BC_16-23_Payne

Brunswick County BC16.23
Local Government Permit Number
CAMA
MINOR DEVELOPMENT
PERMIT
N1-
CoastahWanagement
E:v1AONMEN AL OUAIIl
as authorized by the State of North Carolina, Department of Environmental quality
and the Coastal Resources Commission for development in an area of environmental
concern pursuant to Section 113A-118 of the General Statutes, "Coastal Area Management
Issued to William Payne, authorizing development in the Estuarine Shore Area of Environmental Concern (AEC) at
891 Bostic Place SW in Shallotte NC 28470, as requested in the permittee's application package, dated 25-Oct-16 and
received complete 26-Oct-16. This permit, issued on 07-Nov-16 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: 82' Retaining Wall.
(1) All proposed development and associated construction must be done in accordance with the permitted work plat
drawings(s) dated received on 26-Oct-16.
(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 [phone] for a final
inspection at completion of work.
(Additional Permit Conditions on Page 2)
ul ivl WILMiNu 1 ON,
NOV 2 y 2016
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, 2019
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.
C nie Marlowe
CAMA Local Permit Official
PO Box 249
B�'w`ji NC 28422 —�-
PERMITTEE
(Signature required if conditions above apply to permit)

Name: William Payne
Minor Permit # 16-23
Date: 07-Nov-16
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 foot 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, until such time as the area
has been properly stabilized with a vegetative cover.
(8) Any proposed for grading within the 30' buffer from the Normal High Water level 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: �t� '�1uv DATE: �DV
PERMITTEE
7�EC�;V'ED
uC,M WILMINGTON, NC
NOV 2 12016

Locality 13r
w l'dc.-
Permit Number` I �—) -3
Ocean Hazard Estuarine Shoreline_V ORW Shoreline Pu is Shho�_ ine Other _
(For official use on QX
r ! C -(5
GENERAL INFORMATION
LAND OWNER
Name t�.J l ltiQft) �WNe
Address f�!!JiJ SC.lMl i YICU 012.
City PC& i�� State W.C-- Zip-LJg31 Phone p D3'SZL-1150
AUTHORIZED
Address
rr•l
City .JiI.LkS-0NVM0- State
ZQ,BSffD Phone ft-EQ-sSff)
LOCATION OF PROJECT: (Ad�ydress, street name and/or directions to site. If not oceanfront, what is the name of the
adjacent waterbody.) 3 hPL � b I l t° 0111 Q. (L I 13 66f'! C P1. W
DESCRIPTION OF PROJECT: (List all proposed construction and land disturbance.) I(il V\) t NQ CJj_
SIZE OF LOT/PARCEL: 30,51(p square feet acres
PROPOSED USE: Residential 0' (Single-family ❑ Multi -family ❑ ) Commercial/Industrial ❑ Other
COMPLETE EITHER (1) OR (2) BELOW (Contact your Local Permit Officer #'you are not sure which AEC applies
to your property):
(1) OCEAN HAZARD ABCs: TOTAL FLOOR AREA OF PROPOSED STRUCTURE: square feet (includes
air conditioned living space, parking elevated above ground level, non -conditioned space elevated above ground level but
excluding non -load -bearing attic space)
(2) COASTAL SHORELINE AECs: SIZE OF BUILDING FOOTPRINT AND OTHER IMPERVIOUS OR BUILT
UPON SURFACES: U 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.)
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?
YES_ NO__
If yes, list the total built upon area/impervious surface allowed for your lot or parcel:
square feet.
RECEIVED
OCT 2 6 2014
_i'vED
;PLMINGTON, NO
"T 2 7 2016

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)
__.Zan owner or record title, Title is vested in O i I f(n()1 ' UNC see Deed Book
page 2-Pi_ in the e) l SLJ iLKC County Registry of 6eeds.
_an owner by virtue of inheritance. Applicant is an heir to the estate of
probate was in County.
0
_if other interest, such as written contract or lease, explain below or use a separate sheet & attach to this application.
NOTIFICATION OFADJACENT 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 thern concerning my intent to develop this property and to apply for a CAMA permit.
(1)
(2)
(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 23 day of 'Oe , 20 IL-,
Landowner or person authorized to act as his/hertagent 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 check for $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 will constitute a violation of
any permit. Any person developing in an AEC without permit is subject *tEGEWLXQal and administrative action.
OCT 2 6 20%

I
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LOT 7A
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SHADED X
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Uri
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EDGE OF MARSH w
PROPOSED
us
_
HOME ON PILINGS o
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4 . NO. 891
30 ` LOT 9
12.8X 15.5 r
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11.8 9
"MEN
30' BLFFER LINE
S
D moo. 169�
O
I\ LOT 10
M �E
70 LOT 9A SHADED X
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m1 11.0
me
LOT IDA
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RECIEiVED
ram, �
DCM WILMINGTON, NC
/ ��/�
NOTES:
_
RECEIVED
SURVEYED BY USING MAP BOOK 6, PAGE 28 %Pq(ZA, ==�
AND EXISTING PHYSICAL CONDITIONS /Y
OCT 2 6 2016
PROPERTY IS IN A FLOOD HAZARD AREA
SEE FEMA MAP 3720109700J / 6/2/2016 FOR FLOOD ZONES
PROPERTY IS IN FLOOD ZONES SHADED X. AE, AEFW
ELEVATIONS ARE NAVD 1988 (GPS READINGS) NOTE; FLOOD ZONES ARE SCALED/MAY BE ERRORS
PLOT PLAN FOR
SCALE
1 — 40
OAAo(\
YALLIAM W. PAYNE ET. UX.
TOWNSHIP
SHALLOTTE
PSH
=O eoo,t.,,�,, �;�
OF
LOTS 8,8A AND 9,9A
COUNTY
BRUNSWICK
STATE
N.C.
L1250
TAR LANDING HEIGHTS
TOWN
MAP BOOK 6. PAGE 28
*. e
� °Sores+�
'
TAX PARCEL 214CO031
DATE
7/10/2016
JAN K. DALE
9p
REVISED a 19/2016
FIELD BOOK
12-17i
N.C. PLS NO. L-1260
891 COPAS RD. - SHALLOTTE, N.C.
910-754-4477
P .S. JAN K. DALE
DRAWN BY
JKD
N.G. PLS NO. L-1250
DWG. NO.
C/ww

