18-22_Minor Permit_20220824 (2)

Locality
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Permit NumberR:) a ` I
Ocean Hazard Estuarine Shoreline °� ORW Shoreline Pub lc Trust Shoreline Other
(For official use only) Ta (� y a N Du o 10 a
GENERAL INFORMATION
LAND OWNER
Name G lrw 5+et Ida 5 cn
Address 3 116 6 e &,,- r C- Kee—lk L-a-n ,
City Ca�& JI rub- 65hcyres State /\/& Zip29YG7 Phone 9% 97
Email G b cx. InSc n ID k k h .S G PP , conl
AUTHORIZED AGENT
Name hee � 4, AG w e -ff Zt:?lle-f 6& ,4
Lr ,
Address 12 q7J `
City`'l�l �r"� State L Zip ZVY5/Phone `"�/a 7' `�7-�
Email L 16171r A A o h111d,�tf5- 7 1014
LOCATION OF PROJECT: (Address, street name and/or directions to site. If not oceanfront, what is the name of the
adjacent waterbody.) 21,) e -`(Me Jf "�. d e-e <-z /S to A -I,(-- :,� t 4- 15�"
1 nA-f-z-� G-& At-5+eA I V/ 4. �fi ir-r=cV bG . I d ��� ��r p
DESCRIPTION OF PROJECT: (List all proposed construction and land disturbance.) 110
5ftgas anP'
SIZE OF LOT/PARCEL: square feet acres
PROPOSED USE: Residential D (Single-family �Muiti-family ❑) Commercial/Industrial ❑ Other ❑
COMPLETE EITHER (1) OR (2) BELOW (Contact your Local Permit Officer if you are not sure which AEC applies
to your property):
(1) OCEAN HAZARD AEC$: 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: "quare 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 js ed by the NC Division of Water Quality?
YBS NO
If yes, list the total built upon area/impervious surface allowed for your lot or parcel: square feet.
RECEIVED
AUG 0 12022

OTHER PERMITS MAY BE REQUIRED: The activity you are planning may require permits other than the CAMA
minor development pen -nit, 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 15 �_t? 1 (15V see Deed Book
page ��'3 in the �w JGIC Co�egistry of Deeds.
an owner by virtue of inheritance. Applicant is an heir to the estate of
probate was in
County.
12�Cif other interest, such as written contract or lease, explain below or use a separate sheet & attach to this application.
A . L, cz
v r� rr'
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.
(1)
(2)
(3)
(4)
(Name) (Address)
C fll d K / n1 b We-Lk,?Co -4
R"A u S Lenka , � t r) 41 > ,.�►a.� �l. �'., �. Z4 < ��l1�3c_ 0' 4 `� G
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 ine 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, pennission to Division of Coastal Management staff,
the Local Pen -nit Officer and their agents to enter on the aforementioned lands in connection with evaluating information
related to this permit application.
Ell
This the 74k day of ILA I , 20 ? Z
Xkl,Mld'e'�, /,7G. A64P-PT
Landowner or�6rson authorized to act as his/her went for purpose of filing a CAMA permit application
This application includes: general information (this form), a site drawing as described on the back of this application, the
ownership statement, the Ocean Hazard AEC Notice where necessary, a checkfor $100.00 made payable to the locality, and
any information as may be provided orally by the applicant. The details of the application as described by these sources are
incorporated without reference in any permit which may be issued. Deviation from these details will constitute a violation of
any permit. Any person developing in an AEC without permit is subject to civil, criminal and administrative action.
RECEIVED
AUG u 1 2022

t.ECElVED
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LOCATfON MAP (No scale)
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fMPERV10U5 CALCULATIONS
IMPERVIOUS AREA
"CU5E 1907 5F
TOTALIMFEKVIOU5 IN AEC 1579 S
28.8 %
TOTAL AEC AREA 5453 5F
LOT AREA 10.3GA 5P
PROPO5I=P 51rE PLAN FOR Im
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LAND
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Crystal Babson SURVEYING
P.A.
