HB_04-032_Eastern Carolina Construction & Dev

Jun 04 04 03:31p TOWN OF HOLDEN BEACH 8108429315
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L=l Government
CAMA
.o%M11RPEVEL0PMENT
�PERMIT
as ed 0,,o,, \s_tto f North Carolina, Department of Environment
and Nature esou��S,(iYl1Fe Coastal Resources Commission for development
in an are"Pd vironmental wricern pursuantto Section 113A-1 to of the
ram. v� ` �,�,,,,� � General Statutes. "Co tat Area ManaSamen�'
Issued to'r'T f `V aVC)l w,& C .4-(D'Vl authorizing deve1mgrit in ��Flo,,r�ra
at 471 0 olea l 61 V5. (v r `T
p.2
aoo 631DL
Permit Number
as requested in the permittes's application, dated
This permit, issued on is subject to compliance with the application and site drawing (where consistent
withthe permit), all appikablaregulationswdspeclatcondhions and notes set forth below. Any violation of these terms may subject
permisee to aline. imprisonment or civil action, or may cause the permit to be null and void. ,
PERMIT TO CONSTRUCT AN AMENITIES BUELDING, INSTALL A SEPTIC SYSEM
AND A 4 FOOT WIDE WALKWAY.
All proposed development and associated construction must be done in accordance with the
permitted work plat drawing(s)•%' ..
1. No dune disturbance of a dunes area will not be allowed for this development because the
dune's protective value would be weakened or reduced. 1
2. All construction must conform to the and all other local, State and Federal 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. Pursuant to 15 NCAC, Subchapter 7J. 0406 (b), this permit may, not be transferred, or
otherwise disposed of to a third party, except by the Division Director.
i
5. The structure must be set back 60 feet from the first line of stable natrual vegetation
OUNV). The pemvttee is required to contact the Local Permit Officer shortly before het
plans to begin construction to avenge a setback measurement which will be effective for
sitcty(60) days barring a major shoreline change. Construction must begin within sudy (60)
days of the determination or the measurement is void and must be redone.
This permit action may be appealed by the pernittee or other
qualdied persons within twenty (20) days of the issuing date.
From the date of an appeal, any work conducted under this per-
mit rn.st cause until the appeal is resolved.
This permit must be on the project site and accessible to the
permit officerwhan the project is inspected for compliance.
Any maintenance work or project modifications not covered
underthis permit requires furthorwritten permit approval.
31 A!I prgrltmuslase when this permit expires on December
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 Manaoement
��sit
M,-
2'd STE6211180I6 HOH3H N30-101-1 JO WMOI dbE:EO 40 LO unr

Jun 04 04 03:31p TOWN OF HOLDEN BEACH 9108429315
Local Government
LAMA
MINOR DEVELOPMENT
PERMIT
as aufhorized by the State of North Carolina, Department of Environment
and Natural Resources and the Coastal Resources Comm&sion for development
�ramr- nn in an area of
environmental concern pursuant to Section 113A-119 of the
Issued to't� f i V V�I �+ p t d->vV: � g� Slatule6, 'Co tar Area m; a �n
Q 1 authorizin deve ment in
p.3
aoo c �-
Permit Number
as requested in the permittee's application, dated c1 —tr7
This permit, issued on — is subject to compliance with the application and site drawing (where consistent
wahthe permit), all applicable regulations and special conditions and notes setforth below. Any violation of these terms may subject,
permitee to a tine, imprisonment or civil action, or may cause the permit to be null and void.
6. Any structure authorized by this permit shall be relocated or dismantled when it
becomes imminently threatened by changes in shoreline configuration. The structure(s)
shall be relocated or dismantled within two (2) years of the time when it becomes
imminently threatened, and in any case, upon its collapse or subsidence. However, if
natural shoreline recovery or beach renourishment takes place within two (2) years of the
time the structure becomes imminently threatened, so that the structure in no longer
imminently threatened, then it need not be relocated or dismantled at that time. This
condition shall not affect the permit holder's right to seek authorbation of temporary
protective measures allowed by CRC Rules.
7. In accordance with T15A NCAC 7H. 0308(a), no seawall or riprap revetments will be allowed
in the fimrre should any structure become threatened from erosion.
8 All construction shall meet all requirements of chapter.157.060 and Chapter 158.00 located
in the Town of Holden Beach Code of Ordinances and any other sections that apply to the
construction of the single family residence.
9. The innovative swrmwater system authorized with this permit must be maintained for the
life of the structure addressed
This permit action may be appealed by the permitlee or other
qualified persons within twenty (20) days of the issuing date.
From the dale of an appeal, any work conducted under this per-
mit m,.st cease until the appeal is resolved.
This permit must be on the project site and accessible to the
permit officer when the project Is inspected for compliance.
Any maintenance work or project modifications not Covered
under this permit requires further written permit approval.
All work m st tease when this permit expires on December
31. W&
In issuing this permit It is agreed that this project is consistent
with the local Land Use Plan and all applicable ordinances.
This permit may not be transferred to another party without
the written approval of the Division of Coastal Management.
� a - • � t ear•
a Fi
6'd 9166211180116 H3H39 N3O'101-1 30 1,11901 dU6:EO 40 LO unr