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
`Q�
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner:
Address of Property: /J 2/ 3P. j�f/� e 5,4, /,7�
(LotorStreet*, Street or Road, City & County) /J
Agent's Name#: �1L I( ��l��j��OiL1 Mailing Address: 219 Parr-iS LX&l C�
Agent's phone#: '110'33t� SSt�b `}0501JV1�'i. IJ.�. Zra�4b
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
tl;ey arq proposing. A description or drawing. with dimensions must he nrnviriart with this iotte.
I have no objections to this
have objections to what is being proposed, you mu
7 within 10 days of receipt of this notice. Corresp
igton, NC, 28405-3845. DCM representatives can
iered the same as no objection if voa have been n
I have objections to this proposal
tify the Division of Coastal Management (DCM) in
ice should be mailed to 127 Cardinal Drive Ext,
be contacted at [phone]. No response is
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set
back a Minimum distance of 15' from my area of riparian access unless waived by me. (If you
wish to give the setback, you must initial the appropriate blank below.)
1 do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
Owner Information)
Signature gn ture
Print or Type Name rint or Type Name
Mailing Address Mailing Address
City/State/Zip CttyJState2ip
Telephone Number Telephone Number
Gr_=iiIEG
�2 MINGTON, NC — / CO —,d +nni_
Date Date
Revised 611812012 7 2016

40K
OFOR RENL[� h A� �Y�j
O FOR 1" ���6
ACCOUNT
OCASH
-CHECK
MONEY
DORDER
0 CREDIT
CARD
PAYMENT
V
UU �
SAL. DUE
No. 191659
DOLLARS
TO
RECt_I ED
DCM WILMINGTON, NC
OCT 2 72016

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION(WAIVER FORM
Name of Property Owner:
Address of Property:
% � (Lot or Street #, Sfrf
Agent's Name #: 1'Iil ed. 4AIN6100
Agent's phone #: 110 -33�
/';/L- 20-�' %O
or Road, City & County)
Mailing Address: Z7q i r_!?21 S rye K
�"acks�uyi)le 1J.c. U55yD
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.
i)`l 5 I 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. Correspondence should be mailed to 127 Cardinal Drive Ext.,
Wilmington, NC, 28405-3845. DCM representatives can also be contacted at [phone]. No response is
considered the same as no objection if you have been notified by Certified Mail
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater. boathouse, lift, or groin must be set
bs:ck a minimum distance of 15' oom my area of riparian access unless waived by me. (If you
wish to waive the setback, you must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
v-
trLJ)YVO
do not wish to waive the 15' setback requirement.
(Proper wner Info tion)
Signature
Print or Type Name '-7-
/L6 �L
Mailin Address
City/StatelZip
-32-2 3O
Telephone Number
Date
(Adjacent Property Owner Information)
JrlGi✓t�, ���
Signature
Print or Type Name
y 7 ? 13 u' 5rn C- FL tc-c- s �%
Mailing Address
4/1 t ir_ y t &1 c - Lf 7 0
City/State2ip
21a
Telephone Number
/0-
Date
Revised 6/182012

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AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: L I dlouYi Ali tdt°
Mailing Address: IihD &'MfYlll Irl,) De
Hill S Zt3`131
Phone Number: R31 -33Z' 716 0
Email Address: IV oj-� d 6d)n is A; an 1. L-Dm
I certify that I have authorized
Agent / Contractor
to act on my behalf, for the purpose of applying for andobtainingall CAMApermits
necessary for the following proposed development: I�Ci N INQ L,j
at my property located at 991 LLB L rL. aoj AP- K,e. 2.M q0 ,
in &UAl ,Wl Lk County.
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.
Property Owne Informlaatitoo :
"Y
Signatur
L. i I11 1 �jr
Print or Type N me
.1nU
Title
�� I � f Zl)1✓e
Date
This certification is valid through REC7IVED
LZ / Z5 I ZCL4 DCM WILMINGTON, NC
0 C T 2 7 2016

NIIIII IIIIIIIIIIIIIII IIIIIIIIII I IIII B2980 P0690� %sac ea]
B,u..I.k Co.L, NC Register of Deeds pane 1 of 2
B,vnda D. Clenwns ReOlster of Deeds
10-01-2009 15:90:45A01 Brt lck Canty, NC
NC REVENUE STAMP: $700.00 (N190T191
Ck5 �� f.1.,49,13Cosn1
Refund: C.r:•c __FnNmCe_
❑Pc�a•: s.:.va�ta ,�wuwwwasn
oia��w
ivsbamem Bv: rlxv 4, e;:�..:+e a uciil.
NORTH CAROLINA GENERAL WARRANTY DEED
STATE OF NORTH CAROLINA
COUNTY OF BRUNSWICK
Excise Talc: $700.00
This instrument was prepared by: MatCallum & Associates PLLC
4914 Main Street, Shallotte, NC 28470
Brief description for the Index: LOTS 8, 8A, 9 AND 9A, TAR LANDING HEIGHTS SUBDIVISION
Pucel No.: 214CB031
THIS DEED made this In day of October, 2009 by and between NICHOLAS A. HARTMAN
AND WIFE, DEBORA K HARTMAN. GRANTOR, and WILLIAM W. PAYNE(MARRIED),
GRANTEE, whosemailing address is: 1468 Summit View Dr., Rock Hill, SC 29732.
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 of that certain lot, tract or parcel of land situated in the Town/City of,
BRUNSWIGK County, North Carolina and more particularly described as follows:
BEING ALL OF LOTS 8, SA, 9 AND 9A, TAR LANDING HEIGHTS, AS SHOWN ON A MAP
OF THE SAME PREPARED BY V.M. HERLMCH, RIB, OCI OBER AND NOVEMBER, 1959 AND
DULY RECORDED INMAP BOOK 6AT PAGE 28 OF THE BRUNSWICK COUNTY REGISTRY.
DCM WILMINGTON, NC
OCT 2 7 2016

