NH_15-04_Venters

NEW HANOVER COUNTY
Local Government
CAMA
MINOR DEVELOPMENT
15-04
Permit Number
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 George Venters , authorizing development in the Ocean Hazard (AEC) at 128 Beach Rd. S., in Wilmington,
NC, as requested in the permittee's application, dated January 6, 2015. This permit, issued on January 26, 2015, 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: Construction of a Second Floor Addition, First Floor Dining Expansion; Deck Addition and New Septic
System.
(1) All proposed development and associated construction must be done in accordance with the permitted work plat
drawings(s) dated received on January 7, 2015.
(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 910-798.7118 for a final inspection at
completion of work.
(Additional Permit Conditions on Page 2)
This permit action may be appealed by the pernittee or other qualified persons
within twenty (20) days of the issuing date. This permt 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.
a Z
Christine R.Youfflgl-
CAMA LOCAL PERMITOOFFICIAL
230 Government Center Drive, Suite 110
Wilmington,441W03 i `v c LD
DCIM WILNIIINGTON, NC
MAR 0 4 2015
PERMITTEE
(Signature required If conditions above apply to permit)

Name: George Venters
Minor Permit # 15.04
Date: January 26, 2015
Page 2
(5) The structure must set back a minimum of 60' feet from the first line of stable natural vegetation, as determined by
the DCM, the LPO, or other assigned agent of the DCM.
(6) The perrnittee is required to contact the Local Permit Officer at 910-798-7118, shortly before he plans to begin
construction to arrange a setback measurement that will be effective for sixty (60) days barring a major shoreline
change. Construction must begin within sixty (60) days of the determination or the measurement is void and must
be redone.
(7) All buildings constructed within the ocean hazard area 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.
(8) All buildings must be elevated on pilings with a diameter of at least 8 inches in diameter if round, or 8 inches to a
side if square: and the first floor level of the sills and joists must meet the 100-year flood level elevation.
(9) All pilings shall have a tip penetration greater than eight feet below the lowest ground elevation under the structure.
(10)Dune disturbances will be allowed only to the extent necessary for development and if the dune's protective value is
not weakened or reduced. Disturbed dune areas will be immediately stabilized.
(11)AII unconsolidated material resulting from associated grading and landscaping shall be retained on site by effective
sedimentation and erosion control measures. Disturbed areas shall be vegetatatively stabilized (planted and
mulched) within 14 days of construction completion.
(12)Any structure authorized by this permit shall be relocated or dismantled when it becomes imminently threatened by
changes in shoreline configuration. The structure(s) shall be relocated or dismantled within two years of the time
when it becomes imminently threatened, and in any case upon its collapse or subsidence. However, if natural
shoreline recovery or beach renourishment takes place within two years of the time the structure becomes
imminently threatened, so that the structure is no longer imminently threatened, then it need not be relocated or
dismantled at that time. This condition shall not affect the permit holders right to seek authorization of temporary
protective measures allowed under CRC rules.
SIGNATURE:
PERMITTEE
DATE:
RECEIVED
DCM WILMINGTON, NC
MAR 0 4 2015

NEW HANOVER COUNTY
Local Government
��.j1T1v
MINOR DEVELOPMENT
PERMIT
15_04
Permit Number
as authorized by the state of North Carolina, Department of EnvlronmeM,
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 George Venters , authorizing development in the Ocean Hazard (AEC) at 128 Beach Rd. S., in Wilmington,
NC, as requested in the pernittee's application, dated January 6, 2015. This permit, issued on January 26, 2015, 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: Construction of a Second Floor Addition, First Floor Dining Expansion; Deck Addition and New Septic
System.
(1) All proposed development and associated construction must be done in accordance with the permitted work plat
drawings(s) dated received on January 7, 2015.
(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 gjfl,ZR 7,IijilIVa-fnal inspection at
completion of work. CM WILMINGTON, NC
(Additional Permit Conditions on Page 2) FEB 1 9 2015
This permit action may be appealed by the permitlee 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, 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.
Christine R. BoutWrd
CAMA LOCAL PERMIT OFFICIAL
230 Government Center Drive, Suite 110
Wilmington, NC 28403
PERMITTEE
(Signature required if conditions above apply to permit)

