BC_16-18_Payne

Brunswick County BC16.18
Local Government Permit Number
CAMA
MINOR DEVELOPMENT
PERMIT
iAsmi N,unagemenr
J: V IBGM`tf[iTAL EUhL15Y
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 Concem (AEC) at
891 Bostic Place SW in Shallotte NO 28470, as requested in the permittee's application package, dated 25-Aug-16 and
received complete 29-Auq-16. This permit, issued on 12-Sep-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: 8' x 30' Covered Deck.
(1) All proposed development and associated construction must be done in accordance with the permitted work plat
drawings(s) dated received on 25-Aug-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)
is ciVi=G
t,Civl WILMINuTON,
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.
onnie Marlowe
CAMA Local Permit Official
PO Box 249
Bolivia, NO 28422
PERMITTEE
(Signature required if conditions above apply to permit)

Name: William Payne
Minor Permit # 16.18
Date: 12-Sep-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 240 square feet is authorized.
(6) Unless specifically allowed in 15A NCAC 07H-0209(d)(10), and shown on the permitted plan drawing, all
developmenticonstruction 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.
RECEi VED
DCM WILMINGTON, INC
S E P 12 2016
SIGNATURE: "'� Q ' ate'/ DATE: 912-/4
PERMITTEE

Locality
Permit Number""' l l0 — ( g
Ocean Hazard Estuarine Shoreline V ORW Shoreline Public Trust Shoreline Other
(For official use only) —FaX P6 K*J 42 1 U C6031
GENERAL INFORMATION
LAND OWNER
Address /44, t5 n rr) V r e-o br
City �dc A IV/ State Alt'. Zip o?9731 Phone 90 3 - 3�Pa - `1'6i1
AUTHORIZED AGENT
Nameann'a dt5Vin ( LS 4 ni AY; V,1dr e.* 0T Y17P Li3!c li Y,a
Address ,2.,�dl9 1/S �� /'//✓
City Aam n she ad State /1 t /I Zip �5�3_ Phone q1V - J'0 3 - d�%3/
Email fF •- — �in@r»o�i. fa/stn e55 rd r�)
LOCATION OF PROJECT: (Address, street name and/or directions to site. If not oceanfront, what is the name of the
adjacent waterbody.) ;� ha/��: ✓'1 aJ-
3D CeYeraal cJs L,14 %'A9- 4
DESCRIPTION OF PROJECT: (List all proposed construction and land disturbance.) ' n_J 4 e-
SIZE OF LOT/PARCEL: � .�iG square feet acres
PROPOSED USE: Residential [d (Single-family g Multi -family ❑ ) Commercial/Industrial ❑ Other []
COMPLETE EITHER (1) OR (2) BELOW (Contact your Local Permit Officer ifyou are not sure which AEC applies
to your property):
(1) OCEAN HAZARD AECs: TOTAL FLOORAREA 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 SHORYLINE AECS: SIZE OF BUILDING FOOTPRINT AND OTHER IMPERVIOUS OR BUILT
UPON SURFACES: jA q�ar' e'eet£ (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.
H '�C-EiVED
DCM WILMINGTON, NBECEIVED
AUG 2 9.2016 AUG 2 9 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)
✓ an owner or record title, Title is vested in L//;/ a'n f/d� ae' , see Deed Book
page _a in the 6CUP '5u) 0 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 CAMA permit.
(Name) (Address)
(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 aJ' S day ofdzj f, 20 /G
Landowner or person authorizeffto act as hislher 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 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 to civil, crirr qnd adnyrf�ltqtive action.
)CM wry .. GTON, r: RECEIVED
AUG 2 9 2016 AUG 2 9 2016