IIIIIII I IIIIIII IIII IIII I IIIIIII III B2ssa Fassi a ' .tea,
arunspick County, NC Register of needs Pape 2 of 2
The property hereinabove described was acquired by Grantor by recorded in Book 2558,
Page 319.
TO HAVE AND TO HOID the aforesaid lot, tract 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 said 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 mated. Title to the property herein above
described is subject to the following exceptions:
1. All applicable zoning and land use ordinances, statutes and regulations.
2. Ad valorem taxes not yet due and payable.
3. All applicable restrictive covenants and utility easements of record.
The designation Grantor and Grantee as used herein shall include said parties, their heirs,
successors and assigns, and shall include singular, phnal, masculine, feminine or neuter as required by
context.
IN WITNESS WHEREOF, the Grantor has duly executed the foregoing as of the day and year
fast above written.
NICHOLAS A. HARTMAN
DEBORA K HARTMAN
Stamnf
Countyof aa6
I certify thatNICHOLAS A. HARTMAN and DEBORA K HARTMAN personally appeared before
me this day, and 1 have seen satisfactory evidence of the principal's identify, by currrent state or
federal identification with the principal's photograph in the form of a-Dro wc< AnPP nz a.: each
acknowledging to me that he or she voluntarily signed the foregoing document for the purpose stated
therein and in the capacity indicated.
Witness my hand and Notarial stamp or seal, this Ls} day of 200s
My Commission Expires: jD Oil
( (D..0
Notary
DGM WILMINGTON. NC
0 C 1 2 7 `1016

IIIIIIIIIIIIIIIIIIIIII(IIIIIIIIIIIIII B2980 Pas9z�0-01-209
o7 aa0sox
8runaWck County, NC Register of needs pegc 1 of S
/r
Presen ,(tit'!-. ---Fret
/ C6ta1.Ck^CFinance_—
❑ Podons � accwaa n eee:;a dw a •:raze
otaiporat
U n......wn�•ye 7.�f M•'tfStY'O'CMB�
105tlaakwCdl:aaw ra.�T./:tag ereafad
NORTH CAROLINA DEED.OF TRUST
SATISFACI70N: The debt secured by thewithmDeed ofTrust
together with the note(s) secured d=cbyhmbem satisfied in fall -
This the day of . 20
Parcel Idngif. No.214CB031 Veti5ed by Cowtyoa the_ day of ,20_
By.
Mai iBox to: JAMBS J. MACCALLUM, THE LAW OFFICE OF JAMBS J. MACCALLUM, PLLC., 4914 MAIN STREET,
This instummt was ptepmedby: THE LAW OFFICE OF JAMBS J. MACCALLUM, PLLC.4914 MAIN STREET
Brief description forthe Index: LT 8, SA, 9 & 9A, TARLANDING HEJGH'fS SUBDIVISION
THIS DEED ofTRLWua&mis 24th &yof September .2009 byandtietwonx
GRANTOR TRUSTEE BENEFICLARY
The Law OJT= of James J. MacCaOnm Nicholas A. Hagan and Debora
WB.I.IAM W. PAYNE (MARRIED) P.O. Box 2283 Heron.
1469 Summit View Dr. SheNoac, NC 28459
Rock Hill, SC 29732 4407 Wye Rd.
Lakeland, LA 707S2
Ether in appropriate blo* for cza party: --me addr=6 and, ifsm+mp*S_, character ofmtity, e.g. corporation or partoasbip
The deagoanon Cimator, TYhmtM and Beneficiary as used herem shaft inebalc said partic; theirheus, wocessom and assign, end
shill include singular, ph-1, ma —lime, frnrioine m venter as required by-WcxL
WITNASSETH, That wbraras the Grsnmr is indebted to the Benefimaly m dw psmcipai sum of
—Two Hundred Fifty Thousand and 00/100 Doll= (5 `•"•250,000.0 ), as evidm,zd by a
17o>mssoxyNote ofessm date herewitb, the lams ofwhieham hwmpmtedbv®byrefeeoce. Th final doe daft foepaymmrs of
aaid3?rn�ssoryNote, ifmteoorapaiQ is NwemberU .2012
NC BuAsociation Fo.No. L-5 ®1976, Revised 0 September 1985, 2002'
14meed by AgreementwithtbeNCHazAssociation-1981 SoflPro Corporation, 333 E. SixFcd3 Rd., Rsleig% NC 27609
IEC' ":-;VED
DCI\A WILMINGTON, NC
0 C T 2 7 [016

