HB_04-039_Matthews

FROM L
PHONE NO. : 910 e939995
Apr. 05 2004 01:38PM P1
TOWN Of HOLDEN 482004-039
BEACH Per -nit Number
Local Cnviirnmanr CAMA
MINOR DEVELOPMENT
PERMIT
as ttetlrw�ed M tl.a state of North Carah" Papranene efle vftq arorrC
aM rlaYtrar aamrtes aM the Caam1 Resourtea Camrnerrtan Ier devdnPmmt
is Marie of enrrrenndq torroera WtroaK to Section LM-US ofUse
C,..,, h SaMMtr'C,," Area Marayeoele i i
issued to Mary Lou Matthews authorizing development in Ocean Hazard Area at 624 Ocean Blvd. West as
requested in the permittee's application, dated 3116/04. This permit, issued on April 1, 2004. 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.
PEAMr.r MA INSTALL SEPTIC SYSTEM, C7ONSTR(IC7':INCYLEFA-WLY RESMEN'--&
GRAVEL DRIVEWAY, AND RETSA"770.NAREAS
A COASTAL WETLANDS LLYE WW BESTAM By LOCAL PER)Lfr7' OFFK'ER AND THE
U.S ARMY CORPS OF ENGLKEERS Mr✓ST DETERtME THE 404. URISDLCT!Ou PRIOR TO
ALL COWR UCTION OF PERtdGSBEING ISSUFD
7. Itmr to initiffiin6 any taad -dsesbiwg wuvides adequate sedimtmrstire/aosion Lvatrol measures :test be employed
to prevent lee movem m of unttnnwhhrted euterials imc the marsh or water. These measres must remain in plate MW
such time as the area u pnopedy stabilized with vegeteed cover.
2. Any lunge or ranges et the phaty for development, coostrtwtion or land Aar xtivities will requve a re-evalua ioa
aftd mudifrcauou of his Prn A.
3. All coashuctioa must corfo-71ft to the 1ntLrrlatioral auileing Cudc teyuiremcft and all other Letvi, Suee and
Federal rc(,wbt:oac.
4. All proposed dovalopment and associated cuactrtrctioa must be dome jr: ecct Atoce w1h the permitted wadMiat
drawing(s) that were subdiftwd on 3-11414.
S. ptusvam to IS NCAC, Srbchwift/ - �.0406 ibl, this permit may » be Migned, nar_�frn d. wit: of ntlrvoise
disposed of to a third parry.
This pearl edam may be aporatn tr tk Re n*= x otw
4d orsas aiRe+iwaary (Zt) myt d me Ltwinp datef fan
!ere aim d an app mi sr work cov ucad under Rile permit rest
tease unf:l erne dVde-4 is moved.
Ths Wrnt MM ere M the p W of, and exnalbte to the pemYi
9ScCobar He pqW is nfpedCa is COrfK"N*.
Arty wa1 ie vice woad or ogee{ madk etoi not cow mf: uM
!lit petrK raprm It;,rtr wimen Pond apctorl.
AS vwk mil wsa when a ppmt erprm m peeet"r 3s.
W
e k9mil Wk ireon it is aef®te Ll2 ths;*,to a eo msie-1 we
ale uxi L�,d use Plan and es appltabhe Omftmm .
Tlris par:nii mar rat be transkaed to anolhef parry tftx the
wtdlei aopwd Co are Diadem Of Cndd Matagenmrl.
lip-1.�1���• :jl,a__��.L�/
r
RHONDA PHLLFS
C NIA LOW PM of 09C&
Z'd 9Tf82*9016 H0U30 1,130-10H A0 N10101 Rast1T i0 90 �Jw

FROM : L PHONE NO. : 910 8939B95 Apr. 05 2004 01:38PM P2
r.
Name Mary Lou Matthews
Minor Permit a HB 2004-D39
Page Two
6_ Marsh and wetlands shall be those areas so designated by CAM.A and the ti.5- Army Corps of
Engineers and shown on plat used for the project Also plat must include the certification which
scares The plat accurately depicts the boundary of the 404 line and must be signed by the Corps of
Engineer representative.
7. Town Ordinaacr 157.027: On lots containing marsh or wetlands the pilrs supporting the
structure shall not be located closer than sevcn (7) feet form an existing bulkhead, the COE line . or
CAMA line whichever is closer.
A. Town Ordnance 157.027: fill martial placed landward of the marsh line is not allowed to slip
or wash into the marsh.