LOT 7A
AE 11.0 / S„AOED X
c1n'o 5 3'18420 E
mc[ a
�.
uut� 1
LOT 8A
f
EXIST
SEPTIC
75' CAMA ILINE D h
y
TANK+
\ 0 12.4
\`
14.4
i1.1 60.00
EDGE OF MARSH
%
PROPOSED
HOME ON PILINGS
A5 N0. 891
t(1 30' BLFFER LINE
Z i
O A`
t
A SHAD=D X
Grr� LOT 9A _
11.0
o:
�
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VICINITY MAP NTS
P1Y
R/W
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LOT 7 ly 4
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LOT 8 @
TSM o~
CONC a 1�
20.460
h3
M
ore
m /t�
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LOT 9
M ROM
6999 B4oim1
uonu�xr
LOT 10
�\
RECEIVED
\
DCM WILMINGTON, NC
LOT t0A p�
1>1`
=�h
AUG 2 9 2016
NOTES:
SURVEYED BY USING MAP BOOK 6, PAGE 28
RECEIVED
AND EXISTING PHYSICAL CONDITIONS S
PROPERTY IS IN A FLOOD HAZARD AREA
AUG 2 9 2016
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'
OAA
WILLIAM W. PAYNE ET. UX.
TOWNSHIP
SHALLOTTE
PZA
r0 apO "0. ���¢��'
OF
LOTS B,SA AND 9,9A
COUNTY
BRUNSWICK
412'.A
TAR LANDING NEMiNTS
STATE
N.C.
NAP BOOK 6, PACE 28
TOWN
4'�zynVG"r'v
TAX PARCEL 214CS031
DATE
T 30/2018
I RENSED B 19 2018
JAN K. DALE
FIELD BOOK
12-171
N.C. PLS NO. L-1250
P .S. JAN K. DALE
891 COPAS RD. - SHALLOTTE, N.C.
DRAWN BY
JKD
A.C. PLS NO. L-1250
910-754-4477
DWG. NO.
C/WW5

IIIIIIIIIIIIIIIIIIJill IIIIIIIIIIII III B2980 F0690;;�=::.on,
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la:Z-2M 15:10:/0.001 0runsuick Canty, NC
NC REVENUE STAMP: S700A0 (N190M)
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NORTH CAROLINA GENERAL WARRANTY DEED
STATE OF NORTH CAROLINA
COUNTY OF BRUNSWICK
Excise Tax: $700.00
This instrument was prepared by: MacCallum & Associates PLLC
4914 Main Street, Shallorte, NC 28470
Brief description for the Index: LOTS 8, 8A, 9 AND 9A, TAR LANDING HER
Parcel No.: 214CB031
THIS DEED made this Ist day of October, 2009 by and between NICHOLAS A. HARTMAN
AND WIFE, DEBORA K. HARTMAN, GRANTOR, and WILLIAM W. PAYNE(MARRIED),
GRANTEE, whose mailing address is: 1468 Summit View Dr., Rock HID, 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
BRUNSWICI County, North Carolina and more particularly described as follows:
BEING ALL OF LOTS 8, 8A, 9 AND 9A, TAR LANDING HEIGHTS, AS SHOWN ON A MAP
OF THE SAMB PREPARED BY V.M. HERLEVICH, RLS, OCTOBER AND NOVEMBER, 1959 AND
DULY RECORDED IN MAP BOOK 6 AT PAGE 28 OF THE BRUNSWICK COUNTY REGISTRY.
RECEIVED
DCM WILMINGTON, NC
AUG 2 9 2016

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: 4/1, /%ia,y /0
Mailing Address: %S�� J`ei, f V%eu 2)rlye
Phone Number: 3 -7/5z"
Email Address:ia.a�Cc»n)eC /
I certify that I have authorized -buy,r�a ZI'A'n (�/0:4M 2940 /)1 J�/"6 e ice,
Aqent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: -1r �ra p m� r far �i rw
at my property located at &s>li`r Aidae
in A: un s;u; Gh County.
I furthermore certify that f 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 Owner Information:
Signature
Print or Type Name
Title
Date
This certification is valid through
RECEIVED
DCM WILMINGTON, NC
AUG 2 9 2016
RECEIVED
AUG 292016

/We
give Custom Built Homes of the Carolinas
ME
permission to sign or do whatever is needed to pull
any and all permits on our home.
6V& P^ `t� h7.1/
L2 / y19,-
RECEIVED
DCM WILMINGTON, NC
AUG 292016
RECEIVED