IIIIII IIIIIIIIIII IIII IIIIIIIIiIIIIII a?saa Pa6s3 0-0=-.a 2m2
Brunswick county, NC Register at Deeds page 2 of 5
NOW. BEREFORE,as security for said indebtedness,adnnc®tets and otbersines expended byBeaeficiarypursuant to min
Dad of Trust and costs of collection (including armmeys fees as provided in the Promissory Note) sad after valuable
comideratiou, the receipt of wh$h is hereby acknowledged, the Grantor has bug®e1, sold given and conveyed and does by these
presents bacpm, sc% give, Brat sod conveym uid Thador bus heirs, or sucom ors, and assigns, de pared(s) ofland dIsated m
the City of Township, Brunswick County,
North Carolina, (the °Prcmim) and mompartimtarly described as follows:
SEE EXHIBIT A ATTACHED
TO HAVE AND TO HOLD said Premises with all privileges and appw4nances thereimm belonging to said Trustee, his heirs,
successors, and assigns forever, upon the trusts, lams and conditions, ad for the uses hereinafter act forth.
If the Grater shall pay the Note seemed hereby in accordance with its terms, together with interest tterzon, and any
rmewzts m extension thereof in whole or in pray all other sums secured hereby and shell comply with all of the covenants,
terms and conditions of this Deed of Trust, then this conveyance shall be null and void and may be canceled of record at the
request and the expense of the Grata.
If: tnweve , it= shall be any default (a) in the payment of my sums due ode, the Note, this Deed of Trust or any other
msmnecnt seeming the Now ad such default is not tuned wihm tm (10) days firm the due date, car (b) if there shall be default
in my of the other covenants, tams or woditions of the Note secured hereby, or my failure or neglect to wmply.with the
covmats, terms or conditions contained in this Deed of Trust or any other iminaccnt securing the Note and such defiuit is at
need within fifleeo (15) days after written notice, then and in any of such evens, without further notice, it Shan belawful for
and the duty of the Truster, upon request of the Beneficiary, to sell the land herein conveyed at public auction for cash, of
having fast giving such notice ofheazing is to commencement of foreclosure proceedings and obtained such findings or leave
of court as may thin be required by law and giving such entice and advertising the time and place of such sale in such insurer
as may then be provided by law, and upon such and any resales ad upon compliance with the law then relating to foreclamre
proceedings under power of sale to convey tide to the purchaser in as fun and ample roamer as the Thatee is empowered The
Trustee shall be authorized to retain an attorney to represent him insuch proceedings.
The proceeds of the Sate shall after the Trustee :saint his com riasion togedmr with reasonable attorneys fen incurred by
the Trustee in such proceedings, be applied to the costs of age, mcluding, but not limited to, costs of collection, taxes,
msessmenb, costs of recording, service fees and incidental axpendinucs, the amount due on the Nam hereby seared and
advancements and other sums expended by the Beneficiary according to the provisions hereof and otherwise as required by The
than existing law relating to foreclosures. The Trustees commission shad be five percent (56/6) of than gross proceeds of the sale
or the ndr®ne sum of S whichever is greater, for a completed foreclosure. In the evsm funacu sere is
commenced, but not completed, the Grantor shall pay all expenses incurred by Trustee, including reasorabls attorneys fees, and
a partial commission computed on five per cart (5%) of the aaanding indebtedness or the above sated mimmsm sum.
whichever is greater, in accordance with the following schedule, to -wit: one-fourth (''/a) thereof before the Trustee issues a
notice of hearing on the right to forectosum; or ,half ('/a) thereof after issuace of said notice, duce -fourths ('/.) thereof aft"
such beating; ad the greater of the full wuumission or mininmmsum after the initial sale.
And due said Grantor does hereby oovenam and agtss with the Trustee as follows:
1. INSURANCE. Grantor shall keep all improvements on said land, now or hereafter erected, constantly insured far the
benefit of the Beneficiary against loss by fire, windstorm and such other casualties and contingencies, in such manner and in
such companies and for such amounts, not less than that amount necessary to pay the sum secured by this Dad ofTrnsy and as
may be satisfactory to the Beneficiary. Grunter shall purchase such insurance, pay all pre®lnes theret'a, and shall deliver to
BeaeSciary such policies along with evidence of premium payments as long as the Note secured bamby remains anpaid. If
Grantor fails to purchase such msmame, pay prermma therefor or deliver said policies along with evidence of payment of
prendoms thereon, then Beneficiary, ar his option, may purchase such insurance. Such amounts paid by Beneficiary shall be
added to the principal of the Nom seamed by this Deed ofTrusy ad shall be due mdpayable upon demand of Beneficiary. All
proceeds from any insurance an maintained shall at the option of Beneficiary be applied, in to debt seemed hereby and if
payable in mm fllo,rna, applied in the mverse order of maturity of inch Install is or to the repair or reconstruction of my
improvements located upon the Property.
2. TAXES, ASSESSMENTS, CHARGES. Grantor shall pay all taxes, assessments and charges as may be lawfully levied
against said Prendses within thirty (30) days after the same shag become due. In the event that Gmnmr tails to so pay all taxes,
asusmxna and charges n herein required, than Beneficiary, at his option, my pay the same and the amounts so paid shall be
added to the principal ofte Note seared by this Deed ofTrusy and shall be due and payable upon demand ofHencficiiny.
3. ASSIGNMENTS OF RENTS AND PROFITS Grantor assigns to Beaficiary, in the rent ofdefauly all rmts and profits
from the land and my improvements thereon, and audiences Beneficiary to ever upon and take possession of such land and
improvements, w rent same, at my reasonable ram of rent determbred by Beneficiary, and after deducting from any such revs
the cost ofreletting and wlleetioo, to apply the remainder to the debt seemed hereby.
4. PARTIAL RELEASE. Grantor shell not be entitled to the partial release of any of the above described property unless a
specific provision providing therefor is included in this Deed of That In the event a partial relearn provision is included in this
Deed of Trust' Grantor mart strictly comply with the terms thereof: Notwitrsanding anything herein contained, Grantor shell
NC Bar Association Form No. GS O 1976, Revised O September 1985, 2002
Printed by Agreement with the NC Bar Association —1981 SoftPro Corporation, 333 E. Six Finks Rd., Raleigh, NC 27609
REC-7:iVED
DCM WILMINGTON, NC
OCT 2 7 2016