Jun 04 04 03:31p TOWN OF HOLDEN HERCH 3108429315
I�oldencJh
Local Government
CAMA
MINOR DEVELOPMENT
PERMIT
as authorized by the State of North Carolina, Departmam of Environment
and Natural Resources and the Coastal Resources Commission for development
in an area of environmental concern pursuant to Section 113A-11 a of the
GeneralStatutes, o�l AreaMn re
Issued to 1 ��.A-�fahorizindeva mem in '
el =r7 I O c� n � Lid, tQ�esT -
p-4
Coo 63a
Permit Number
as requested in the permittee's application, dated
This permit Issued on is subject to compliance with the application and site dra onsisteq
w'^the permit), an applicable regulations and special conditio ns and notes setforth below.Anyv10:, tion of the a smay A�
pe niftee to a fine, imprisonment or civil action, or may muse the permit to be null and void. v
to. Section 158.09 (C)(4) states in part that it is the intent of these regul;,�A tha�
stormwater flew be contained within property lines in question, and not be directed,polldd
adjacent real estate. G
11. All construction tnatcrials located below base flood elevation shall be treated material.
12. An approved set of building plans shall be on the job site for all inspections.
13. All construction shall meet the requirements of the stormwater plan that was dated 4-28-04
stamped by Mr. Norris and the plan that was designed by Haden Stanziale stamped May 28,
2004..
14. Pools, pool decks, walkways, and associated accessory buildings placed tinder or adjacent to
coastal buildings must be structurally independent of the building and its foundation.
15. Whm locating the additions on the platted lot remember that FEMA also states that human
alteration of sand dunes within V Zones is also prohibited These natural features are important
first lines of defense against coastal storms and can do much to reduce losses to inland coastal
development. It is for these reasons that they are protected against alteration.
This permit action may be appealed by the permihae or other
qualified persons within twenty (20) days of the issuing date.
From the date of an appeal, any work conducted under this per-
mh rn.sl cease until the appeal is resolved.
This permit must be on the project site and accessible to the
permit officer when the project is inspected for compliance.
Any maintenance work or project modifications not covered
under this permit requires further written permit approval.
All work mu a when this permit expires on December
31. (7�
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.
� • � �rtf / � � � � t.
--)n 0=t-a
b'd S1662"016 HOU39 N30-lOH 3D WMOI dbC:60 b0 LO unr

Jun 04 04 03:31p TOWN OF HOLDEN BENCH 9108420315
—76n 4otden���
Local Government
LAMA
MINOR DEVELOPMENT
PERMIT
as authorized by the State of North Carolina, Department of Environment
and Natural Resources and the Coastal Resources Commission for development
in an area of envimnmantal concern pursuant to Section 113A-118 of the
r,� ''jjam�� General Statutes, 'Cc al AreaMana amen
Issued to-flS-� fro A0��1mylsii p,y authorizing deve�pment in =i �p
p.5
aoG b3a
Permit Number
as requested in the permittee's application, dated
This permit, issued on is subject to compliance with the application and site drawing (where consistent
with the permit), all applicable regulations and special conditions and notessetiorth below. Any violation of these terms may subject
permitlee to a fine, imprisonment or civil action, or may cause the permit to be null and v-id.
16. The struitrtCte must be located entirely off of the frontal dime.
17. The structure must be elevated on pilings with a diameter of at least eight (8) inches and the
first floor level of the sills and joists must meet the 100 year flood elevation level of 18 feet
18. All pilings shall extend at least five (5) feet belowmean sea level-
19. All development shall meet all the requirements of section 157.077, 157.062 and chapter
94..
20. All development shall meet all requirements of 15A NCAC 07H .03K 15A NCAC 07H
.0308.
21. All unconsolidated material resulting from associated grading and landscaping shall be
retained on site by effective sedimentation and erosion control measures.
22. Before pouting all concrete permitted the engineer that designed the stormwater plan shall
inspect the site to verify in writing that the site meets the approved stormwater requirements that
he has designed.
This permit action may be appealed by the permihee or other
qualified persons within twenty (20) days of the issuing date.
From the date of an appeal, any work conducted under this per-
mit m,.st cease until the appeal is resolved.
This permit must be on the project she and accessible to the
permit officer when the projects Inspected for compliance.
Any maintenance work or project modifications not covered
under this permit requires further written permit approval.
31AD work mu 7 ase when this permit expires on December
,�
In issuing this permit it is agreed that this projectile 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.
` Pca�� c�
a • � �ti 0 � �i I.
rl m ¢ion abbe apply o pe:.rit)
S'd 91E6248OT6 1-13113H N3Q10H 30 1,117101 dSC:60 10 LO unr