-a3 -ao��
Data ; Fp
')�r.e1
Adjacent Property Owner
iZtis� I�ns}ic �'1n(�
MailSt9rA1(G �, f1 v 13 t 70
City, State, Zip Code
DearAdjacenl Property.
Er..
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rr'
SHALLDTTEr'NC 2847D
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0443
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$
45
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❑Ream Receipt (eledmnk) s to nrl
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Genf d Mal R.Mded 0e1ivmy $ r�_-
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psipnaare Reetrided DelNay $
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Postage $0.47
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08/29/2016
Total Postage and Fees
$6.47
$
�
Sent To
-K1,5
oPdzNo._- _- -- ------------------
------------------
t'
This letter is to inform you that t, �(� I I i a ts1 PC.(, have applied for a CAMA Minor
Property OwnerVV �/
Permit on my property at U(f 7I`� /U c c S h �� k i /171� rin
COUNTY PropertyAddress
Brunswick 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, Ifyou hove any questions or comments about my proposed project,
please contact me at DSO3 •- 3 �,� - ') j .5 C, or by mail at the address listed below. Ifyou wish to
Applicant's Telephone
file wdtlen comments orobjections with the Brunswick County CAMA Minor Permit Program, you may submit
them to:
Connie Marlowe
Brunswick County Planning Department
PO Box 249
Bolivia NC 28422
Sincerely,
Nhlc a 1
Property Owner
/ri(;Ts' Su;iatn,1- UaekJ
Mailing Address
City, State, Zip Code
RECEIVED
DCM WILMINGTON, NC
AUG 2 9 2016
RECEIVED
AUG 2 9 2016

Brunswick County Health Services
!Tmm)
CN c 25 Courthouse Drive N.E.Post Office Box 9Bolivia, North Carolina 28422-0009 Noeth�aectino
„NA0Pvhiic Health
910-253-2250 1-888-428-4429
David M. Stanley, III MPH T. Cris Harrelson, MPA, REHS
Executive Director Health and Human Services Health Services Director
August 19, 2016
Custom Built Homes of the Carolinas
22019 US Hwy 17 N
Hampstead, N. C. 28443
RE: BCHD file e-10170561- 891 Bostic Place
Dear Sir:
The BCHD 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,
/n aRLl l Luree'�klol
Mark Weeks
lziFt ,I '_D
DCN,1 vin t�ft�EEi-
AUG J* J�

Date_ �y
Adjacent Prope Owner
K� l j AS Pi: PJ12
Mail!!'ng Address
4zatLn4a , JIJC, r3Ky7A
City, State, Zip Code
Dear Adjacent Property:
Ir
111.21
SHACLOTTEriNG 28*70
M Certified Mail Fee $3 30 d
—0 $ 7
19 Fxtra Services a Fee$ fMh kna,, addleeayµggypte)
N ❑ flatum Recapt(had py) $
0 ❑Relum ReCe.n (eleAMNC) § 9U+UU
0 ❑c.nmea mail Ras4iCted oewwy § ttl_00
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a �A.47
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rr-1 Sent Ta
E3 Rn5eii6Apt Na., or P08ox No. ------
This letter is to inform you that I, W `1�'' *tit 1�C; 4 C� (� have applied for a CAMA Minor
Property Owner
Permit on my property at �uC{I ;� 6 OCACe S r nde in
COUNTY PropertyAddress
Brunswick 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 oryou may sign and
return the enclosed no objection form. Ifyou have any questions or comments about my proposed project,
please contact me at � 0- _ 3 ;Q - 71 &'-� or by mail at the address listed below. Ifyou wish to
Applicant's Telephone
file written comments orobjections with the Brunswick County CAMA Minor Permit Program, you may submit
them to:
Connie Marlowe
Brunswick County Planning Department
PO Box 249
Bolivia NC 28422
Sincerely, j/J
&L1 Aai /9i% fit
Property Owndr ✓ /
Mailing Address
Pr,r: Ie W. t w I'la
City, State, Zip Code
tF::EiVED
"I'vi MLMINGTON, N
AUG 2 9 2016
05
Postmark
Here
(18/29/2016
RECEIVED
AUG 2 9 2016