IIIIIilylIIIIII11111111111111111111 Lwow 6�ona
8r�mautek County, NC lenrster of Deeds page 3 of 5
not be entitled te my release of property unless Grantor is mt in default and is in full compliance with all of the wrens and
provisions oftbe Not, ibis Deed ofTrust, and any other instnmcat that maybe securing said Note.
S. WASTE. The Granter covenants that he will keep the Premises herein conveyed in as good order, mpair and condf6m n
they are now, reasonable wear aad.kar accepted, and will comply with all governmental mquirmens respecting the premises
or their use, and that he will not eumanit or permit soy waste.
6. CONDEMNATION. In the event that my or all of the Premises shall be condemned and talma order the power of
emmeat domain, Griner shall give ivnnediate written notice in Beneficiary and Beneficiary shall haver the fight re receive and
collect all damages awarded by reason of mcb taking and the right to such damages hereby is assigned in Beneficiary who shall
have the discretion in apply the amosmt so received, in my part there!: to the indebtedness due hereunder and if payable in
im anmenu, applied in the inverse order of maturity of such mstattnrms, or many donation, repair or ..interim of the
premises by Grantor.
7. WARRANTIES. Grantor covenant/ with Trustee and Beneficiary that he is seized of the Premises in fee simple, has the
right to convey the same in fee ample, that title is marketable and free and clear of all encumbrances, and that be will warrant
and defend the title against the lawful chins of all pera as whomsoever. except for the exceptions hereinafter slated Title to
the property hinc osbove de.nbed is subject to the following exceptions:
8. SUBSTITUTION OF TRUSTEE. Grantor and Trustee covenant and agree to and with Beneficiary that in case the said
Trustee, or any sococasor trust, shall di, become incapable of acting, renounce his trust, or for my statism the holder of the
Now dement to replace said Tnsme, than the holder may appoint, in writing, a trustee to take the place ofthe Trustee; and upon
the probate and.gutntiaa of the same, the bounce thus appointed shall succeed to an right/, pow. and duties ofthe Trustee.
THE FOLLOWING PARAGRAPH, 9. SALE OF PREMISES, SHALL NOT APPLY UNLESS THE
BLOCK TO THE LEFT MARGIN OF TffiS SENTENCE IS MARKED AND/OR INITIALED,
9. SALE OF PREMISES. Grantor agrees that if the Premises or any part thereof or interest therein is sold assigned,
ormufrued, conveyed or otberwise aEemted by Grantor, whethervolinamly or imohmpn7y or by operation of -law [other than:
(i) the creation of a lim or other encumbrance subordinate w this Deed ofTrnst abide does not reuse to a mmiler of rights of
occupancy in the Premises; (ia) the creation of a purclume money serenity imemat for household appliancea; (ih) a canal:[ by
devise, descant, or operation of law me the cloth of ajoint tenor or Imnt by the entirety; (iv) the grant of a leaschold moos[
ofthme (3) years or less not containing an option to purchase; (v) a bander to a mh&c maWtiag from the death of a Gm m,,
(vs) a transfer where the spouse or children of the Granter become the owner of the Pre�sea; (vh) a a mfer mesdtiog from a
decree of a dissolution ofmarriag, legal separation ngseemeu; or from m incidental property Setticm nd agreement by which
the spews: of the Grantor beeomett an owner of the Premises; (van) a wasafor into an inter vivos rest in which the Grantor is
and rmaius a beneficiary and which don not .late to a bsmfer of rigbp of occupancy is the Premises], withom the prim
written consent of Bemfieaary, Beneficiary, at its own option, may declare the Now seemed heathy and all other obligation
hereunder to be forthwith due and payable. Any charge in the legal or equitable title of the Premises or in the beneficial
ownership of the Psemoses, including the sale, conveyance or disposition of a majorityinterest in the Grantor if a cmpaiation or
partnership. whether or not of record and whether or not for consideration, .ball be deemed inbe the maser oftor interest in
the Promises.
10. ADVANCEMENTS. If Grantor shall fait to perform my of the covenants or obligations :opined berein or in any oil=
imtrsment given as additional security for the Note secured hereby, the Beneficiary may, but witlwan obligation. make advances
in perform such covenants or obligations, and all sueb some; so advanced shalt be added to the principal sum, shall bear interest
at the rate provided in the Now waned hereby for sans due after default and shall be due from Granter on demand of the
Beneficiary. No advancement or anything contained in this paragraph shall constitute a waiver by Beneficiary or prevent such
failure to perform from constituting an event ofdefaolt
11. INDEMNITY. If my suit or proceeding be brought against the Trustee or Beneficiary or if any suit or pr ...dmg be
brought which may affect the value or tide of the Premises, Granter shall defend, indeamify and hold harmless and on demand
reimburse Trustee or Beneficiary from any less, cost, damage or expense and my mots expended by Trustee or Beneficiary,
shallbear enter t m provided in the Now seemui hereby for rams due after default and shall be dun andpayable our demand
12. WAIVERS. Grammar waives all rights to regsmc mmsbaliog of assets by the Trustee or Beneficiary. No delay or
omission of the Trustee or Beneficiary in the exercise of my rigbk power or remedy ansiog under the Note or this Deed of
Trust shall be deemed a waiver ofmy defmt or acquiescence thereh or shall impair or waive the exercise of such right, power
or remedy by Trustee or Beneficiary at any other time.
13. CIVIL ACTION. In the event that the Trustee is named as a party. my civil action as Trustee in this Deed ofTcust the
Take shall be entitled to employ an attorney at law, including himself if he is a licensed attorney, w epramt him in said
action and the reasonable attorneys fee of the Trustee in such action shall be paid by the Beneficiary and added in the principal
ofthe Note seared by this Deed of Trust and bear interest at the rate provided in the Now for aura due 0er default
14. PRIOR LIENS. Default under the ter® of any instrument seemed by a lian to which this Deed ofTrurt is subordinate
Shan eonemw default *eremder
15. OTHER TERMS.
NC Bar Association Form, No. L5 O 1976, Revised O September 1985, 2002
Printed by Agreement with the NC Bar Association —1981 SoBPro Corporation, 333 1— Stec Forks Rd., Raleigh, NC 275o9
"?EC -6 ED
DOM WILMINGTON, NO
0 C T 2 72016