. e Jun 04 04 03:32p TOWN OF HOLDEN REACH 9108429315 P,6
� �4oldenna aoo o3a
Local Government Permit Number
CAMA
MINOR DEVELOPMENT
PERMIT
as authorized by the Stale of North Carolina, Department of Environment
and Natural Resources and the Coastal Resources Commission for development
in an area of environmental concern pursuant to Section 113A-118 of the
General Statutes, 'Co tal Area Mana amen'
Issued to { IV lU � ct l'�`�ir�l( ii �'V; authorizing dev�ment in _ we�'J
as requested in the pemnidee's application, dated
This permit, issued on — is subject to compliance with the application and site drawing (where consistent
with th a permit), all applicable regulations and special conditions and notes set forth below. Any violation of these terms may subject
perm itlee, to a fine, imprisonment or civil action, or may cause the permit to be null and void.
23. We will also need a statement from the engineer that designed the ' r stomtwa tbE
final has been requested that verifys that this development has been the
approved stormwater plan and that it meets the towns ordinate. \U,l„nl, _ � .tN I. UU����
24. This permit may be renewed for one (1) year is requested before
GO Pg'i PL
This permit action may be appealed by the permittee or other
qualified persons within twenty (20) days of the issuing date.
From the date of an appeal, any work conducted underthis per-
mit m„st cease until the appeal is resolved.
This permit must be on the project site and accessible to the
permit officer when the project is inspected for compliance.
Any maintenance work or project modificefions not covered
under this permit requires further written permit approval.
All work must cease when this permit expires on December
31. A Wr%
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.
9'd 91E6248016 HOU38 N307lOH 30 WM01 d9E:CC 40 LO um1

Jun 04 04 03:32p TOWN OF HOLDEN BEACH 9108429315
_ p.7
u71 O 6ean 'E ( Vd - (, 6-TJ
AEC HAZARD NOTICE
Project is In An: ✓ Ocean Erodible Area High Hazard Flood Area_ Inlet Hazard Area
Date Lot Was Platted:
This notice is intended to make you, the applicant, aware
of the special risks and conditions associated with
development in this area, which is subject to natural
hazards such as storms, erosion and currents. The rules of
the Coastal Resources Commission require that you
receive an AEC Hazard Notice and acknowledge that
notice in writing before a permit for development can be
issued.
The Commission'srules onbuildingstandards,oceanfront
setbacks and dune alteration are designed to m inim ire,but
not eliminate, property loss from hazards. By granting
permits, the Coastal Resounxs Commission does not
gguuarantee the safety of the development and assumes no
liabflity for future damage to the development
The best available information, as accepted by the Coastal
ResourcesCommission, indicates that the annual ocean
erosion rate for the area where your property is located is
a feet per year.
The rate was established ' by careful analysis of aerial
photographs of the coastline taken over the past 50 years.
Studles�4122 indicate that the shoreline could move as
muc►4a4;Q feet landwArd in a major storm.
Theflood waters in a majoisiarm arepredicted tobeabout
17 feet deep ui this area
Preferred oceanfront protection measures are beach
nourishment and relocation of threatened structures.
Hard erosion control structures such as bulkheads,
seawalls, revetments, groins, jetties and breakwaters are
prohibited. Temporary devices, including sand bags, may
be allowed under certain conditions.
This structure shall be relocated or dismantled within two
years of becoming imminently threatened.
The applicant must acknowledge this information and
requirements by signing this notice in the below space.
Without the proper signature, the application will not be
comple
M
SPECIAL NOTE: This hazard notice is required for
development in areas subject to sudden and massive
storms and erosion. Permitsissued for development in this
area expire on December 31 of the third year following the
year in which the permit was issued. Shortly before work
begins on the project site, the Local Permit Officer will
determine the vegetation line and setback distance at your
site. If the property has seen little change and the proposed
development can still meet the setback requirement, the
LPO will inform you thatyyooumayybegin work. Itis fmpor
tant thatyou check with the LPO before the pernut expires
for official approval to continue the work after the permit
has expired. Generally, if foundation pilings have been
placed and substantial progress is continuing, permit
renewal may not be necessary. If substantial progress has
not been made, the permit must be renewed and a new
setback line established. It is unlawful to continue work
after permit expiration without this approval.
For more information, contact:
Emomm—
LAMM VIP
Revised 11193
L'd 9166EV80TS HOH3a N30-1OH HO WMOl d96:CD 10 LO unr