RECEtVEl3
AUGll19'.'101G

IIIIIII1111IIIIIII IIII IIIIIIlillllIII R �s IU. <�a,
B,u i.k County, NC asalster of ne.ft pag. Z of 2
The property hereinabove described was acquired by Grantor by recorded in Book 2558,
Page 319.
TO HAVE AND TO HOLD the aforesaid lot, tact 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 stated. Title to the property hereinabove
described is subject to the following exceptions:
1. All applicable zoning and land use ordinances, natures and regulations.
2. Ad valorem axes 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, plural, masculine, feminine or neuter as required by
context.
IN WIINESS WHEREOF, the Grantor has duly executed the foregoing as of the day and year
first above written.
-21.
NICHOLAS A. HARTMAN
'k.
DEBORA K. HARTMAN
Sateof j/n4K er61n%,._
County of a n&a. . i r k
I certify that NICHOLAS A. HARTMAN and DEBORA K HARTMAN personally appeared before
me this day, and I have seen satisfactory evidence of the principal's identity, by curredt state or
federal identification with the principal's photograph in the foam of a-Dr;1WC1. j i Pp n c s _ each
acknowledging to me that he or she voluntarily signed the foregoing document for the purpose sated
therein and in the capacity indicated.
Witness my hand and Notarial stamp or seal, this 1s+ day of 021 J.2002. tptnnnnuytf
�GpttOl Np %%'
My commission Epires:Qqjlo 0 11 l j�,ai� �f � w"�tfC�"'e 0
Notary Public;cl�l,„6t�}='z °vito'�' t�M
Cott �s
'���'�yCAROUH' �•
RECEIVED
DCM WILMINGTON, NC
AUG 2 9 2016

Illllllllllllllllllllllllllllilllful ersaa aas9z ;; = aM2
B,..Il k Ceunty, NC Register of oeeds page t of S
Ck$Ck;;CD�S
Refund: Ca: � Finance—
❑ Fmba:s c' aucw+a't M Z R Jw u. •:raters
olcaQMat.
Y�NStl'U"m'`Eeitat:ea-scexi'.ii o9a QPd�
NORTH CAROLINA DEED OF TRUST
SATISFACTION: The debt scoured by the within Deed of Trust
together with the notes) secured thereby has been seBafied so fia
This the day of .20
pacel ldsotiHa No. 214CB031 Verified by County on the_ day of 20_
By.
MatUBox n: JAWS J. MACCALLUM, THE LAW OFFICE OF JAWS J. MACCALLUM, PLLC., 4914 MAIN STREET,
This instnmtent was prepared by: THE LAW OFFICE OF JAMES J. MACCALLUM, PLLC_ 4914 MAIN STREET.
Brief daeription for the led=. LT 8, BA, 9 d 9A, TAR LANDING HEIGHTS SUBDIVISION
THIS DEED ofTRUSroule this 241h dry of September 2009,byaodbetween:
GRANTOR TRUSTEE BENEFICIARY
The Law Office of James J. MacCalhw Nicholas A. Hmhnan and Debora
WIIIAAM W. PAYNE WARR®) P.O. Box 2283 Harmtan
1468 Summit View Dr. Shallurq NC 28459
Rock Hill, SC 29732 4407 Wye Rd.
Lakeland LA 70752
Emer in appmpriatc block for each party: mme address, and, if appropriate, character of emity, e.g. ompe stion M pert=ft
The desigttadoo Gmmor, Ttusta, and Bmeficisry as used baem shall include said parties, dt it heirs, wocasea, tied assiM and
shall=hide singular, plurg rin.<uline, fenainirc or neuterw requited bycoulad.
WITNESSETH, That whams the Grmor is indebted to tie Heoefciay in the principal surat of
—Two Hundred Fifty Thousand and 001100 Dollars ($ etRt250.000.0 )_ as evideocedd by a
PrormvoryNoe of even date baewith, the tee of wbicb are mompmealhaeinbynf r . The fmd dne date forpaym of
said ProuxiusseyNote, if not sooner paid, is November 12 2012
NC Bar Association Form No. 1,5 ®1976, Revised ® September 1985, 2002
Printed by Agnemeat with the NC Bw Association —1991 SoflPM Corporation, 333 E. Six Forks Rd, Raleigh, NC 27609
RECEIVED
GTON, NC
AUG 2 9 2016