9. No till material is to be placed in federal or wasybl wetlands- Temporary storage of materials or
soil in wetlands is strictly prohibited.
10. The proposed construction shall meet all requiremem% trf section 158.00 and 157.060 located in
the Code of Ordinances.
11. The innotiativc slormwater system authorized with this permit must be mainnrincd for the lift of
the structure addressed.
12_ It is Dated that coastal marsh exists on the property, and that the proposed development
addressed on the submitted plat dated is not located within this marsh_
13. It is noted that there are federal wcdandss on this ptopency, as delineated by /shown on the plat
dated March 1, 2002, and tbat the proposed dcvclop_�'nt addressed on the submitted plat dated
March 11, 2004 is not located within t!rrw wedand_g.
14. No cxcavation or filling of any wetlands or waters is authorized under this permit.
15_ A copy of this permit shall be available onsite for regulatory inspection.
16_ The structure shall be set !rack a minimum of 60 feet from the first line of stable witural
vegetation, as determined by the DCM or the LPO.
17. Pursuant to 15A NCAC 077-040&b), this permit tray not be assigned, tractsfened, sold or
otherwise disposed of to a third party by the applicarragent, or any entity other than the NC
Division of Coastal Management
ta. ALL CONSTRUCTION AND FILL 1HUs r HE INSTALLED IN ACCORDANCE Wrrlf
SECDON 15S.00 OF TfiE TOWN OF HOLDEN BEACH CODE OF ORDINANCE.
19. Fkase be advised that nothing including graters, overhangs, t»oflines, steps, shall be
cantilevered over the coastal wetland line or constructed ever the coastal wetland lime.
20. The concrete slab will be a finished elevation of 9.4.
"ha Derma anion mxr x ap0 om oy the p4rngx ur mer
mestar! pv$= w3tm twenty (20% days o! tro 'nwu q tam. From
Ire dale o` M aDped. my work �nduded under the pere'tt
mane _ild to appe* a resohed.
Pas PECTA mint be M inn W-4= ate and stew"b to newer
drrfRr when t! prated fs Yrarened IDrOpnpliMDa-
N'r T ,n%,nM.% rank ar prapd ana"115m nn t:OMK Ut%
this pencil requite tuMry vndten Wnit appoval.
4e,,*m;ls;u .1+ the pema exxres m Decenbur 31.
1, issuia9 MX itas
nMY aeem wh
to bcw rd Use Rv ad A aM"ic
TiaPurrs �' robe trMtknth ateaWMW the
r ..Jw. aPpr w a ttr Dmbion of Coasiat varo-4 rl
e'd so 4du

FROM : L PHDNE ND. : 910 e939995 Hpr. 05 2004 01:39PM P3
6-d
Name Mary Lou Manthews
Minor Permit #HB 2004-C39
Page Three
21. Any structure authorized by this perrmt shall be reheated or dismantled w'h'n it bt'coul -
imminently threatened by changes in shoreline configuration The structure(s) shall be relocated or
dismantled within two (2) years of the t'me when it heeomes imminently threatened, and in any case,
upon its collapse or subsidence. ffowcver, if nsttaal shoreline "'cry or beech renounshment takes
place within Two (2) years of the time the structure becomes imutincrtly threatened, so that the
structure in no longer irrtmit wily threatened, then it need not Se relocated oc dismanded at that time.
This condition shall not affect the permit holder's right to seek authorization of Temporary protective
measures allowed by CRC Rules
22- Such enclosed space Is to be used solely for storage and by signing this permit
you
as the owner Understand that this area shall not be used for human habitation-
21. The space below the lowest floor that is located in V Zones must either be free of
obstruction or constructed with non -supporting breakaway materials. preferred
consinlction materials are open wood latticework or insect screening. However, stolid
breakaway wall panels are allowed.
27. Any construction below the lowest floor should collapse under wind and water
loads without causing collapse. displacement, or other structural damage to the
elevated portion of the building or the supporting foundation system- If non -
supporting breakaway walls are used, they are to have a design safe -loading
resistance of not less than ten nor more than twenty pounds per 94Ware foot. If
breakaway walls exceed the twenty -pound criteria, they must be designed or certified
by a registered protessional engineer or architect, using the V,Zone Certification
form.