0695 ;s 40 46 oar
(EadtyName)
By.
Title.
BY -
Title•.
pa9a + at a
wntmn
Stem aforesaid, certify flat WILLlAM W. PAYNE(MARRIEDI
personally appeared before me this day and
for the putposcs,*=n expressed. Witness my hand and Notarial
2009.
Stem ofNorth Carolina - County of
7, the undersigned Notary Public of the County and State aforesaid, certify that
personally cane before use ma day and acknowledged that be is the
of , a North Cmolina
or c rporetiodl®ted liability company/gerend paftncx t}iffited parm¢sbip (smh through the
inapplicable), and that by authority duly&=and m the act of such entity, _hc signed the forgoing iwft un tin im name on
imbebalfuitsaetanddeed. Wimess myland and Notarial smmp orseal, this dayof 20 .
My Commission Expires:
Notary Public
State of North Carohm-Cmmty of
T, d, mderaigocd Notary Public of the County and State afomssid, 'certify that
WitnessmyhmdmdxotarialammpmsciLft_dayef 20_.
MyCo®iasioa Expnes: '
Notary Public
The forgoing Certificatc(s) of
islme certified to be correct This instrument and this certificate are duly registered at the date and time and in the Book and Page
sbown on the fistpagc bemof
Regoux of Deeds for County
Deputy/Assistant - Register of Deeds
NC Bar Association Fom No. L-5 ® 1976, Revised C September 1985, 2002
Printed byAgeemeut will the NC Bar Association —1981 SottPro Corporation, 333 E. Six Forks Rd, Raleigh, NC 27609

EXHIBIT A
BEING ALL OF LOTS 8, 8A, 9 AND 9A, TAR LANDING HEIGHTS, AS SHOWN ON A MAP OF THE SAME
PREPARED BY Y.M. HERLEVICH, RLS, OCTOBER AND NOVEMSER, 1959 AND DULY RECORDED IN
MAP BOOK 6 AT PAGE 28 OF THE BRUNSWICK COUNTY REGISTRY.
IIIII IIIIIIIIIIIIIIilllllllllllllllll B? � M' C" �� = :2
BrunsufcM Ceunty, W R.9tst.r of O.ae peg. 5 of 5
E-SE-.'_;vEC)
DCM WILMINGTON, NC
OCT 2 7 2016

Brunswick County Health Services y�
jPJasl`IICA CpG� � J ,(`y 1L:F:: �.
25 Courthouse Drive N.E. Post Office Box 9 �=
Bolivia, North Carolina 28422-0009
°°??x caRo�`� No`tlt enrolina
910-253-2250 1-888-428-4429 Po6[clle�tth
D-avid bf.. Stanley, 111 MPH T. Cris Harrelson, MPA, REHS
Executive Director Health and Human Services
August 19, 2016
Custom Built Homes of the Carolinas
22019 US Hwy 17 N
Hampstead, N. C. 28443
RE: BCHD file T,10/ 70561- 891 Bostic Place
Health Services Director
Dear Sir:
The BC14D has been to this site to do an existing septic system recheck, and found that the
system is intact, but the following issues must be addressed before any authorization to construct
permit will be issued. They are as follows:
1.) A certified septic installer is needed to hook up the system with a generator to make sure
that all components of the system are working properly, such as the floats, pressure head,
valves, etc....
2.) Permanent physical barriers are needed to protect the system from vehicular traffic. A
copy of our policy is attached for your review.
3.) The water meter and the water line to the home must be installed at least 10 feet from the
septic field.
Please feel free to contact me at 910-253-2257 with any questions that you might have.
Sincerely,
/'I'l ak Ll � , Gc-Ic. C-�1
Mark Weeks
REG[=iVED
DCM WILMINGTON, NC
GCT 2 < M6

Brunswick County Health Department BCHD # 10-70561
r
Environmental Health Section
Wastewater Collection, Treatment
and Subsurface Disposal System
x ca�v OPERATION PERNIIT Ci< " C/�
In accordance with the provisions of Article 11 of Chapter 130A, General Statut
North Carolina 15A NCAC 18A.1900 et seq., and other applicable Laws and Rules as amended,
PERMISSION IS HEREBY GRANTED TO:
Owner William W. Payne
Address 1468 Summit View Drive
Rock Hill, SC 29372
FOR THE
operation of a _ _3 4 E GPD wastewater collection, treatment and disposal system
WHICH SHALL SERVE: J) x1 " , k,
SYSTEM DESCRIPTION: pump to conventional system- 3 50 ft drain lines
LOCATED: Lot _9 8A,9, & 9A Blk. Sec. Tar Landine Hieahts S/D
Tax Map Reference 214CB031
GIS Location 891 & 2 Bostic Rd
with no discharge of wastes to the ground surface or surface waters per 15A NCAC 18A section.
1900 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"] as
described in the Improvements Permit and accompanying data.
The system is classified as a TYPE 3-b9 Wastewater Treatment and Disposal System in
accordance with 15 NCAC ISA. I961
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 BCHD within 90 days of such
changes.
AEA. _iVED
1:1CM WILMINGTON, NC
OCT 2 7 2016