�J3aoo�
AFFIDAVIT OF PUBLICATION
STATE OF NORTH CAROLINA
COUNTY OF NEW HANOVER
Before the undersigned, a Notary Public of Said County and State,
DIANE P. KEENAN
Who, being duly sworn or affirmed, according to the law, says that he/she is
CLASSIFIED ADVERTISING MANAGER
of THE WILMINGTON STAR -NEWS, INC., a corporation organized and doing business under
the Laws of the State of North Carolina, and publishing a newspaper known as WILMINGTON
CAMA PERMIT NOTICE MORNING STAR & SUNDAY STAR -NEWS in the City of Wilmington
Pursuant to NCGS 113-
119(b), the municipality
CAMA PERMIT NOTICE Pursuant to NCGS 113-119(b), the municipality of TOWN OF
of TOWN OF HOLDEN
BEACH notice that
HOLDEN BEACH gives notice that on 2124104, applicant Eastern Carolina's Construction and
gives
on 2n Car, applicant
Carolina's Con-
Development applied for a CAMA minor development permit to construct an amenities buddin
strucEastern
tion and Develop-
AMA
ment applied fora CAMA
minor development per-
TOWN
to an
OF HOLDEN BEACH
buildsconstruct
amenities builtling park-
am
ing area and insrll Septic
STREET
system at 471 Ocean
BO rd West.
This application may be
was inserted in the aforesaid newspaper in space, and QaQ&NQlaAACH NC 28462
inspected at the below
address. Public com-
ments received by
3/10Ix
3/111/64 will be consid-
Rhonda Phillips
CAMA Local Permit Officer
110 Rothschild street. And at the time of such publication Wilmington Star -News was a newspaper meeting all the
Holden Beach, NC 28462
Phone: [phone] requirements and qualifications prescribed by Sec. No. 1-597 G.S. of N.C.
Tit..
Sworn or affirmed to, and ^suMbscr'i'bed before me this c3 day of
M GOV _il A.D., ad.�
In Testimony Whereof, I have hereunto set my hand and affixed Ivy of?icial seal, dhe day and
year aforesaid.
My commission expires � day of R, 20—QLQ
Upon reading the aforegoing affidavit with the advertisement thereto annexed it is adjudged by the Court that the said
publication was duly and properly made, and that the summons has been duly and legally served on the defe (s).
This day ofMAR 10
ll d t✓ `� ��
rk of Superior Court
MAIL TO: DIVISION OF
COASTAL MANAGEMENT

