HB_03-025E_Crouch

The Town of Holden Beach
Incorporated 1969
110 Rothschild Street Phone: [phone]
Holden Beach, North Carolina 28462 Fax: [phone]
Mayor:
Jim Lowell
Mayor Pro -Tern:
Sandy Miller
commissioners:
J. Alan Holden
Charlie Boyle
Jack Smith
TimTimmermann
Town Manager:
Steven M. WheelerOctober 7, 2003
James Crouch
136 Tarpon Drive
Holden Beach, NC 28462
EXEMPTION #2003-025E
Dear Mr.Crouch:
The plans were submitted for your home at 136 Tarpon Drive have been approved.
Enclosed you will find an CAMA exemption for the proposed project. This permit is
being issued only for the repairs that are listed below. If there is any further proposed
work to be done please contact the office for the necessary permits before construction
begins. If you have any further questions please feel free to contact our office.
REPLACE DRAIN FIELD ONLY11111111111 M
(G.S. 113-103 (5) (B) (5) and 7K. 0209) states that structures may be repaired in a similar
manner, size and location as the original structure. No expansions or additions are
permissible. The repairs are limited to 501/6 of the physical value of the existing structure
(septic system) per calendar year.
Since the repairs the structure appears to be less than 50% of the value of the structure,
you are authorized by this letter to make the repairs as indicated. Please note that this
authorization is only applicable for the structure to be repaired as indicated in the
information you provided.
Sincerely
Rhonda Phillips,
Local Permit Officer
Visit www.hbtovvnhall.com

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S41.
N.C. Gvwd Cw*80 bq Licaee Na 30470
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S a 0Pe1Vb' No. SS121M3
September 4, 2003
Att: Rhonda
Town of Holden Beach
110 Rothschild St.
Holden Beach, NC 28462
Reference: James Crouch 136 Tarpon Drive Holden Beach, NC
1891 HOLDEN BEACH RD. SW
SUPPLY, NC 2B462
TELEPHONE tM0) se24007
FAX: [phone]•4004
Enclosed is a copy of the repair application submitted to Brunswick County Health
Department for the reference property. Our company will be performing the repair to
septic system. The nitrification field of the septic system is the area to be repaired.
Sincerely,
'0,61ar. Pl:'`-
Melissa P. Lee
Office Manager
Enclosures

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Brun8N1ck County Health
Department
25 Courthouse Drive N.E.
Post Office Box 9
Bolivia, North Carolina 28422-0009
Bolivia 253-2250 Leland 763-1312
Southport 457-5281
Fax #[phone]
Donald l Yoasey
Hea&h Director APPLICATION FOR EXISTING SEWAGE SYSTEM REPAIR
)DAME OF APPLICANT: F a R ey
MAB.INGADDRESS: 11101 AJ*- (lit•c� W+' SW
CITY: Sw �, STATE: N C. ZIP: 8`! 4 2
HOME PHONE NO: WORK: SN t-4003 OTHER: StKz- VeeV
PROP TY OWNER PREVIOUS OWNER OF PROPERTY
ORI DIAL PERMIT # TAX PARCEL ID# # OF EXISTING BEDROOMS N OCCUP/EMPL
SUBDIVISION: Fy RaCS LOT# 231 BLOCK SECTION
ADDRESS OF PROPERTY & DIRECTIONS tlt.- -r&-- or- V►U--
LOT DBMENSIONS: FRONT i REAR _5-0 SIDE AO SIDE L (ACREAGE)
WATER SUPPLY LOCATION: FRONT / REAR! SIDE_ (PUBLIC OR PRIVATE) gbh` L'
DISTANCE FROM SEPTIC SYSTEM
SEPTIC SYSTEM LOCATION: FRONT ✓ REAR _ SIDE _ (AGE OF SEPTIC SYSTEM
DISTANCE FROM BUILDING FOUNDATION/DECKS, STEPS & PORCHES PROPERTY LINE
DATES SEPTIC SYTEM PUMPED w uwJ
DATES SEPTIC SYSTEM REPAIRED _ _ _ _►✓ A7
I CERTIFY THAT THE ABOVE INFORMATION IS TRUE TO THE BEST OF MY KNOWLEDGE AND
BELIEF. I AUTHORIZE THE BRUNSWICK COUNTY HEALTH DEPARTMENT TO INSPECT THE
PROPERTY DESCRIBED ABOVE
FafR ID%%) -
SIGNATURE
(OWNERIAGENT)
DATE �p; PLEASE USE THE BACK OF THIS FORM TO DRAW
PROPERTY DIAGRAM/INFORMATION IF NEEDED.