23. FLOOD RESISANT MATERIALS ARE REQUIRED FOR THE STORAGE AREA
THAT WILL BE LOCATED BELOW THE BASE FLOOD ELEVATION. PLEASE
CONTACT TOWN HALL FOR A COPY OF THE FEMA APPROVED MATERIALS IF YOU
HAVE ANY QUESTIONS ABOUT THIS REQUIREMENT.
i29. Please be advised that the Base flood is a VE with an elevation of 18 feet. The lowest
horizon member must be at a elevation of at least 18 feet above sea level -
This perm saw 'nay tic appealed by ma pe"um or other
WeKW pasoaz W"n WMV Ra; c "at to c6ws date. Flnrn
the darn d er, sop"," nark cutluG G uider drs MTO AILS
ome umi the awed is rew-ad.
-N, p9mR cruet Ue , #-pqtftSpE BM ao P!*b to dw pmNt
OSM when Ire P*m 61agredFdlot MVWM.
Any Mainw. M y"k or ptoyed moddr#ee r1A Catered mMer
dds pemn;, re7uie fudhar "MM porTil appn>vat.
AL Loh must oeae wMf. Ns 9VH1 MOM m Dear+ebv 11'
tea-
n 6su"eq ari wr m A A a3'aeo mat bus p9ao 6 =Aware sir+
ltie local Land Use plat and at 4*k4de ardnmr wthout me
Ths oemn rnp ad be toWea
ed to molter PM
wrtLy ari o d ft I)Wsba of Coast Man29�11.
-tt i t n w dFi -acute aPpY b Pam;
91E6ZbB0t6 11313311 U30-10H 30 Wr�01 QEErll i❑ Sn �dH

FROM : L PHONE NO. : 910 e939895
Apr. 05 2004 01:40PM P4
AEC HAZARD NOTICE
Project Is In An: —Ocean Erodible area L:: F gh Hazard Flood Area _.
Date Lot Was Platted:
Ths notice ia.rtterhdud to make vau, tilt• applicant, aware
.,f the �peeiat as` and conairlons associated with
cevciryment in this: arm, which is subict to natural
,azanls such as storms, erosion and currents. Thezules of
the Coastal resu%rice; Comrnissirs regm.r that wu
receive an AEC Hazard Notice and ackno-v:edge that
notice in wcng before a permit Inr devekr} ment con be
j3k:um_
ThcCommissior'srultao.'n �.titding3[a¢tdards.t%eaAflnAL
sefavcksanci duneaiterati7=tare dev�ed to m�ims0bu<
not eliminate, mpemIons from ha-rards. 3j grareng
pcsrnits, the Coastal RGooro=. Corrunassion dues not
guarantee tee sase.v cf tie ciew0oppment and assume_a no
liah$iIy far E_tute damage to the deveiopr..ert.
rtt best eva:lable informarior., as acozotee by the Coastal
Resources Commission, indicates that tha annual ocean
erosion rate for the area where your prnperry is kcate= :s
-_ `eel per year.
The rate was established by cars—ful analysis a aeaial
photographs of the mastline taken aver ihepmt 50 years.
SCidies c+icate teat Inc shor_irte could move as
mutt as ueet:ands-and in a major sham.
T"*�qpflood water:m ::, aaar storm are rred
_a
icted m be aiv��t
feet deep in dus area.
Preferred oceazttrort ?rcttectiar. measures art beach
nourishment artd relocation of thseatimed strucrx�.
Hard erosion control strtclures such as bulkheads,
5h walls, re"tm citts. grams lathes and bre?.Nva[er.: Ehe
9prie
derives,
olaitea. Temporary including sand bags, reap
allowed tinder certain condii ins.
'this str_cture shall be relocated Or dismantles within to
years of becoming imminently threztenad.
The applicant must ad=viiedge th:> infnrmadon and
requirenex'ts by signing this notice art the be�ow space.
Witsout the proper wgria!trre, :he appLcatien will no)!be
4_ S- el
'atd
Inlet Hazard Area
SPECIAL NOTE: "lius haza-d m-ice l; require3 for
development in areas subject to su'.den and mass:ve
siorrrs anti r•ro5ior.. ?'t:rc,is issued far deer.+.;+p-tnerl ir• ini=
a-
. Ca orfire no, December 31 of site Laird w_wr:c,lln:.:nq the
year ir. Much Une perms. was issued- .'iitnrtly btu fcire work
l;eg'ns rm line projec! s:te, tlte' veal ;'ermi: Officer will
cetc=;r>r they ve�a;ign lin=v+d selbi;k distance a: your
slte-1 i :heorop�iy has seen kiticiltdnge and :he oroposed
do;'4upment can still meet the .stlbaZ: ague etnen!, the
1.p0 will i:rform yo-a'"hat you m5 vbegin work -It is impor-
trnt slat you chick vA th the L�Obefare the permit expires
la, offidsl appmmval to continue the work after the peso:,
loess e>5ired. Generall%, _ fouttdation pilings have been
yiacee And substantial grog sss is cannnu_ng, permit
renewm! may rani he :necessary. It substantial progress has
not been rnade. the pmmlt melt be renewed and a new
setba& line established- It is irniawf vl to wnrinue work
after penwt ext?aatlon v.. met this approval.