Name: George Venters
Minor Permit # 15-04
Date: January 26, 2015
Page 2
(5) The structure must set back a minimum of 60' feet from the first line of stable natural vegetation, as determined by
the DCM, the LPO, or other assigned agent of the DCM.
(6) The permittee is required to contact the Local Permit Officer at 910-798-7118, shortly before he plans to begin
construction to arrange a setback measurement that will be effective for sixty (60) days barring a major shoreline
change. Construction must begin within sixty (60) days of the determination or the measurement is void and must
be redone.
(7) All buildings constructed within the ocean hazard area 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.
(8) All buildings must be elevated on pilings with a diameter of at least 8 inches in diameter if round, or 8 inches to a
side if square; and the first floor level of the sills and joists must meet the 100-year flood level elevation.
(9) All pilings shall have a tip penetration greater than eight feet below the lowest ground elevation under the structure.
(10)Dune disturbances will be allowed only to the extent necessary for development and if the dune's protective value is
not weakened or reduced. Disturbed dune areas will be immediately stabilized.
(11)AII unconsolidated material resulting from associated grading and landscaping shall be retained on site by effective
sedimentation and erosion control measures. Disturbed areas shall be vegetatatively stabilized (planted and
mulched) within 14 days of construction completion.
(12)Any structure authorized by this permit shall be relocated or dismantled when it becomes imminently threatened by
changes in shoreline configuration. The structure(s) shall be relocated or dismantled within two years of the time
when it becomes imminently threatened and in any case upon its collapse or subsidence. However, if natural
shoreline recovery or beach renourishment takes place within two years of the time the structure becomes
imminently threatened, so that the structure is no longer imminently threatened, then it need not be relocated or
dismantled at that time. This condition shall not affect the permit holder's right to seek authorization of temporary
protective measures allowed under CRC rules.
SIGNATURE:
PERMITTEE
DATE:
RECEIVED
DCM WILMINGTON, NC
FEB 1B2015

Luc Jity _ �i6 Permit Number '0
Crean I laz.:rd Estuarine Shoreline ORW Shoreline _—Public Trust Shareli ne _Other_
(For official use only)
GENERAL INFORMATION
1, • tr
Ciro ,eA-1-0 Gil State NG Zip_ *_607 Phone 919-i!p4—'54e0
AUTVJORIZED AGENT
Name Joft S1 f?E\JN LT 'WCVhT�er , pe .
Address 45A Tx5C3 "r' -DR .
City W 1 LM 10 &-tog State 11C Zip 29+11 Phone AID --
LOCATION OF PROJECT: (Address, street name and/or directions to site. If not oceanfront, what is dte name of
7J`
the adjacent watcrbody?) 126 0hk-_ t V-D. �7sOLCN , i sl teou" El (a' j4T 143L t b
DESCRIPTION OF PROJECT (List all proposed construction and land disturbance.)
At > Aetma n oA t t5T f mp- 0Y1W st a!
VAR-lbus 111T�R1012 �t-l0✓ATlt�rl6 zx kUnc n �a�, s,
zs,z6y = {,eStG 4.11evrR111
SIZE OF LCT/PARCEL: 2 5� oi�© square feet acres
PROPOSED USE: Residential --/(Single-family _ Multi -family _) Commerical/Industrial _
Other
TOTAL ENCLOSED FWOR AREA OF A BUILDING IN THE OCEAN HAZARD A kFA Op ENTvT-
ROi`<'MEN i�1I. CONCERN (AEC): 51 �6 square feet (includes all floors and roof -covered decks)
SIZI? OF BUILDING FOOTPRINT AND OTHER IMPERVIOUS OR BUII I= ON ES IN
THE COASTAL SHORELINE AREA OF ENVIRONMENTAL CONCERN (AEC): scl. ft,
(Calculations include the ar a of the roof/drip line of all buildings, driveways, covered decks, concre(a 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) xichin ?5 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 Outsranding
Resource Waters
(3.) within 30 feet of the Public Trust Shoreline AEC R E C C I V E D
(Contact your Local Permit Officer if you are not sure which AEC applies to your property.) DCM WILMINGTON, NC
STATE STORMWATER MANAGEMENT PERMIT Is the project located in an area subject to a JAN 2 120115
State Stormwater Management Permit issued by the N.C. Division of Water Quality?
YES_ NO_�
I: yes, list the total built -upon area/impervious surface allowed for your lot or parcel. square feet.