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PAGE 01
N.C. Gw l Comacan0 Lit No 30170
UI14mited Clans kMon: Highway: PU (Water A Soww Lines)
N.C. PoBwon Conaot Opanaon Ceh4aWn
S OpwdwNo SS 12043
Date: _ 'I /i/ A 3
Subject: IVA p.
Message:
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1 a81 HOLDEN BEACH AM. SW
SUPPLY. NC 28462
TELEPHONE [phone]
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BRUNSWICK COUNTY HEALTH DEPARTMENT ALTERNATIVE SYSTEM
Authorization For Wastewater Systani Construction Permit
BCHD a 90 —1r35 7R
Plan review by A . DATE 'F -/- - 0 3
Site evaluation by C-1- DATE 4-.I'--03
Site modifications, completed and inspected by DATE
AUTHORIZATION TO CONSTRUCT ISSUED THIS Zb rk DAY
OF pis
BRUNSWICK COUNTY HEALTH DEPARTMENT
ENVRONMEMAL HEALTH OP4160H
R.S. �y P✓►� !e - fa - e J
MHO
ecluired—
Pre^-construction conference for site by: _(_
Date: ,_
Present for conference (list): CI,.;, 4.,,� r C..,..�
Pre -construction conference for construction of system by:
Date:
Present for conference (list):
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SYSTEM OR ITS REQUIRED SETBACKS.
INSTALLATION REQUIREMENTS
1. The installer shall be currently registered with this department
2. A ore-nstallalion QPOW-c C is to be held on the site prior in beaihnhihe any site modification or cot nwilon Of the
PMDOW structure or fine sewage Collection tresirnent and disposal System. Amending Chase confp9noes shatl be
representatiyaspf the Stale 8/or Local Health Department project erhgsheer or designer, ooniractor. budder; proposed
system operalorhrstaller, and the owner or this authored agent.
3. The contractor shalt be responsible for notification of to ergihea and the BCHD for system inspection in stages as
required and prior to backfiing any portion of the system. No portion of the system shall be backfilled or placed into
use without prior approval of the BCHD.
4. The system shall be installed In accordance with the approved $et of Plena and sPecitieations- Any demation in site
moddications. plains. specification. 1pyouk materials or other system component shall be approved by the design
engineer and the Munwick Cohnty Health Ueparunent prior ID ista WWn of the systen'I. Fadhae to do so may result in
delay or refusal of final approgl Of the system. and may render the Parmti nuM and void-
5- The system shall be irslalled in a timely manner and staged so as to avoid unnecessary emosure to weather.
6. The location and identification of all property lines, easements, water lines. and other appropriate utilities shall be the
responsaiily of the nstaller.
T Other.•
OPERATION PERMIT REQUIREMENTS
1. An Operation Permit shall be issued by the ECHO Prior to placing the system into use, or making any cormectiorts to the
system.
Z Prior to issuance of the Operation Permit-.
- Mre system shelf be carhpkted, installed, and tested in accordance with the approved design. including proper
abandonment of tanks ezaling wells, and other components. The ooftified subsurface system Operator for the
syaaatn shaM be present for the testing and starblp of the installation.
final Iandscaping, water divhs WM devicesand vegetative cover requirements and pressure adjustiment shalt be
oomplete0,
- the Engihea, Designer or applicable responst le parties shah submit aabull Pfau b fine ECHO, the plans shall
reflect any charges or alteratoru f m Mine aa.approved plans. The flint PUMP delivery rate for the Installation "I
also be delem i ned and pro%*W to BCHD as pat of the final CarWkabD h.
3 For inhales tut required evaluation by a caroled sod s or proeecsional ghsokhggf a written CettifsSUon shall the
shabmAcd that the site syahxth installation was 10 in accordance with that epeafietl si6a0instellation regt cements
For systems that have .
4. e been agYheered or designed by a private eonsdterq . the designer or engineer (as applicable)
shall catty in hurling to the Brhrwa ck Cprshly 1IealMn Department, that he has inspected the ndaltatorh and that it has
been named according so the approved plans and specifications.