IIIIIIIIIIIIIIIIIIIIIIIIIII1111111111 B? g ?OscgA mo°;'aa°002
aruns ick County, the Register of Deem page 2 of S
NOW, THEREFORE, as seemity for said Indebtedness, advancements ad odua sums expended by Beneficiarypur uma w this
Deed of Trust and costs of collection (mclud n attorneys fees as provided in the Promissory Note) and other valuable
comideration, the receipt ofwhich is hereby admowirdged, the Grantor bas bargained, sold, given and conveyed and door by these
presents bsrgrm, sell, give, grant and convey to said Trustee, his heirs, or successors, and assigns, de parcel(s) of lad slated in
the City of Township, Brunswick County,
North Carolina, (the'Pttciesw') ad mom particularly described as follows:
SEE EXHIBIT A ATTACHED
TO HAVE AND TO HOLD said Prommur with all privileges and app emarce s thaeww belonging In ad Tnmwc, his hems,
successors, and assign forever. upun the tnoq terns and carclim n, and for the wea luncenafter set forth
If the Grantor shall pay the Now secured hereby in accordance with is arms, togetbar with interest thereon, and my
renewals or extension thereof in whole or m part, all other sum secured hereby and shall Comply with all of the covenants,
teems and condition of this Deed of Trust, Wen this conveyance ahall be roll and void and may be canocled of record at the
request and the expense of the Grantor.
K however, there shall be any default (a) in the payment of my soon due under the Not, this Deed of Trust , any other
instrument securing the Now and such default is not cured within two (10) days from the due date, or (b) if Wore shall be default
in any of the other covenants, terms or conditions of the Now secured hereby, or any failure or mom in comply.with the
covemna, terms or conditions contacted in this Deed of Trust or my other instrument securing the Note and such default is out
cured within fifteen (15) days after written notic, then and in my of such events, without father notice, it shall be lawful for
and the duty of the Trustee, upon request of the Beneficiary, to sell the lad herein Conveyed at public auction for rash, after
having first giving such notice of hearing as w Cotmeencement of foreelorne proccedinga and obtained such findin or leave
of court as may then be required by law and Vying such notice and advertising the Erne and place of such We in such m9mer
as my then be provided by law, and upon such and any resales and upon compliance with the law then prating to forecloura
proceedings under power of sale to Convey title It, the purchaser in as full and ample pampa as the Trustee is empowered. The
Trustee shall be authorized to resin m attorney to represent him in such proceedings.
The proceeds of the Site shall after the Trustee retains his commission, together with reasonable attorneys fees incurred by
the Trustee in such proceedings, be applied in the costs of We, inchrdng, but ant limited w, costs of collection, taxes,
asaCssmena, coca of recording, service fen and mcidemal expenditures, the amount due on the Now hereby secured and
advancements and other sums expended by the Bereficiary according to the provisions hereof ad otherwise s required by the
then existing law relating to foreclosures. The Trustee's cormassion shall be five percent (5%) of the gross proceeds of the sale
or the dnimm sum of S whichever is greater, for a completed foreclosure. In the event foreclosure is
Commenced, but not completed, the Grans f shall pay all expenses incurred by Trento, including reasonable attorneys fees, and
a partial commission computed on five pan teen (591a) of the outstanding indebtedness or the above sated uinampm sun,
wbicheva is greats, in accordance with the following schcdul, to -wit.. ono-fuurth ('/.) thereof before the Trustee issue a
mtim of hearing on the right to foreclosure; one-half ('/a) thereof after issuance of said notice, Wrenfourths ('/.) thereof after
such hearing; and the greater of the full coondsion or ®ni®tm sum after the initial sale.
And the said Grantor does hereby, corvemen and agree with the Trust= as follows:
1. INSURANCE. Grantor shall keep all improvernm s on said led, now or hereafter erected, constantly merged for the
benefit of the Beneficiary age invt loss by fits, windstorm and such other casualties and contingencies, in such rummer and in
such companies and for such amounts, net less than that amount necessary in pay the sum secured by the Deed of Trust, and s
may be satisfactory to the Beneficiary. Grantor shall purchase such insurance, pay all premiums therefor, and sball deliver in
Beneficiary such policies along with evidence of premium payments as long as the Note secured hereby resonant unpaid If
Grantor fails to purchase such insurance, pay predumn therefor or deliver said policies along with evidence of payment of
premiss thereon, then Beneficiary, at his option, may purchase such insurance. Such amr,una paid by Beneficiary shall be
added to the principal of the Now seemed by this Deed of Trust, and shall be due and payable upon demand of BemeSciary. AB
proceeds from any insurance so maintained shall at the option of Bencliciery be appliedw the debt secured hereby and if
payable in installments, applied in the inverse order of maturity of such imaBmens or m the repair or reconstruction of my
improvemma located upon the Property.
2. TAXES, ASSESSMENTS, CHARGES. Grantor shall pay all taxes, amessomens and charges as, may be lawfully levied
against said Premises "thin thirty (30) days after the same shall become due. In the even that Grantor fails to to pay an rues,
eimsco mum and charges s berein required, then Beneficiary, at his option, may pay the same and the amounts so paid shall be
added w the principal of the Now secured by this Deed of Trust, and shall be due and payable upon demand ofBemficimy.
3. ASSIGNMENTS OF RENTS AND PROFITS. Grantor assigns to Beneficiary, in the event ofdeauh, all revs and profits
from the land and any improvements thereon, and and ormns Beneficiary in enter upon and take possession of such lad and
improvements, to rent seem, at my reasonable rate of rent determined by Beneficiary, and after deducting from any such rents
the cost of telettmg and collection, in apply the remainder to the debt secured hereby.
4. PARTIAL RELEASE. Grantor sball net be entitled to the partial release of my of the above described property unhim a
specific provision providing therefor is included in this Deed of Tnat In the event a partial release provision is included in this
Deed of Tnst, Grantor most strictly comply with the terms thereof Notwithstanding anything baein contained, Grantor shall
NC Her Association Form No. L5 01976, Revised ® September 1985, 2002
Printed by Agreement with the NC Per Association —1981 Stuffier, Corporation, 333 E. Six Forks Rd.. Raleigh, NC 27609
RECEIVED
DCM WILMINGTON, NC
AUG 2 9 2016

