Mailing Address:
903, 9, MR),6 fit,
Benne,�yilfe SG 29S12-
Email: dcv5,su,-4i) e (o gntit l - cgm
Phone (Vli-)
Agent's Mailing Address:
Grey{ fufllar KQ1n1A-PJ,m co,
S9- Lwp G'vU-P-,
U,n�Cs,' Ag5G>8
Email: �rnclmiltPrst�mv�nq l(rgi�.ct�7v1
Phone (8}3) i2`7G
I certify that t have authorized the agent listed above to act on my behalf, for the purpose of applying
for, and obtaining all CAMA Permits necessary to install or construct the following (activity):
R�rnov� ��II f -G-Dm �s'sC 3�` Cipa, ke?b,,q- ->Jl dv P t
For my property located at ) %(v5 `J))1()Ae -Pbin+
This certification is valid 1 year from (date)
�Z,�Lcl��
Pro arty caner Signature Date
N.C. Division or Coastal Management
127 Cacdinal Drive &l., wilminglon, NC 28405 R E C E I V E D
Phone:[phone] FAX: [phone]ntemet:ww.nwoasialmanagement.net CM WILMINGTON, NC
An EQvel 0pP&knN1ANM%9WR15Dn&WDY& MAR 0 2 2015

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