Any necessary easements, Plats, or other documents shall be recorded with the Register of Deeds and copies
submitted Io the BCHD,
- The owner and a Public Management Erhtay/Supaaface System Certified Operator shall execute a corhtacy which
addressee all of the requirements for maintenance, monibring, and repodinhg in Section .11181 and the
requirements of the Schedule Of Operation and Mairdenance to be a part of the Operaton Permit for the jaciMy-
Pmvaiorhs of said Corhtied shell be in effect for as long as the system is in use.
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Brunswick County Health Department
Environmental Health Section
Alternative Sawn" Treatment and Dloposal System
Application 2 • R/3-e r 1 NJ -.25533 z�
Tax Parcel 0 y
System Type- SA
AUTHORIZATION TO CONSTRUCT
FOR
WASTEWATER COLLECTION, TREATMENT, AND DISPOSAL SYSTEM
In accordance with the provisions of Article 11 of Chapter 130A, General Standee of North Carolina as amended,
AND other applicable Laws and Rules
PERM6SM IS HEREBY GRANTED TO
i
to conspuct install a westrnerN and disposal system as destxbed below.
To Sarre: s, Dev M181 s r merealN//i S&nployeesN 7# O�ypany C
Cammen�, Deserbtion! P--',. � 1.•.... f �r/.. � r_ ��
The ft'61em components com"alc of Type sysbm— WWS-W1, PURAFLO PEAT BKIFILTER, TYPE A
Design Flow -J L o GPD
1, COLLECTION SYSTEM, CONVENTIONAL PLUIIABNG
(MUST COMPLY WITH ALL APPLICABLE MG CABLE STATE AND LOCAL PLUMBCODES)
IL TANKAGE: A. SEPTIC TANKaY
S) GALLONS CAPACITY 7 fix.,'y
D. PUMP TANK L GALLONS CAPACITY/
D. OTHER: are asotic tank 4hAl h....,.r.. A .".
ALL TANKS, FORCE MAINS, PRESSURE LINES TO BE LEAK TESTED AND CERTIFIED BYAPPROPREIATE
PARTIESJJYI tanks and risers Shall be trusted to be wabrSW by a 24 hour hydrostatic leakage test tort kxAod at the $as
Prior to system $Mrkrp. A water krel chsnge of +I- % ffmh or more ow 24 naffs, or visual oblarl/dti0h of10ekage shall
be cause for blure of fire UsL
ACCESS RISERS REQUIRED ON ALL INSPECTIONS & SERVICE HATCHES ON TANKS -RISERS TO EXTEND 4-6'
ABOVE FINISHED GRADE
IY. PUMP CHAMMERIDOSNG TANK -
AL DOSING PUMP(S): SIZE, MAKE. MODEL tfr1 y> AIn n i i' I z Y, pti ( .S. T 5- 1 0
NUMBER OF PUMPS REQUIRED: o.� B. DISCHARGE PIPING: SiZE�INCH MATERIAL' SCH 40 PVC GATE VALVES: YES INTERNAL
CHECK VALVE: YES UNIONMISCONNECT: lLS/= LIFE CHAIN OR ROPE: VFS H ^ ROSNE
ANTISIPON HOLE: YES (3f16IN.1
N. DO G MAIN: DOSE VOLUME SIZE s DRAW DOWN DEPTH: i • 5 wcHES ► t- f o(doses per
day
� MATERIAL: SQU 40 PVC VALVING:`CLEANOUTS,�—
V. CONTROL PANEL:: TYPE: Drla,l o H APR f x i w�
TO INCLUDE: NEMA 4X ENCLOSURE, MANUAL DISCONNECTSOREAKERS FOR PUMP AND ALARM
(SEPARATE CIRCUITS FOR PUMP AND ALARM), H-O-A SWITCH, ALARM (AUDIBLE AND VISIBLE)
SIMPLEX X WITH ALTERNATOR AND ELASPED TIME COUNTERS! EVENT COUNTERS
FLOATS: OFF X ALARM ILAG X
(MUST COMPLY WITH'ALLAPPLICABLE STATE AND LOCAL ELECTRICAL CODES)
VI. PEAT BIOFILTER: _#OF MODULES REOIREO MANIFOLD SIZE _ - INCHES
2 MODULES EQUIPEO WITH WEEP HOLES AT BOTTOM
TYPE A INSTALLATION: SAMPLE CHAMBERS NEXT TO MODULES
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Vt. DISPOSAL FIELD: LTAR—L-d TRENCH DEPTH �o..M—f° W — 4'^ 5i-
BACKFILL: TO BE INSTALLED OVER GRAVEL BEDS AND NEXT TO MODULES.