Lgca'liiy - dLl1� /J 191—e/7 ��' CL(' Permit Number
GENERAL INFORMATION
LAND OWNER
'game Eastern Carolina's Construction and Development Corp.
aar2s 2980 Holden Beach Rd.
City
Supply
AUTHORIZED AGENT
N,me Coastal Construction
State NC Zip 28462 Phone [phone]
Address 2980 Holden Beach Rd.
City Supply State NCB Zip 28462 Phone [phone]
LOCATION OF PROJECT 471 Ocean Boulevard West
: 73 & 74 A. bd;v;st' cn: Robinson Beach
(If not oceanfront, is waterbodv natural or manmade?)
DESCRIPTION OF PROJECT Installation of septic system, construction of
access walkway
IN
AREAS OF ENVIRONMENTAL CONCERN (AEC) CLASSIFICATION
(To be filled in by the Local Permit Officer prior to completing application.)
Ocean Hazard Estuarine Shoreline O RW Shore':, e
construct ocean
FEB 2 5 W
PROPOSED USE LO Residential X Commercial/Industrial Other' OWN OF HOLDEN BEAT i l
SQUARE FOOTAGE OF BUILDING FOOTPRINT AND OTHER IMPERVIOUS OR
BUILT -UPON SURFACES (such as driveways, etc.) within 75 feet of the shoreline (575 feet
of an ORW shoreline)
SQUARE FOOTAGE OF TOTAL FLOOR AREA OF BUILDING 1,995 (Heated)
SQUARE FOOTAGE OF SITE 7,500
OTHER PERMITS MAY BE REQUIRED:
The activity you are planning may require
permits other than the CAMA minor
development permit. As a service we have
compiled a listing of the kinds of permits that
Might be required. We suggest you check
over the list with your LPO to determine if
any of these apply to your project.
Zoning, Drinking Water Well, Septic Tank
(or other sanitary waste treatment system),
Burning, 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_

I, the undersigned, an applicant for a CAMA minor development permit, being either the owner of property in
an AEC or a rson authorized to act as an agent for purposes of applying for a CAMA minor development
permit, certifyethat 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)
Eastern Carolina's Const.&
X an owner or record title, Title is vested in Develo ment Co see Deed Book 1730
page 506 in the Brunswick County Registry o ee
an owner by virtue of inheritance. Applicant is an heir to the estate
probate was in County.
if other interest, such as written contact or lease. explain below or use a separate sheet and attach to this
application.
NOTIFICATION OF ADJACENT PROPERTY OWNERS
I furthermore certify that the following persons are owners of properties adjoining ' d'*rty. I affirm that I
have given ACTUAL NOTICE to each of them concerning my intent to develop this `mod to apply for
a CAMA permit. a,
(Name) (Address)' ^�
0) _ Edward & Deborah 217 King George Loop, Cary, 51 lr"js <, ,A
(2)
(3)
(4)
FOR DEVELOPERS IN OCEAN HAZARD AND ESTUARINE HAZARD
I acknowledge that the land owner is aware that the proposed development is planned for an area which may
be susceptible to erosion and/or flooding. I acknowledge that the local permit officer has explained to me the
particular hazard problems associated with this lot. This explanation was accompanied by recommendations
concerning stabilization and floodproofing techniques.
PERMISSION TO ENTER ON LAND
I furthermore certify that I am authorized to grant and do in fact grant permission to the local permit officer
and his agents to enter on the aforementioned lands in connection with evaluating information related to this
permit application.
This application includes: general information (this form), a site drawing as described on the back of this ap-
plication, the ownership statement, the AEC hazard notice where necessary, a check for $50.00 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 a per-
mit is subject to civil, criminal and administrative action.
This the 23 day of February 20 03
caner or -person authorized to ac his agent
for purposes of filing a CAMA permit4pplication.

LA U11
DATE: Z ZOD�
DEAR ADJACENT PROPERTY OWNER:
This letter is to inform you that I have applied for a CAMA Permit on the property
owned by F n<kffl (jQ nh' na )&Slw&v at l Yll �O/� G� Q�t _ � kG
aveIorrIVld ('are (sb=taddMS)
Holder Beach, NC. I have enclosed a copy of permit application and a copy of the
drawing of proposed project.
If you have any comments on the proposed project, please contact
Rhonda Phillips, Local CAMA Officer, Town of Holden Beach,
Holden Beach, NC 29462 - Telephone -( 910) 942-6498.
Sincerely,
110 Rothsc ' 5P AL
0�
O O
Q�
CEO .

u-7 3
DATE: Ftb► caj 200�
To: Jq8I L o Yl
rRI d
r �• aq��
DEAR ADJACENT PROPERTY OWNER:
This letter is to inform you that I have applied for a CAMA Permit on the property
owned by Ea4rt1 IArghnASl(mlmtbm 9L atthIID 0 I'APn 66Lh, Js: S'uo�lV,
0pVal0(fii[/L-t Corp (,t�etsedMG)
Holder Beach, NC. I have enclosed a copy of permit application and a copy of the
drawing of proposed project.
\f,ZZ) A,
If you have any comments on the proposed project, please contact
Rhonda Phillips, Local CAMA Officer; Town of Holden Beach, 110 Roths St. R, 6
Holden Beach, NC 29462 - Telephone -( 910) 842-6488.
Sincerely,
k an�,�
wner or Agent)
TELEPHONE NUMBS 2-5q,
G�� `Q
co
O�
G