Fur mi:r a it:f ortnation, centad:
Luca: Pfif! :6 011!ic41'
S-d 91EG2iHOi6 HOd36 d0 UMD! etE:11 40 s❑ add

C>�o
CAMA PERMIT NOTICE
Pursuant to NCGS 11aA-119(b), the
municipality of Town of Holden Beach, a
locality authorized to issue CAMA permits
TOWN OF HOLDEN BEACH
in the areas of environmental concern,
hereby gives NOTICE that on March 17,
STATE OF NORTH CAROLINA 110 ROTHSCHILD STREET
applicant Mary Lou Matthews, ap-
plied for a CAMA minor development perer-
plied
COUNTY OFBRUNSWICK HOLDEN BEACH, NC 28462
mit to construct a single family residence,
gravel driveway, septic system at 624 Ocean
Blvd. West.
The application may inspected at the
below address.dress. Public comments received
AFFIDAVIT OF PUBLICATION
by April 2, 2004, will be considered later
comments will be accepted and considered
up to the time of permit decision. Project
modifications may occur based on Anther
Before the undersigned, a Notary Public of said County and State,
review and comments. Notice of the permit
duly commissioned, qualified, and authorized by law to administer
decision in this matter will be provided up-
on written request.
oaths, personally appeared
Rhonda Phillips
Local CAMA Permit Officer
110 Rethschfld street
Scott R. Harrell
Holden Beach, NC 2S462
(910)842-649e
who, being first duly sworn, deposes and says: that he is
Mar. 26
Publisher
(Owner, partner, publisher, or other officer or employee
authorized to make this affidavit)
of The Brunswick Beacon, a newspaper published, issued, and en-
tered as periodical mail in the Town of Shallotte in the said County
and State; that he is authorized to make this affidavit and sworn state-
ment; that the notice or other legal advertisement, a true copy of
which is attached hereto, was published in The Brunswick Beacon on
the following date(s):
March 25, 2004
and that the said newspaper in which such notice, paper document or
legal advertisement was published, was at the time of each and every
such publication, a newspaper meeting all the requirements and qual-
ifications of Section 1-597 of the General Statutes of North Carolina
and was a qualified newspaper within the meaning of Section 1-597
of the General Statutes of North Carolina. r
This the 25th day of March, 2004.
...............................................
(Signature of person making affidavit)
Sworn to and subscribed before me this 25th day of
March, 2004.
ata �GTAgy
4A6.. '• U�'.
(Notary Public) ':;�s�,'•..�- _,,.••
My comrnission expires: December 29, 2004.

_ocatin Permit Number o7p0�vt7
Jcean Hazard Estuarine Shoreline _ORW Shoreline _Public Trust Shoreline -
Other -(For official use only)
GENERAL INFORMATION
LAND OVTTER
Name
TOW14 OF, HOI,DESBREET
110 ROTHBCH NC 28462
VAOLDEN
Address '.:2g Cl Z 1 " '(-
City �s State -Ale-, Zip f2jsP?1e Phone
AUTHORIZED AGENT
Name S c --
Address /r���
City
State tiG Zip -? Phone 9/0 L !
LOCATION OF PROJECT:
and/or directions to site. If not oceanfront, what is the name of the
OF PROJECT: (List all proposed construction and land disturbance.) .� S Y,.t 'On
SIZE OF LOT/PARCEL:!i �� r) square feet acres
PROPOSED USE: Residential �Sinele-family _ Multi -family _) Comincrical/Industrial _ Other
TOTAL ENCLOSED FLOOR AREA OF A BUILDING IN THE OCEAN HAZARD AREA OF
ENVD3o1�'MENTAL CONCERN (AEC): /i/gS square feet (includes all floors and roof covered decks)
TM
SIZE OF BUILDING FOOTPRINT AND OTHER IMPERVIOUS OR BUILT -UPON S,
COASTAL SHORELINE AREA OF ENVIItONMEN rAL CONCERN (AEC)-: et�
(Calculations includes the area of the roof/drip line of all buildings, driveways, covered decks, Crete of MAIR 'soo 2004
ptos,
etc. that are within the applicable AEC.)(Attacb vour calculations with the project drawing .