02NOP06941a sa< 002
arunwuk County, NC Register of Ueoads page 3 of 5
ant be entitled to any reheat of property oleo Grantor is rent in default and um bill Compliance with all of the [ems and
provisions of the Now, this Deed of Trust, and my other instrument that may be searing said Now.
5. WASM The Grantor covewnb that he will keep the Prermses herein conveyed it as good order, repair and condition as
they are now, reasonable wear and4rar excepted, and will comply with all governmental requirements reap=bng the Premises
or their use, and that he Will net commit or perrmt any waste.
6. CONDEMNATION. In the event that any or all of the Pmrmsea shall be condemned and taken ender the power of
eminent domain, Grantor shall give immediate written notice to Beneficiary and Beneficiary shall have the right to restive and
collect all damages awarded by reason of mcb taking, and the right to sorb damages hereby is assigned to Beneficiary who shall
have the discretion to apply the amount so received, or my post therms: to the m&btcdrnss due hereunder and if payable in
insallmco$ applied in the inverse order of maturity of such insaUmenb, or to any alteration, repair or restoration of the
Promises by Grantor.
7. WARRANTIES. Grantor Covenants with Trustee and Beneficiary that he is sersed of the Premises in fee simple, has the
right to convey the same in fee simple, that title is marketable and fen and clear of all encumbrances, and that he will warrant
and defend the tide against the lawful claims of all persons whomsoever, except for the exceptions herein- Rer stated Title to
the property hoemabove described is subject to the following exceptions:
8. STIBSRT MON OF TRUSTEE. Ormtor and Trustee covenant and agree to and with Beneficiary that in cue the said
Trustee, or any successor tiume, shall die, became incapable of acting, renounce his trust, or fen my reason the holder of the
Note deshu to replace said Trustee, then the holder may appoint, in writing, a tmta to take the place of the Tnutee; and upon
tlre�rob¢te a� registration otth same, the trustee thus appointed shall succeed to all rigbts, powers and duties of the Trustee.
❑THE FOLLOWING PARAGRAPH, 9. SALE OF PREMISES, SHALL NOT APPLY UNLESS THE
BLOCK TO THE LEFT MARGIN OF THIS SENTENCE IS MARKED AND/OR INITIALED.
9. SALE OF PREMISES. Grantor agrees that if the Premises or any part thereof cr interest therein is sold, assigned,
transferred, conveyed m odwrwiw alienated by Grantor, whether volmtnrily or involuntarily or by operation of law (other than:
(i) the creation of a lien or other eonrmbrance subordinate to this Deed of Trust which does not relate to a transfer of rights of
occupancy in the Premisrs; (ii) the creation of a purchase money security interest for household appliances; (ih) a transfer by
devise, descent, or operation of lawon the death of a joint team m tenant by the mdrtty; (iv) the great of a keaseboldimaut
of three (3) years or less not containing anoption to purchase; (v) a tnmfer to a relative resulting from the death of a Grantor;
(vi) a transfer where the spout or children of the Grantor become the owner of the Premises; (vu) a transfer resulting from a
decree of a dissolution of marriage, legal separation agreement, or from an incidental property settlement agreement, by which
the spouse of the Grantor becomes an owner of the Premises; (via) a nailer into an inter vivoe that in which the Gamor is
and remains a beneficiary and which does not relate to a transfer of rights of occupancy in the Premises), without the prior
written consent of Beneficiary, Beneficiary, at its own option, my declare the Now secured hereby and all other obligations
bercmder to be forthwith due and payable. Any change in the legal or equitable title of the Prermsea or in the beneficial
ownership of the Premises, including the sale, Conveyance or disposition of a majority interest in the Grantor if a corporation or
partnership, whether or not of record and whether or act for consideration, shall be deemed to be the transfer of an interest in
the Premises.
10. ADVANCEMENTS. If Grantor shall fail to perform any of the covenants m obligations Comined herein or in my other
instruniem given as additional security for the Now secured hereby, the Beneficiary may, but without obligation, make achsinces
to perform such covestante or obligations, and all such nmms so advanced shall be added to tin principal sum, shall bear interest
at the rate provided in the Note seemed hereby far sum due after default and shall be dun from Grantor on demand of the
Beneficiary. No advancement or anything contained in this paragraph shall Constitute a waiver by Beoelimary or prevent such
failure to pat= from constituting an event of default
11. INDEMNITY. H any suit or prig be brought against the Trustee or Beneficiary m if my shut or proceeding be
brought which say affect the value m title of the Premises, Grantor shall defend, indemnify and hold harmless and on demand
reimburse Trustee or Beneficiary from my loss, cost, damage or expense and any sums expended by Trustee or Beneficiary
shall bear mutest as provided in the Now served bmby fin sum+ due after dchult and shall be due and payable on demand.
12. WAIVERS. Crmmr waives all rights to require marshaling of assets by the Trustee or Beneficiary. No delay or
omission of the Trustee or Beneficiary in the remise of any right, power m remedy arising under the Non or this Dad of
Trust shall be deemed a waiver of my default or acgutesceace therein m shall impair or waive the txame of such right, power
m remedy by Trustee, or Beneficiary at my other time.
13. CIVIL ACTION. In the event that the Trustee is named as a party to my civil action as Trustee in this Dad of Trust, the
Trustee shall be entitled to employ m attorney at law, including birmelf if he is a licensed attorney, to represent him in said
action and the reasonable attorneys fee of the Trustee in such action shall be paid by the Beneficiary and added to the principal
of the Now sawed by this Deed of Trost and bear interest at the ran provided in the Note fin rams due after default.
14. PRIOR LIENS. Default under the terms of any instrument seared by a !ire to which this Deed of Trust is subordinate
shall Constitute default bereunder.
15. OTHER TERMS.
NC Bar Association Form No. I.5 ® 1976, Revised ® September 1985, 2002
Printed by Agreement with the NC Bar Association —1981 SoBPro Corporation, 333 E She Forks Rd, Raleigh, NC 27609
RECEIVED
DUM ICMINGTON, NC
AUG 2 9 2016