IUIIIIIINIIIIYIIIII'IIIRII�I��A
Ms. Judy Long
4716 B Northgate Blvd.
Myrtle Beach, SC 29577
U.S. Postal Service Delivery Confirmation Receipt
Postage and Delivery Confirmation fees must be paid before mailing.
-a Article Sent To: (to be completed by mailer) �\
w� 17dwafcld De6zn-FI. AtLAArSan
zr aid &aq Ceor> e L.oep
No POSTAL CUSTOMER:
Keep this n:ceipt. For inquiries: Access
0o Postmark internal web site atw .usps.com
cs Here or call 1-800-222-1 at
117
�o
C r`
CHECK ONE (POSTAL USE ONLY)
m ❑ Priority Mail
0
❑ Standard Mail (B)
PS Form 152, March 1999 (See Reverse) -
U.S. Postal Service Delivery Confirmation Receipt
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ostage and Delivery Confirmation fees must be paid before mailing.
Article Sent To: (to be completed by mailer)
Ms. Jk�� any -
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��Y���e 13eaf�rSG �y57�
POSTAL CUSTOMER:
Postmark Keep this receipt. Forinquiries: Access
Here Intemet web site st www.usps.com
Dread 1-900-222.1917
PS Fotm 152, March 1999
'NECK ONE (POSTAL USE ONLY)
-� �n❑ ,P,ri�ority Mail
y wTandard Mail (a)
/a (see Reverse)
C'
line's Construction & Development Corp.
Beach Rd. ��Nvlt
28462
h
0304 7990 0002 4878 1668 co
O�
U
Edward & Deborah Anderson
217 King George Loop
Cary, NC 27511

Bry"i� County Health Department Application # oo-5412311
Environmental Health Section Tax Parcel # ,2q4-00-6611
Wastewater Collection, Treatment Type
and Subsurface Disposal System
IMPROVEMENT PERMIT
FOR WASTEWATER COLLECTION, TREATMENT, AND DISPOSAL SYSTEM
In accordance with the provisions of Article 11 of Chapter 130A, General Statutes of North Carolina, 15A NCAC 18A . 1900 e
seq., and other applicable Laws and Rules
PERMISSION IS HEREBY GRANTED TO:
Owner DD;%J&
Address / A /;."� : r G.'
c r
Phone
FOR THE
Installation of a wastewater collection, treatment, and disposal system to serve:
Residential !el-111 Bedroom �d�l� Commercial -14-- Employees �p Max dccupany ds M 5
Comments/Use &- el
pursuant to 15A NCAC 18A.1900 as amended and in conformity with the application and other suppp g dat ubsequently filed and
approved by the DEHNRIor the Brunswick County Health Department and considered a part of this pe it O
Facility to be served: Name
Address/Location y%/ f�co�— ✓� - /+ia Sf
Description 6«L(. _ C./ u� B .s Pr:o• n-`JA' -I
The owner shall be subject to the following conditions, limitations, and construction requirements for the installation and operation of thi
system: .
1. This permit is effectiveonlyiv 1th respect to the specific design flow facilities, and the nature and volume of waste described in the
Permit Application, and othefpuppordng data. Changes in the proposed use, waste flow, nature or volume of waste render this
Permit void.
2. 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 filing submitted beforr
the Operations Permit or Authorization to Construct is issued, conditional on recordation and enforcement of easemem
3. The designated repair area is to have no parking, driveways, or other impervious material located on it.
4. The issuance of this permit does not preclude the pernittee from complying with any and all statues, regulations, or ordinances
which may be imposed by other government agencies which have jurisdiction, or any other permits issued by this department.
5. The permit shall become invalid if the information submitted in the application was falsified or changed, if the permit was based on
inaccurate or incomplete information, or if the designated site is altered.
6. Before Authorization to Construct a Wastewater Treatment and Disposal System is issued, all site modifications., plans,
specifications, draft legal paperwork must be completed and approved.
7. Sites requiring complex designs for wastewater systems, may require approval of plans and specifications before the Improvemen
Permit is issued.
PERMIT ISSUED THIS DAY OF Teb!"�✓ i �o' `�
DATE OF PERMIT EXPIRATION o2 - z%- O �
BRUNSWICK COUNTY HEALTH DEPARTMENT ENVIRONMENTAL HEALTH DIVISION
6^-�' 17C R.S.
PERMIT.STA 111I 97

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