Choose the AEC area that applies to your property: DIVISION OF
(1)within 75 feet of Normal High'dater for the Estuarine Shoreline AEC Cn e ��
(2)within 575 feet of Normal High Water for the Estuarine Shoreline AEC, adjacent to Outs 9MENT
(3)within 30 feet of the Public Trust Shoreline AEC
(Contact your Local Permit Officer if you are not sure which AEC applies to your property.)
STATE STORMWATER MANAGEMENT'PERMTT: Is the project located inyr area subject to a State Stormwatea
Management Permit issued by the NC Dr^ Q nY7 n ^ ES 1/ NO
u a u is
If yes, list the total built upon area/imp c or parcel. GCS 3 square feet.
MAR 1 & = I I to e�7
TOWN OF HOLDFni ?r7^^U

S1-AYEMiN1 OF OWNERSHIP >
r
I, the undersigned, an applicant for a CAMA minor development permit, being either the owner of property in >
an AEC or a arson authorized to act as an agent for purposes of applying for a CAMA minor development Z
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)
✓owner or record titl Title is vested in/o/,Z— �/` jy+� see Deed Book
page in the wy sw � c County Registryof Dees.
_ an owner by virtue of inheritance. Applicant is an heir to the estate of
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.
r^
O
n
IOTIFICATION OF ADJACENT PROPERTY OWNERS
r-
furthermore certify that the following persons are owners of properties adjoining this property. I affirm that I
ave given ACTUAL NOTICE to each of them concerning my intent to develop this property and to apply for
CAMA permit. I
(Name) „ (Address)
)R DEVELOPERS IN OCEAN HAZARD AND ESTUARINE HAZARD AREAS:
cknowledge that the land owner is aware that the proposed development is planned for an area which may
susceptible to erosion and/or flooding. I acknowledge that the local permit officer has explained to me the
rticular hazard problems associated with this lot. This explanation was accompanied by recommendations
iceming stabilization and floodproofing techniques.
:RMISSION TO ENTER ON LAND
irthermore certify that I am authorized to grant and do in fact grant permiss t e oc ee�rrnr,ntpo
o e
I his agents to enter on the aforementioned lands in connection with evaluartyll
mitapplication. MMA�RR a' s application includes: general information (this form), a site drawing as des d oh'�ii?' U199 Phis a :anon, the ownership statement, the AEC hazard notice where necessary, a foa5 SA�q }e dyable to
locality, and any information as may be provided orally by the applicant. The deta' bbYy t�9Q4'CQQ¢divd b�an{�''
cribed by these sources are incorporated without reference in any permit w1Q® lets
n these details will constitute a violation of any permit. Any person developing in an AEC without a per -
is subject to civil, criminal and administrative action.
i the _ day of c�F F4 20 4i
otivner or person authorized to act as his agent
for purposes of tiling a CAMA permit application.

I
0 SUPPLY W 28OL 1 b? a L 777,77
a
Postage $ $0.60
I 0470
Certified Fee 09
i . Postmark
Rehm Receipt Fee Hera
(Endorsement Required) 0, 00
i Restricted DelNery Fed
I (Fndorseiment Required)
1
Talel Postage 6 Feee $ $4.65 03/05/2004
®LOEAHFOH 451C 1 A L U S El
50.60
n
O
Poetess $
i $2.30 0470
Y
C�
� canlnaa Fee 09
$1.75 Postmark
C/)
Retum Receipt Fee
(Emile ARt Raqulred) Here
7 RasMcted Delivery Fee $0.00
(Endmaememt Regaired)
O
Total Postage a Fees $ $4.65 03/05/2004
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rn

Date: 2-25-04
To: Jim D. Griffin Jr.
Holden Beach Enterprises
3711 Windy Point Rd. SW
Supply, NC 28462
DEAR ADJACENT PROPERTY OWNER:
THIS LETTER IS TO INFORM YOU THAT I HAVE APPLIED FOR A CAMA
PERMIT ON THE PROPERTY OWNED BY MARY LOU MATTHEWS AT 624
OCEAN BOULEVARD WEST, HOLDEN BEACH, N.C. ENCLOSED IS A COPY OF
PERMIT APPLICATION AND A COPY OF THE DRAWING OF THE PROPOSED
PROJECT.