3. 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.
4. The Owner/Operator, as applicable, is responsible for compliance with 15A NCAC 18A
Section. 1900 et seq.-Laws and Rules for Sanitary Sewage Collection, Treatment, and
Disposal.
5. No addition, expansion; alteration, or repair (other than the replacement of components with
like components) shall be made to the system without. first obtaining authorization or an
Improvement Permit from the BCHD in accordance with NCGS 130A-336. Replacement of
components shall be noted on inspection reports.
6. This permit may be suspended or revoked unless all conditions of this permit are complied
with and the system. is in all respects in compliance with this permit.
7. Failure to abide by the conditions and limitations contained in this permit may subject the
Owner to enforcement action in accordance with NCGS 130A-18, 130A-22C, 130A-23,
and/or 130A-25.
8. A useable repair area as designated herein, with buffers, shall be maintained and reserved for
the addition to or replacement of the initial system drainfields. The area shall be separate
from the area of the initial system.
9. No traffic, vehicles, construction of any type or excavation shall be allowed on the system or
repair area_
10. The BCHD may amend, revise, or revoke and reissue this permit including frequencies in the
schedule of operation and maintenance based on monitoring data, water usage, system
performance, or facility use.
11. It shall be the responsibility of the Owner to notify any future or subsequent owners of the
requirements contained within this permit, including the requirement to contract with a
management entity.
12. The owner is responsible for compliance with 15A NCAC I8A section .1900 - Laws and
Rules for Sewage Collection, Treatment, and Disposal.
13. All subsequent owners of this property and sewage system, shall execute a contract between
the owner and. an approved management entity or the operations permit will become invalid
immediately. Management of the sewer system to be provided at all times.
14. All contracts between owners, management entity (Public or Private), or Health Department,
shall be reviewed and approved before being accepted.
15. 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.
16. A properly certified Operator shall be provided at all times as indicated on the
Authorization to Construct. For Type III systems, this would be the property
owner,
U. PERFORMANCESTANDARDS
1. In the event of failure of the system to perform satisfactorily, as determined by the
BCHD, the owner shall take immediate corrective actions, including actions as may
be required by the BCHD, such as the construction of additional or replacement
OPERATION PERMIT
11112/197
=CEHIVED
LIVIINGTON, NC
OCT 2 7 2016

wastewater treatment or disposal facilities, upon receipt of a repair Improvement
Permit.
2. The septage generated from this system shall be transported and disposed of in
accordance with Article 9 of Chapter 130A 15A NCAC 13B et seq. and in a manner
approved by the North Carolina Division of Solid Waste Management. The Owner
shall specify the approved hauler and disposal sites and submit this information in
writing to this office within 30 days. The BCHD shall be notified of any changes in
this information.
3. Adequate measures shall be taken to divert stormwater from the system and drainfield
areas.
4. Diversion or bypassing of untreated or partially treated wastewater from the facility is
prohibited.
S. The issuance of this permit shall not relieve the Owner of the responsibility for
damages to surface or groundwaters resulting from the operation of this facility.
M. OPERATION AND MAINTENANCE REQUIREMENTS
1. The system shall be properly maintained and operated at all times in accordance
with the Laws and Rules, and with the Schedule of Operation and Maintenance of
this permit
2. The application rates to the disposal field shall not exceed 1.10 gpolsq, ft.
3. No traffic, vehicles, or excavation shall be allowed on the system drainfield or
repair area except that of the system operator or authorized personnel.
4. The Owner shall have at all times, an Operator in Responsible Charge [ORC]
designated for this system who is properly certified for subsurface wastewater
treatment and disposal systems and/or wastewater treatment as deemed applicable
for this system. The ORC shall be under contract to the Owner or an employee of
the Owner for the duration of this permit. A copy of the executed contract shall
be submitted to the BCHD prior to the date of Operation Permit issuance.
Notification of any changes to this contract or a change in the system ORC shall
be submitted in writing to the BCHD at least 30 days in advance of the change.
(If a Ttrpe III system, then the information described above in item 94 is not
required, but is recommended. For Type III systems, the property owner
may act as the operator of the system. For Type III systems where the
property owner acts as the operator, maintenance and service contracts shall
not be required.)
5. This system is classified as a Type 3-bg System and shall be inspected by the
ORC at a minimum frequency of 1 time per 5 year.
6. The facilities shall be effectively maintained as a ground absorption system to
prevent the discharge of any wastewater to the ground surface, surface waters, or
groundwater.
7. The owner is responsible for keeping the plumbing system of the house in good
repair and eliminating leaks, drips, or excess flows as they are found. The owner
shall also test the alarm panel monthly to insure proper operation.
- A "startup" inspection shall be conducted with the engineer, the BCHD, the
installer, the Owner, and the Operator present
6iEC =iVED
DCM WILMINGTON, NC
OPERATION PERMIT 3 11/12/197 OCT 2 .I'1;I'}6

A permanent barrier shall be provided and in place around the systernlrepair areas
before the Operations Permit is issued.
TOTAL DESIGN CAPACTFY one 1 Connections x 4 Bedrooms/residence
I20 GPD for a total flow of 480 GPD.
THE FOLLOWING DOCUMENTS ARE CONSIDERED A PART OF THIS PERMIT
AND COMPLIANCE IS REQUIRED:
- The application for Permit.
- The site evaluations.
- The Improvements Permit -The Authorization to Construct.
- Article I 1 of Chapter I30A o f the General Statutes of North Carolina entitled
"Wastewater Systems".
- Rules for Sewage Treatment and Disposal Systems 15A NCAC 18A.1900.
- Approved Plans and Technical Specifications.
- Letters-
- The Declaration of Easement, Tripartite Agreements, Covenants, Homeowners
Association By -Laws, Articles of incorporation, Conditions and Restrictions
regarding this installation and system-
- As -Built plans and specifications and technical manuals.
- Other
SCHEDULE OF REQUIRED OPERATION AND MAINTENANCE
(This list of maintenance items is suggested, as applicable, for Type III systems, but not required)
Every 6 months: Septic tanks shall be inspected for influentlefBuent line blockage, tank / riser / pipe connection
leakage, wastewater levels and solids accumulation. Blockages or leaks shall be repaired. Tanks shall be pumped
when the solids level exceeds one-third of the liquid capacity of the tank in the inlet chamber, and as otherwise
determined necessary by the ORC or the BCHD. The outlet filter shall be inspected for clogging (recommend
cleaning at each inspection)
Every 6 months: The actual dosing volume shall be measured at each dosing station. The flow rate to
field zone shall be measured after each field has be flushed and pressure head adjusted.
Every 6 months: All laterals of each drainfield zone shall be flushed of solids accumulation with the zone valve
opened. Design pressure had adjustment shall be made.
Every 3months: Pump shall be inspected for leaks and solids accumulation. Leaks shall be repaired and solids
removed as necessary. Pump controls, floats, and alarm shall be checked for proper operation. All components of
the pumpfcontrol system shall be kept in compliance with design standards.
Every 3 months: Collection sewer and components shalt be inspected for blockage, leakage, sludge and
accumulation. Systems shall be purged of solids accumulation. Any leaks shall be repaired immediately.
Every week: Dosing pump chamber or station shall be inspected for leaks and solids accumulation. Leaks shall be
repaired and solids removed as necessary. Pumps, controls, floats, panel components, alarm and autodial shall be
checked for proper operation. All components of the pump/control system be kept in compliance with design I�
standards.
t
.,,N, NC
OPERATION PERMIT 4 O C T p 7 2016
11112/1W