RECEIVED JAN 0 7 2015
yMER pERIo-'lI TS IVLW BE REQLTMW: The activity you are planning may requite permits other rhan the CAMA minor, 10
10
levelopment permit. As a service os have compiled a list of the kinds of permits that might be required. We suggest you cbeck over the list
vith your LPO to determine if any of these apply to your project, Zoning, Drinking Water Well, Septic Tank (or other sanitary waste t"
rearment system), Burring, Electrical, Plumbing, Heating and Air Conditioning, Insulation and Energy Conservation, PIA Certification, (�
;and Dune. Sediment Control, Subdivision Appmvai, D4obile Home Park Approval, Highway, Connection, and others.
Z
j TA EEME2•TI' OF OWNMHIP:
i, the undersigned, anIapplicant 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) R I ta
_✓m owner or record tide -Tide is vested in GOOP49 G Vfe"TW'& see Deed Book !!p G G
page _L4!U in the MEW kAWM ..County Registry of Deeds.
_an owner by virtue of itnccricmce. 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 and attach cc this application.
No 'nFICATi ION OF ADJACENT 13RO PEIXTY 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 CAMA permit.
(Name) (Address)
(2) ?-AVLA y ::,�}4�17C I'�fs RfG�lGlk 1ZI> sunk K
1
(3)
(4)
FOR DEVELOpER.S IN OCEAN HAZARD AND ESTUARINE HAZARD APES:
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 aaltitnl1a - Jjj4 1 moms associ-
ated with this lot. This explanation was accompanied by recommendations concerning staBi(rttiifdlblll
ch-
niques. JAN 2 1206
PEltMISSi40IT-7 TO ENTER ON LAND:
I furthermore terrify 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.
This the day of /JA#J UhKY , 2012
J�i�iat.�tf . �,QLyfT>"sGT

RECEIVED JAN p 7 2015 I4�`O+
AEC HAZARD NOTICE
Project Is In An: Ocean Erodible Area —High Hazard Flood Area ^ inlet Hazard Area
Property Owner:
tt �• a� R
Property Address: i Ba?�Ci• •
Date Lot Was Platted:
This notice is intended to make you, the applkank aware of the
special risks and conditions associated with development in this
aura, which is subject to natural hazards such as storms, erosion
and cameuts. The rules of the Coastal Resources Commission
require that youreceive anAEC HazardNotice and acknowledge
that notice in writing before a permit for development can be
issued.
The Commission's roles on building standards, oceanfront
setbacks and dune alterations are designed to minimize, but not
eliminate, property loss from hazards. By grunting permits, the
Coastal Resources Commission does notguarantee the safety of
the development and assumes no liability for future damage to
the development. Permits issued in the Ocean Harard Area of
Environmental Concern include the condition that structures be
relocated or dismantled iftheybecomeimminentlythreatened by
changes in shoreline configuration. The structure(s) must be
relocated or dismantled within two (2) years of becoming
imminently threatened, and in any case upon its collapse or
subsidence
The best available information, as accepted by the Coastal
Resources Commission, indicates that the annual long-term
average ocean efusion rate for the area where your property is
located is _-1 feet per year.
The rate was established by careful analysis ofaenalphotographs
of the coastline taken over the past 50 years.
Studifs also indicate that the shoreline couldmove as much as
.b feet landward in a major storm.
The icrd waters in a major storm are predicted to be about
I *Itfeet deep in this area.
Preferred oceanfront protection measures are beach nourishment
and relocation of threatened structures. Hard erosion control
structures such as bulkheads, seawalls, revetments, groins, jetties
and breakwaters are prohibited Temporary sand bags may be
authorized under certain uvraiitions.
The applicant must achwwledgethis information and requirements
by signing thispetra in theAce below Without the proper
signature,th94pp40riwiffcomplete.
SPECIAL NOTE. This huzardnotice is required for development
in areas subject to sudden and massive storms and erosion. Permits
issued for development in this area expire on December 31 ofthe
third year following the year in which the permit was issued
Shortly before work begins on the project site, the Local Permit
Officer must be contacted to determine the vegetation line and
setback distance at your site. Ifthe property has am little change
since the time ofpermitissue=. and the proposed development
can still meet the setback requirement, the LPO wilt inform you
that you may begin work. Substantial progress on the project
must be made within 60 days of this setback determination, or
the setback must be remeasured. Also, the occurrence ofa major
shoreline change as the resultofastorm within the 6(Waypenod
will necessitate rememurement of the setback. It is important
dwyou eheckwiththe LPO before thepermtt empires fraolflcral
approval to continue the work after the permit has expired
Generally, tffoundation pilings have been placed and substantial
progress is continuing, permit renewal can be authorized. It is
unlawful to continue work after permit expiration.
For more information, conrocL-
2,6p GD\MOMQi 4T C111yR_'bR ,
Address
1jew thw0vtp- C°""m/
Locality
g 10 - -44 S -
Phone Number
RECEIVED
DCM WILMINGTON, NC
JAN 2 F 2UM