IF YOU HAVE ANY COMMENTS ON THE PROPOSED PROJECT, PLEASE
CONTACT RHONDA PHILLIPS, LOCAL CAMA OFFICER, TOWN OF HOLDEN
BEACI-L N.C. 28462 — (910-842-6488)
SINCERELY,
BR1AN MATTHEWS
PHONE # [phone]
ECEIVE
MA 19 2004 ��
D1V1S10'V OF V�
COas7,�AL f0,4NAGEpjp r

uTMV0141110
To: Gary S. Oppito
10746 Weatherstone Rd.
Loveland, OH 45140-7404
DEAR ADJACENT PROPERTY OWNER:
THIS LETTER IS TO INFORM YOU THAT I HAVE APPLIED FOR A CAMA
PERMIT ON THE PROPERTY OWNED BY MARY LOU MATTHEWS AT 624
OCEAN BOULEVARD WEST, HOLDEN BEACH, N.C. ENCLOSED IS A COPY OF
PERMIT APPLICATION AND A COPY OF THE DRAWING OF THE PROPOSED
PROJECT.
IF YOU HAVE ANY COMMENTS ON THE PROPOSED PROJECT, PLEASE
CONTACT RHONDA PHILLIPS, LOCAL CAMA OFFICER, TOWN OF HOLDEN
BEACH, N.C. 28462 — (910-842-6488)
SINCERELY,
BRIAN MATTHEWS
PHONE # [phone]
E(czE
MAP, 19 2004
DIVISION OF
COASTAL MANAGEMENT

1
I B. FRANK
ODELL WILLIA SON j BOYD
DEED BOOK 11L9, AG� 93 I D.B. 162—S
D.B. 162-5
I o
I I I I I j NAND I ROBERT B. MORGAN I I
AND I ^? Un
ZI I ROBERT C. BYRD I I rm
NI DEED BOOK 146. PAGE 659
p: N I I I
+I
FI I a I
I I of I
I I I i
I MARY LOU I oMARY LOU
MATTHEWS NI
MATTHEWS
D
(REPUTED OWNER) 14 (REPUTED OWNER)
I DEED BOOK 1)8)76, DEED BOOK 18))91PAGE 112,
I I 12.468 SO.1Fi. I f I 12,468 SPAGE O SFT.
I
A`
i I 37 _, I I ERB
t I I404 LINE ANDt
COASTAL WETLAND
I LINE OCTOBER, 2003
(POINTS 2-5) '1� y404 DNE FLAGGED
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/` BY THE U.S.A.C.E.
LOCATED OCTOBER, 2003
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NR e.e� 583'04'12"W J
TIE LINE:
COMMENCING AT HB MONUMENT 'HB
AND E - 2,209,780.110); THENCE S
(N.C. GRID COORDINATES: N - 58.8
N 7645'29'E 424.28 FEET TO A 'M
TO ERB 'A`; THENCE S 83"04'12"W
ORIENTED TO N.C. GRID NORTH, N.A.
DISTANCES.
HOLDS
ENTE
.61 V.2 (REPU
MAR 19 2004
DIVISIO
TAB MAN OF_
ERB
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COASTAL WETLANDS I
LINE FLAGGED BY
THE TOWN OF HOLDEN
/BEACH OCTOBER. 2003 BL
BACON ISL
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PE1A J 153
OF SAND

7.2
VACANT
LOT
7.4
8.8+
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RICHARD-A. WINKLER, P.E.
239 OCEAN BLVD. EAST
HOLDEN BEACH, N.C. 28462
[phone]
M ATTH E WS
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SURVEY INFORMATION FROM �-
A DOCUMENT BY BRUNSIMCK a.e
SURVEYING DATED 2-10-04 88
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SCALE: 1' = 20'
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�n=iswick County Health Department Application # ?ie-4,yq ,
Environmental Health Section Tax Parcel #
Wastewater Collection, Treatment d yL
Type 1� A
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 et
seq., and other applicable Laws and Rules
PERMISSION IS HEREBY GRANTED TO -
Owner B `/! Ra /Y1�7`t
Address ,fG.? ar 1 ✓i
Phone
FOR THE
Installation of a wastewater collection, treatment, and disposal system to serve:
Resident
aomerl Be mEmployees Max OccupanyCommentsNse�' /��
pursuantto 15A NCAC 18A.1900 amended andrin conformity with the application and other supporting data subsequently filed and
approved by the DEHNR/or the Brunswick County Health Department and considered a part of this permit
Facility to be served: Name _-&'.:.I c- I / r c x
Address/Location ). .SSA .cam 25/-I A-"'4
Description_ '/[ �O)-f ,,,2LIC-Cjff-072-
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 effective only with respect to the specific design flow facilities, and the nature and volume of waste described in the
Permit Application, and other supporting 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.