IIIIIIIIIIIIIIIIIIJill IIIIIIIIII IIII B29� P069? _ 6
aroesvtck County, NC Raatster of Deeds paaa 4
Oof 5
IN WITNESS WHEREOF, the rantobas dulY executed We fwesoiog ss gl the day and year Brat show w ttm
Title:
BY
Title:
Title:
State
My
(rintity Name)
'C`
d SatealaretaK certify that MLl.1AM W. PAYNE(MARRIEDS
are pictorially appeared before me this day and
Mt for the p m expressed Witness my hand and Notarial
2009 A
State of North Carolina -County of
I, the nnderaigoed Notary Public of the County and State aforesaid, certify that
personally came before ma this day and aclmoadedged that he is rho
of . a Worth Carolina
or corporahowbmted liability couyau gm -al parmership/1®ted partnership (strike through the
inapplicable). and that by authority drily givm and as the act of such entity, _he signed the foregoing instrument in its tame on
itsbebalf as itsact and dad. Witness myhand and Notarial stamp or seal, this_ day of 20 .
My Commission Expires:
Notary Public
State ofNortb Carolmn-Cmayof
1, the tudesimpied Notary Public of 6e Comity sad SWe afoxcsaid, cm* that
Witness my band and Notarial stamp orsenl, do dayof. .20 .
My fission
Notary Public
The fomgomg Certificate(s) of
is/are certified to be omrea This instrument and this certificate are duly:egged at do date and time and in lle Book and Page
shown on the first page hereof
Registm of Deeds for Cattily
Deputy/Assistant - Register of Deeds
NC Ba Association F.=No. L5 ® 1976, Revised ® Sepmmber 1985, 2002
Printed by Agreement with the NC Bar Association-1991 SoltPro Corpomdon, 333 E. Six Forks Rd, Raleigh, NC 27609
k;:--:C.EiVED
UCM WILMINGTON, NC
AUG 2 9 2016