RECEIVED JAN 0 7 2015
FXWA
N=ENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Pat McCrory Braxton C. Davis
Governor Director
John E Skvada, III
Secretary
AGENT AUTHORIZATION FORM
Date:
Name of Property Owner Applying for Permit: Name of Authorized Agent for this project:
Owner's
.'
.,
Agents Mailing Address:
456 06ISGAq;k DR
Wtt_wu4 &091 t4L -ZS+(l
Phone Number ('}ILlCao4-S!4SL7 Phone Number (A 10 fp$&•51251
I certify that I 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):
For property locatedi f A t•
This
't
RECEIVED
Property a Signature Date DCM WILMiNGTOAI NC
JAN 21205
127 Cardinal Drwe Eq., ftr ington, NC 28405 N fl Camli/,p'a
Phone: 910-79&72151 FAX 910-395,1984 Intemet: www.ncooaaWmanagwwt.net ratu�i../[/�
M EWO Oppww* f A%muinAcvmEmpMw

RECEIVED FEB 1 9 2015
i
WR
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor Donald R. Van der Vaart
Secretary
AGENT AUTHORIZATION FORM
Date: 2 12 f 5
Name of Property Owner Applying for Permit: Name of Authorized Agent for this project:
Geame Venters Jo" -eW-&,,L-V 1yGt'I'1Tr,(�
Owner's Mailing Address:
709 Yarmouth Road
Rateieh. NC 7-1-4 o 4-
Agent's Mailing Address:
'T7i. g alb-��►71-I rc y�ifrZ.
W tu44 14ra-1 b4 iJ64!:, 7A411
Email:_ gventers(alvanguardne.com Email3y!ltd5jjjtZC.WA;r.TAszr— yn..'(T 6MA{L.(%1M-0,
Phone [phone] Phone t !R (; g G - 3131
I certify that I have authorized the agent listed above to act on my behalf, for the purpose of applying
for, and obtaining all LAMA Permits necessary to install or construct the following (activity):
This certification -is valid 1
from (date)
Property Owner Signature
Date
N.C. Division of Coastal Managemeq
127 Cardnal Drive Ed., Wilmington, NC 2&405
nlnne 910-79&72151 FAK 910395-M Wmet w-Fvumastahmnagemenf.nat
An E*W Opporhnlly 5A6mnFe Acfon
RECEIVED
DCM WILMINGTON, NC
FEB 1 9 2015

RECEIVED JAN 0 7 2015
If mailing letter, please send as:
CERTIFIED MML
RETURN RECEIPT REQUESTED
Dear AULA.. 7?;L614 AV-27T
This letter is o no
MOMrs.
plans to construct
Date: 12,2-, 1 +-
riparian landowner, that
on their pperty, located at
in (, rocTl f.14T
(The sketch on the reverse side accurately depicts the proposed construction)
• �'� •l �� �_� 1• Wit_ _ftl C7/.as soonpossible.
CAMA Local Permit Office
New Hanover County Inspections Department
Zoning Division
230 Market Place Drive, Suite 110
Wilmington, North Carolina, 28403
Comments will be considered up until the time of issuance of a permit -
Sincerely,
RECEIVED
,/ DCM WILMINGTON, NC
I have rto objections to the project as presently proposed. JAN 2 1 20 I5
T I have objections to the project as presently proposed and have enclosed comments_
Signature
Date

15-oy
(Domestic Mail Only: No lnsuranCe
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RECEIVED
DCM WILMINGTON, NC
JAN 2 1206

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Postal Service
TIFIED MAIL •RECEIPT
Mail Only:No Insurae CoverageProvided)
n^�; inl�,i mntlo,e v�slt our website a: yrww.usps.com,:
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RECEIVED
DCM WILMINGTON, NC
JAN 2 12615