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 permittee 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 Improvement
Permit is issued.
PERMIT ISSUED THIS _� DAY OF :. Z—o oa
DATE OF PERMIT EXPIRATION /- 8= 0 1 MqR i q MMnn'' J�
BRUNSWICK COUNTY HEALTH DEPARTMENT 9 IRONIv1EN HEA IVISION
R.S. COASTAk MANAGEII/FNT
PERMIT.STA
11/10997

PIY LU-'/IJW Rti. C'�-��i-ilr�!t l�S�.iW
Brunswick County Health Department Application # W-`%S` 23R
Environmental Health Section Tax Parcel # ,? . C -o'7Z
Alternative Sewage Treatment and Disposal System System Type - 5A
AUTHORIZATION TO CONSTRUCT
FOR
WASTEWATER COLLECTION, TREATMENT, AND DISPOSAL SYSTEM
In accordance with the provisions of Article 11 of Chapter 130A, General Statutes of North Carolina as amended,
AND other applicable Laws and Rules
PERMISSION IS HEREBY GRANTED TO
Owner
Phone I
to construct, install a sewage treatment and disposal system as described below:
To Serve: Residential Coms Cgqmmercial #E��p:1loyeesNQ Max Occupany
Comments, Describbon: A:'7 5`.re- G
ADDRESS/LOCATION:
The system components consists of: Type system—IWWS-98-1, PURAFLO PEAT BIOFILTER, TYPE A
Design Flow =,?&y GPD
I. COLLECTION SYSTEM: CONVENTIONAL PLUMBING
(MUST COMPLY WITH ALL APPLICABLE STATE AND LOCAL PLUMBING CODES)
II. TANKAGE: A. SEPTIC TANK(S) 10D GALLONS CAPACITY
B. PUMPTANK /va- GALLONS CAPACITY
D. OTHER: the septic tank shall be equipped with an effluent filter at the outlet, a screened Dump vault in
the tank, or equivalent effluent filtration device as specked by Bord Na Mona.
ALL TANKS, FORCE MAINS, PRESSURE LINES TO BE LEAK TESTED AND CERTIFIED BY APPROPREIATE
PARTIES. All tanks and risers shall be tested to be watertight by a 24 hour hydrostatic leakage test.conducted at the site
prior to system startup. A water level change of inch or more over 24 hours, or visual observation of leakage shall
be cause for failure of the test
ACCESS RISERS REQUIRED ON ALL INSPECTIONS & SERVICE HATCHES ON TANKS -RISERS TO EXTEND 4-6'
ABOVE FINISHED GRADE
III. PUMP CHAMBER/DOSING TANK: /o v
A. DOSING PUMP(S): SIZE, MAKE, MODEL M. sR J77y on . (tom '24 .. z
NUMBER OF PUMPS REQUIRIYI: oD;Z
B. DISCHARGE PIPING: SIZE,,::frNCH MATERIAL: _SCH 40 PVC GATE VALVES: YES. INTERNAL
CHECK VALVE: YES UNION/DISCONNECT: YESWVCI LIFT CHAIN OR ROPE: YES. NON -CORROSIVE
ANTISIPON HOLE: YES (3/161N.)
C. DOSE VOLUME:,3o gallons DRAW DOWN DEPTH: I i INCHES %L # of doses per day
IV. DOSING MAIN: SIZE: INCH MATERIAL: SCH 40 PVC VALVING: CLEANOU S:
V. CONTROL PANEL:: y� TYPE: 14-"3C/2- F,R Tmlr �✓, C-1 of �yy�
TO INCLUDE: NEMA4X ENCLOSURE, MANUAL DISCONNECTS/BREAKERS FO PUMP AND ALi4RM
(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 / LAG X
(MUST COMPLY WITH A L APPLICABLE STATE AND LOCAL ELECTRICAL CODE
VI. PEAT BIOFILTER: #OF MODULES REQIRED MANIFOLD SIZE �l �
;2_ MODULES EQUIPED WITH WEEP HOLES AT BO M
TYPE A INSTALLATION: SAMPLE CHAMBERS NEXT TO MODULES MAR g 20
Oy
pennitaut t cCgS PAL MgNA FM
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FAIT

VII. DISPOSAL FIELD: LTAR I TRENCH DEPTHLK"i4l l� -� Pf �it` Ito r /3pL1`
�{"E .e .