MODULE TOPS TO REMAIN AT 61NCHES ABOVE FINISHED GRADE MIN COVER OVER ROCK BEDS IS 8
INCHES. BACKFILL TO BE INSTALLED WITH A SIDESLOPE OF AT LEAST 1:4 SMESLOPE
A. TYPE A:
1. UTILIZING A ROCK BED UNDER EACH MODULE, 13ED LENGTH AFT. WIDTH f y FT.
DEPTH OF ROCK USED FOR BED (81N MIN) INCH
comments: 900taIdie fabric (ceoable of remaNnci sit seed oarticlesl is to be use on all a anww surfs r4 e,..w*
VIII. APPURTENANCES TO SYSTEMS:
A. SUBSURFACE DRAINAGE: TYPE: DEPTH:
INSTALLER:
B. AREA FILL: FILL DEPTH: MATERIAL- SAND/ LOAMY SAND SIZE OF BASAL AREA- WIDE x LONG
SEE FILL PLAN FOR ADDITIONAL DETALS AND SPECIFICATIONS. FOR TYPE A SYSTEM$, NO EQUIPMENT
OR MACHINERY SHALL BE ALLOWED OVER THE EXPOSED SITE-
C. LANDSCAPING, ALL SITES SHALL BE LANDSCAPED SUFFICIENT TO PROVIDE SURFACE RUNOFF AND TO
PREVENT PONDING OF RAIN OR OTHER SURFACE WATERS.
D. COMMENTS, SITE MODIFICATIONS, ETC., /%.f:,,,s
The Owner shall be subject to the following conditions, limitations, and construction requirements for the installation of this
system:
1. The authoraabon is effective only with resoeu 10 Nis SP=ft deeipn flow and 18C11"s, and the nature and volume of
waste descrhbe0 in the Permit Application, and other supporting data
2. The permit is not transferable and must be reapplied for at such time as ownership, or management changes
-
3. The designated repair meats 10 have no paAtig, driveways, or ether mpervpus mabrial located on it This
area is to be Protected, reserved and maintenance in a natural state.
4. AN subsequent owners of this property and sewage system, shall exeeule a tontrad between the owner and an
approved management entity before the operations permit a issued. ManagemeM of the sewer system to be provided
at all tsnes.
5. All contracts between owners, management entity (Public or Private), or Health Dept shall be reviewed and approved
before being accepted.
6. A property certified Operator shall be provided as indicated:
Certified Subsurface System Operator J=
7- The asuance of gm permit does not preclude the permttee from comptyng with any aid an statutes, regulations, or
omV=wes which maybe imposed by other govemmeM age aim vhdhioh have )urtsdicbon. orany carer pennds issued by
this department
8. This wastewater systarn shall be installed by a contracbr authortted in writing by the manufacturer, who avail
o00rdn9ts the installation whdh the desVier and the manufadhrees field represenfatve-
9. For ales Mquiig evaluation by a certified sod scientist or professional geolo K said sot scientist / geologist shall be
"am* and supervise any site modifications, and cndcal phases of the wasbwobr system insfaNatiorh.
10. This autlhareabon shag be valid for 60 MWW from tiro dab of sue. The autar¢ation shag become irvalid I fhe
Information submitted in the aPPlIcatiCi+ was fabified or charged. it the permit was based on inaoc rata or Lhcanplete
information, or 9 the designated site is all red. or eilpimlion of this authorvation. a new application shag be submitted to
the BCHD with uPdetad idgmation, as may be applicable or requested.
11. •• A PERMANENT BARRIER SHALL BE PROVIDED AND IN PLACE AROUNDTHE SYSTEMIREPAIR AREA BEFORE
THE OPERATIONS PERMIT 1S ISSUED,
12. ALL APPLICABLE SETBACKS SHALL BE MAINTAINED, NO IRRAGATION SYSTEMS, STORM WATER PONDS /
BASINS, SURFACE/SUBSURFACE DRAINAGE SHALL BE LOCATED IN THE AREA OF THE WASTEWATER
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