OF 136E RIVPR BEND DRIVE
MCIP05ED 51TE PLAN FOR sH NORrn cARouNA Zino
2028 CANIELOT DR5W
MG 1 OG-PAGE 97
SHALLOTTE TWP BRUN5WICK COUNTY. N.C.
5CALE !'y 30' DECEMHER 15, 2020
REVI5ED JUNE 24.2022 POK NORMAL HIGH WATER
REVISED JULY 7.2022 FOR 51TE PLAN
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MC 45-PAGE 3G
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2 PROPERTY 15 5IJDJrCT TO ANY AND ALL RE571RICTIVE COVENANTS
EASEMENTS AND MINERAL RIGHT5 IF APPUCABI.E AND
KECORPFU W THE BRUN5WICK COUNTY REGISTRY.
s PROPERTY 15 LOCATED IN A V� ROOD ZONE.
4 IRON ROP5 PLACED AT ALL CORNERS UKLE55 OTHERWI5E NOTED.
5 PROPERTY SUBJECT TO ALL ZONING REGNIREMENTS OP
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COUNTY N.C.
6 ELEVATION DATUM NAVO 1988
7 TYI15 5URVEY REFLECTS AN A55UILT OF TH15 PROPERTY A5 Of THE
DATE OF 51GNATURF.
8 TH15 5URVEY DOE5 NOT CEKTIPY LEGAL TTLE TO THE LAND ITSELF,
OR TO THE BOUNDARIES SHOWN. U5ER5 OF 7HI5 PLAT 5HOULP
OBTAIN AN ACCURATE LEGAL OPINION A5 TO OWNERSHIP TO THE
BOUNDARIE5 5HOWN"TNi5 PLAT.
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AND THAT TM15 MAF MEET5 THE MINIMUM STANDARDS OF PRACTIC
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IEl➢ DOOR
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File No.: 2006068042A Type: %/ C—
BRUNSWICK COUNTY HEALTH SERVICES
Post Office Box 9 BOLIVIA, NC 28422 [phone]
IMPROVEMENT PERMIT
PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE
An Authorization for Wastewater Construction must be attached to the Improvement Permit before an
other permit can be issued and before a wastewater system can be installed.
Supporting documents such as the completed application form, site evaluation form, fill plan, etc. are considered
a part of the Improvement Permit.
Owner's Name: THOMPSON LAWRENCE H Sr KATIE H Tax Parcel 242MD00102
Lot s: 82 Block: Sec 3 SUBDIVISION MARLEE ACRES
Residential: X Water Supply: Private (well) X Public
No. of units: 1 No. of bedrooms 4 No, of occupants 8
Commercial: Type of business: No. of Employees:
---------------------------- ----------------------------------------------------------------------------------------------
Size of septic to//nk: U 0 O / � gpd/sq.ft. Drainfield sq. feet:, 2
No. of Lines_ Length ea.:J e Trench width''`---r Bed : zC 3Dt-sign Flow gpd:
�Trenchl Bed bottom depth no dee er than �" � r� inches Pump tank volume:
01Z-Z6 r�� �j_..—���l-� R)�L- (if applicable)
if applicable, the following conditions must be met prior to issuance of an Authorization for Wastewater
Construction and prior to wastewater system installation.
X Keep 100 feet from all water supplies (minimum of 50 feet must be maintained).
X Keep 10 feet from all water lines,
X Keep 10 feet from any property lines (no less than 5 feet for lots recorded prior to 7/1/77)
X Do not drive over, park, pave, or build any structure over the area for the septic tank system and the repair
area if applicable.
X Do not install the septic system during wet conditions.
X Maintain Gravity Flow for septic system.
Drainage Maintenance Required.
Suitable Fill material must be installed exactly per the Health Services Department approved fill plan.
Fill check must be completed by the Health Services prior to issue of Authorization for
Wastewater Construction Permit.
Approved for use of Alternative/Innovative Wastewater System (Specify)
_ Submit Wastewater plans to the Health Services for review/approval
X If Septic System Uses Rock Aggregate/Approved Filter Fabric Covering Required
X Septic Tank System must be installed per the Construction Authorization Permit.