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 NOVEMBER, 1959 AND DULY RECORDED IN
MAP BOOK 6 AT PAGE 28 OF THE BRUNSWICK COUNTY REGISTRY.
S'. IMF,lase. 68D0]
Brunsulck Ceunty. W Register of Deads page 5 of 5
RECEIVED
DCM WILMINGTON, NG
AUG 2 9 2016

Alz
Brunswick County Health Department
Environmental Health Section
Wastewater Collection, Treatment
BCHD # 10-70561
ip and Subsurface Drsposal System
�ANp$ OPERATION PERMIT _-V / 6 W—
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_ E GPD wastewater collection, treatment and disposal system
WHICH SHALL SERVE: i) /,� -,i f� S: , �--i' = z .1,�;,rJ,
SYSTEM DESCRIPTION: numn to conventional system- 3 50 ft drain lines
LOCATED: Lot _8,8A,9, & 9A Blk. , Sec. _ Tar Landing Hieehts 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-b5 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 BCHD within 90 days of such
changes.
DCM WILMINGTON, NC
SEP 0 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.
All legal documents must be recorded with the Brunswick County Register of Deeds,
and proof of ftliug submitted before the Operation Permit is issued, conditional on
recordation and enforcement of easement conditional.
4. The Owner/Operator, as applicable, is responsible for compliance with 15A NCAC I SA
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.
IL 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 18A 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 M systems, this would be the property
owner.
EL PERFORMANCE STANDARDS
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 2 R E C ".. i V E D
1t117J197 DCM WILMINGTON, NC
SEP 072016

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 I SA 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.
5. 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.
III. 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 gpd/sq. 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 Tyne III system, then the information described above in item #4 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
OPERATION PERMIT
11/12/197
RECEIVED
DCM WILMINGTON, NC
SEP 0 7 2016

A permanent barrier shall be provided and in place around the system/repair areas
before the Operations Permit is issued.
TOTAL DESIGN CAPACITY one 1 Connections x 4 Bedrooms/residence
120 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 130A 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 OPERATTON 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 influent/effluent 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 [treasured 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 3 months: 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 pump/control system shall be kept in compliance with design standards.
Every 3 months: Collection sewer and components shall 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
standards. 1 L _ I V t_ Li
DCM WILMINGTON, NC
OPERATION PERMIT 4 S E P J 7 2016
11/12/197

Every 6 months: Drainfields 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-I/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 alt 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. Box 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 HI 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 he made available to the BCHD
upon request.
4. A record shall be maintained of all septage removed from the facility. The record
shall include the name of the hauler, permit authorizing the disposal or a letter
,RECEIVED
DCM WILMINGTON, NC
OPERATION PERMIT j
11/12/197 S E P 0 7 2016

from the treatment facility agreeing to accept the septage, date the septage was
hauled, and volume of the septage removed.
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.
VI. 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 made 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
leachate.
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 _ P day of S_^ . ✓! G/� Z C 1�6.
Environmental Health Specialist ,jED
Brunswick County Health Department iNGT0N, NC
S E P 072016
OPERATION PERMIT 6
11/12/197

(If Applicable)
1. Operator n/a
Address
Phone
Operators Contract attached ( Yes) ONO)
2. System installation By: Larry Cox
3. Date of installation: 6/7/10
4. Tank Data:
a. Septic Tank I.D.: OST-1500. STB-85 Date: 4-6-10
b. Pump Tank l.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
OPERATION PERMIT 7 R EC r= i V E D
11/12/197 DCiN WILMINGTON, NC
S E P 0 7 2016

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DCM WILMINGTON, NC
SEP 0 7 1016
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