!•�� - � � �r -w .ter r-w t r r.s.s
ENVIRONMENTAL HEALTH
230 GOVERNMENT CENTER DRIVE, SUITE 140
WIM*UNGTVN, NU 28404
J TELEPHONE [phone], FAX [phone]
..,rnnil-o•
' r�tnD r_1i>C1;C1,1T wLp �RrT
PIN ;A buikfingper nrr cannot be issued with only an ImproverientPrrmif)
R05208001004000 (Expiresfm (5) yecrzfrom dale of1=e)
I ❑ Expansion ❑ New ❑ Repair
,
Issued To: SWIFT, ROBERT
Property Location: 128 BEACH Rd SOUTH - LOT 161 - SECTION 4 - FIGURE 8 ISLAND
Type of Structure: SFD Type of Wastewater System: IVa
,
rermn I.lumocr
ON0663305
Pile Number !
14039 J
Type of Water Supply: PUBLIC WATER SYSTEM Projected Daily Flow: 480 GPD
Number of Bedrooms: 4 Number of Employees: Number of Fixtures:_ Total Sq. Ft Bldg.: Max 9 of Seats:
Pump Required: M Yes . ❑ No ❑ May be required based upon final location and elevations of facilities.
Site lmMwinems required trim to Corsuuctioo Authorization lace: -
Authorized State Ageu"-- � Date: ,See Attached Site Sketch
The Issmeme ofMispemdf bythe.Ye, Hanover ConnryHes Ik Department in no wcygnaramovtke' atra ofva"pernds The permit holder is regenslbiefiw
(y(faRJllg WlrllappraprrmegarerlYng baCtQ IA IMdRg tOw •rq.n. unwo. -�.�.. I. _.[..:.]LJ. � .��_- _. ---- : -
lmprovcmenr Permil shall not be afecMd by a change in the ownership of the site This pent' l is subject to rnmplrance with the provisions of the laws and Rules fcr
Se'+'age Trealernenttmd Dispa.Pal and to condKiuns ofehh pr nit.
Construction Authorization
(Keoulrea for Bunalne reml w
The gonstrrction and installadon requirements of Rules 1950, .195A .1954, 3596, 3957, 3958, and. I P59 are incmporaled by mferenx into reapernril and shall be met
Sjrebhit shag be nntalled in a: eordance with dv aaaahedsysfem layout
T.t,,nd Tn• C,WtFr V(IRTMT
Property Location: 128 BEACH Rd SOUTH - LOT 161 - SECTION 4 - FIGURE 8 ISLAND
Facility Type: SFD ❑ Expansion ❑ New ❑ Repair Basement Fixtures: ❑
Type of Wastewater System: 1Va (Dunw) rroposea s of bearooms: 4
,Installation Reauirements/Conditions
Septic Tank Size: 1.000 gallons Wastewater Flow: 480 GPD
Pump Tank Size: 1,000 gallons
I otat I rencn Lengtn: ri/A n ceu oq. r I.. yinii A i 01,1 f — <<V _
Trench Spacing: 3 Feet on Center
Trenches shall be installed on contour at a Maximum, es
(Trench bottoms shall be level to +,-=114" in all directions) Trench Depth of 8' ABOVE MSL inch
Cadidom: 1. IS X '0' BED WITH 6 X 40' LINBS. BID INSTALLED AT V ABOVEXL. LPP D1STRMUnON WTTNIN BED.
1. MAIN THIN IV rKVMWA1MWM W
3. SUPPLY LANE UNDER DRIVEWAY WILL BE 30" DEEP OR UTILIZE DUCTILE IRON
A. PUNIP, CRUSH AND FILL E: MSTAIG SEPTIC AND Kle TANK
S. ExISTTNG SYSTEM WILL HAVE TO BE REWOVE AND DISPOSED OF AT APPROVED FACATrY.TO INSTALL NEWS 'STE"s.
6, OPERATION PERMIT WILL BE ISSUED ONCE SIGIAID COVMA47 WITH CERTIFIED OPERATOR TO PREFORM OPERATION AND MAINTENANCE IS SUBAATTED.
lfappUwbheIravderstand the sy.tem oye specified isdykrer.:from the type specified on theappucatfons IaexPt err specytcattougrnrspennrr.
RE�CEJ.VED
Owner/Legal Representative Signature:
..... .. .:. ...... ._-.:... _-..". "___. .-:r.�.......r..e .,1.,. ., rx_c!•e!4_dr clMnes_ 1h.:llmrsnucrinn Atrlhoriationslta0 not oe frarurerreQ
when tiv:re is a cho ge in ownership of this site This Corslmc' hon Alhori=Hix, is sdbjeer to compliance with thepraviricns Oflhe lau�rtp 'R�etjfo� ge
Troatmeni am'Dispwal anc to the conditions oflhis permit
Authorized State Agent �� -- ''�� y' h Date,of Issuance: 12/31/2014 Date of Expiration: 12/31/2019
"Healthy People, Healthy Environment, Healthy Community" See Attached Site Sketch
RECEIVED JAN 0 7 fir,

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BAN 7,1, 2015
PATRICK C. BRISTOW
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