X An "accepted" system may be used in the place of a "conventional" system.
X The construction authorization cannot be issued until final storm water plans are received from the
applicant. The applicant is responsible for notifying the health services department if any changes are made to
the storm water plan and, if so, what those changes are. A letter from the engineer responsible for the storm
water plan with the engineer's seal identifying the changes shall satisfy this requirement.
IMPROVEMENT PERMIT ISSUANCE DATE: p Z. 9 EXPIRATION 03AFZ s�
This permit expires 60 months from the date of i4suaria unless otherwise specified
Permit Not Valid Unless Signed by Authorized Agent:
Signature
Actions of Brunswick County Health Services representatives engaged In the evaluation and determination of measures required to
effect compliance with the applicable laws and rules shall in no way be taken as a warranty that sewage treatment and disposal systems
approved and permitted will function In a satisfactory manner for any given period of time. Permit Is subject to revocation if the site
plan or plat whichever is applicable, or the Intended use changes.
The issuance of this permit does not preclude the Permittee from complying with any and all statutes, rules, regulations, or ordinances which may
be imposed by other government agencies (local, state, and federal) which have jurisdiction.
SEPTIC TANKS SHALL HAVE AN APPROVED EFPLUENT FILTER & ACCESS DEVICES
Rev: 04/10/13
Updated 01/0812008

DATE REC: 03/1112016 BRUNSWtCK COUNTY HEALTH SERVICES FILE NO.: 2006068042A
ZONING:
THOMPSON KATIE AND HANK THOMAS $0.00 242MD00102
REC. FROM AMT. PAID TAX PARCEL
505 VINELAND ST WHITEVILLE NC 28472 9102345540
ADDRESS CITY STATE Zip CODE PHONE
THOMPSON LAWRENCE H ETUX KATIE H 82 3
CURRENT PROPERTY OWNER LOT BLOCK SECTION
PROPERTY LOCATED TOWNICITYIAREA: CO SUBDIVISION:
DIRECTIONS; 2028 CAMELOT OR SW 28469 -17S TO 179 TO CAMELOT APPROX 112 MI FROM 904
AUTHORIZATION FOR WASTEWATER CONSTRUCTION PERMIT NOTES
NEW: REVISIDN: RELOCATION: REPAIR:
1. Septic Tank shalt have an approved
Design Flow; 9pd Septic Tank Size: / gal Type: effluent Titter and access devtces as
J applicable.
No. Bedrooms: _ No. occupants/employees Max 2. Maintain all setbacks distances for
fC `` C / � d FL' septic tank systems and wells.
T renchlBed Bottom Depth: Inches: 13 .Cc9 c-tom !� �� 3. All components of the septic systems
P shall be located 100 feet from well.
j _ r-/ 4. An "Accepted" system may be used in
No. Lines: Length Each; Bed Dimensions: ,z 'L c� the place of a "conventional" system.
Fill Check, A—./ Q Approved: A,/ C�(_
Date Authorized Agent
PERMIT ISSUE DATE: Permit Expiration Date: 03 �� Z Q
Authorized Agent: _ -� �!C L,L��7 _ Registration: LE
F I I I T— t �. , l T—T�e✓�O %r �O
NOTE: PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTEN ED USE CHANGES.
L4--4-1,�
—1._-L -.-L- -L 1 l. 1 a 1. I-_.L
Waste Water Sy tem Installer:
Comments: (tank info/ barrier approved)
Rock: Polystyrene Aggregate
OPERATION PERMIT'
Chamber.
Authorized Agent Signature
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�Q �-'f "Jet -lb -'%
Date:
Date:
Either:
Actions of local health department representilives or the State engaged in the evaluation and determination of measures required to effect compliance with the
applicable laws and rules shalt In no way be taken as a warranty that sewage treatment and disposal systems approved and permitted will function in a satisfactory
manner for any given period of time. This issurance of Us permit does not preclude the Permittee from comploying with any and all statues, rules and regulations or
ordinances which may be imposed by other government agencies ( local state, and federal) which have jurisdiction. /
r _