Every 6 months: Drainflelds area shall be inspected for seepage or saturation, settled ground surface, broken pipes,
maintenance of vegetation, protection from traffic, and diversion of surface water. The owner/operator shall repair
of any broken pipe, lateral end caps, or cleanouts within 24 hours of becoming aware of such a problem, The peat
modules will be inspected for any structural damage, accessibility, adequate ventilation, excess odors, insect
infestations, etc...
Every 6 months: Control panel, pumps, floats, valves, electrical controls, and alarms shall be evaluated and field
verified for proper functioning.
Every 6 months and at each inspection: Dosing station flow meters / elapsed run time meters and event counters shall
be read and recorded.
As required:
- For grassed sites - Grass shall be cut regularly or when it exceeds 2-1/2 inches in height.
Lightweight mowers shall be used for cutting grass. Heavy brush / weeds over growth of the site
shall not be allowed. - Saplings, briars, brush, and grass shall be eliminated by hand cutting and/or
herbicides as often as necessary.
IV. MONITORING AND REPORTING REQUIREMENTS
1. Any monitoring deemed necessary by the BCHD to insure surface and
groundwater protection will be established and an acceptable sampling reporting
schedule shall be followed in accordance with Table V(b) of Rule .1961(b) of
Laws and Rules and this permit.
2. One copy of all monitoring data and maintenance records signed by the Owner
and Operator shall be submitted on or before the last day of the month following
each n/a period after permit issuance to the following address:
Brunswick County Health Department
Environmental Health Division
Management Entity Section
P.O. Boa 9
Bolivia, N.0 28422
the monitoring data shall include meter and counter readings from the recording
flow meters at each dosing station.
NOTE: If a Type III system, then no monitoring or reporting requirements
have been assigned for that type of system installation. Any future changes in
such requirements would be by written notification to the property owner.
3. The ORC shall -be responsible for keeping a log of inspections including at least
the following: dates, durations, and times of site visits, observations made,
procedures carried out, any maintenance, repairs or corrective actions taken, meter
readings, measurements, and drawdown rates. This log shall be maintained by the
ORC during the term of this permit and shall be made available to the BCHD
upon request.
4. A record shall be maintained of all septage removed from the facility. The recordp
shall include the name of the hauler, permit authorizing the disposal or a letter, NC
OCT 2 7 2016
OPERATION PERMIT
11/12/197

from the treatment facility agreeing to accept the septage, date the septage was
hauled, and volume of the septage removed-
S. The Owner/Operator shall report by telephone to the BCHD (910-253-2250),
extension 2280 as soon as possible, but in no case more than 24 hours upon
finding the system is malfunctioning by surfacing or back-up of effluent,
discharging directly into groundwater or surface waters, or when repairs are
needed in accordance with NCGS 130A-334(9)(a) and Rule .1961(c ) of Laws and
Rules.
V. GROUNDWATER REQUIREMENTS
All groundwater monitoring, samples, and reporting as deemed necessary by the State of
North Carolina, Department of Environment, Health and Natural Resources, the Division
of Environmental Management and the Brunswick County Health Department shall be
provided.
V1. INSPECTIONS
1. Adequate inspection, maintenance, and cleaning shall be provided by the Owner
to insure proper operation of this facility.
2. The Owner shall inspect the facility to prevent malfunction, deterioration,
operator error, and discharges which may cause or lead to the release of wastes to
the environment, a threat to human health, or a nuisance. The Owner shall keep
an inspection log including at least the following information: date and time of the
inspection, observations made, and any maintenance, repairs, or corrective actions
taken by the owner. This log shall be maintained by the Owner during the term of
this permit and shall be trade available upon request to the BCHD.
3. Any duly authorized officer, employee, or representative of the BCHD or the
premises, or place on or related to the disposal site and system at any reasonable
time for the purpose of determining compliance with this permit; may inspect or
copy any records that must be kept under the terms and conditions of this permit;
or may obtain samples of soil groundwater, surface water, effluent, septage, or
Ieachate.
VIII. SPECIAL CONDITIONS
1. Recommend garbage grinders not be installed in homes.
2. Brunswick County Health Department shall be notified in writing of any changes
in ownership, address, phone # or designated party/agency for
operation/maintenance. Failure to notify the Department of changes shall result in
the permit becoming invalid.
BCHD # 10-70561
Permit issued this ` day of 5_^ C.. _Z N C _ b.
Environmental Health Specialist
Brunswick County Health Department
OPERATION PERMIT
lt/12/197 p/
lAr 7--
z.cl7
D
DUO WILMINGTON, NC
OCT 2 7 2016

a ltApplicable}
1. Operator n/a
Address
Phone
Operators Contract attached (QYes) (®No)
2. System installation By: Larry Cox
3. Date of installation: 6/7/10
4. Tank Data:
a_ Septic Tank I.D.: OST-I500, STB-85 _Date: 4-6-10
b. Pump Tank I.D.: CC&S-476, PT-1000 Date: 6-24-08
5. Date of installation: 8/18/08.8/19/08
6_ Comments:
For Pump Systems:
1. Drawdown at time of final inspection:_ _2 inches
2. Final system installation pump delivery rate: _40 GPM
RECrIVED
DCM WILMINGTON, NC
0 C T 2 7.2016
OPERATION PERMIT 7
1 V 121197