BACKFILL: TO BE INSTALLED OVER GRAVEL BEDS AND NEXT TO MODULE
MODULE TOPS TO REMAIN AT 6 INCHES ABOVE FINISHED GRADE MIN COVER OVER ROCK BEDS IS 6
INCHES. BACKFILL TO BE INSTALLED WITH A SIDESLOPE OF AT LEAST 1:4 SIDESLOPE
A. TYPE A.
1. UTILIZING A ROCK BED UNDER EACH MODULE BED LENGTH it FT. WIDTH 6.7 FT.
DEPTH OF ROCK USED FOR BED (BIN MIN.) ��NCH
comments: geotextile fabric_ (capable of removina silt sized particles) is to be use on all }�exposed surfaces of the rock
ADDITIONAL COMMENTS:
VIII. APPURTENANCES TO SYSTEMS:
A. SUBSURFACE DRAINAGE: TYPE: DEPTH:
B. AREA FILL: FILL DEPTH:_ MATERIAL: SAND / LOAMY SAND SIZE OF BASAL AREA: WIDE x LONG
SEE FILL PLAN FOR ADDITIONAL DETAILS AND SPECIFICATIONS. FOR TYPE A SYSTEMS, 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., B ter:»•
The Owner shall be subject to the following conditions, limitations, and construction requirements for the installation of this
system:
1. This authorization is effective only with respect to the specific design flow and facilities, and the nature and volume of
waste described in the Permit Application, and other supporting data.
2. This permit is not transferable and must be reapplied for at such time as ownership, or management changes.
3. The designated repair area is to have no parking, driveways, or other impervious material located on it This
area is to be protected, reserved and maintenance in a natural state.
4. All subsequent owners of this property and sewage system, shall execute a contren
owner and an
approved management entity before the operations permit is issued. Managema system to be provided
at all times.
5. All contracts between owners, management entity (Public or Private), or Health eviewed and approvbefore being accepted.� 9 200y
6. A properly certified Operator shall be provided as indicated: p
Certified Subsurface System Operator YES COASTAL /`Sq/�n�N pF
7. The issuance of this permit does not preclude the permittee from complying with any and all sttaa6&S4Q s, or
ordinances which may be imposed by other government agencies which have jurisdiction, or any other p�?sued by
this department.
8. This wastewater system shall be installed by a contractor authorized in writing by the manufacturer, who shall
coordinate the installation with the designer and the manufacturer's field representative.
9. For sites requiring evaluation by a certified soil scientist or professional geologist, said soil scientist / geologist shall be
present and supervise any site modifications, and critical phases of the wastewater system installation.
10. This authorization shall be valid for 60 months from the date of issue. The authorization 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, or expiration of this authorization, a new application shall be submitted to
the BCHD with updated information, as may be applicable or requested.
11. "A PERMANENT BARRIER SHALL BE PROVIDED AND IN PLACE AROUNDTHE SYSTEWREPAIR AREA BEFORE
THE OPERATIONS PERMIT IS ISSUED.
12. ALL APPLICABLE SETBACKS SHALL BE MAINTAINED, NO IRRAGATION SYSTEMS, STORM WATER PONDS /
BASINS, SURFACEISUBSURFACE DRAINAGE SHALL BE LOCATED IN THE AREA OF THE WASTEWATER
permit.aut
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y SYSTEM OR ITS REQUIRED SETBACKS.
INSTALLATION REQUIREMENTS
1. The installer shall be currently registered with this department.
2. A pre -installation conference is to be held on the site prior to beginning any site modification or construction of the
proposed structure or the sewage collection treatment and disposal system. Attending these conferences shall be
representatives of the State Wor Local Health Department; project engineer or designer; contractor; builder; proposed
system operatorrinstaller; and the owner or his authorized agent
3. The contractor shall be responsible for notification of the engineer and the BCHD for system inspection in stages as
required and prior to backfilling 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 set of plans and specifications. Any deviation in site
modifications, plans, specification, layout, materials or other system component shall be approved by the design
engineer and the Brunswick County Health Department prior to installation of the system. Failure to do so may result in
delay or refusal of final approval of the system, and may render the Permit null and void.
5. The system shall be installed in a timely manner and staged so as to avoid unnecessary exposure to weather.
6. The location and identification of all property lines, easements, water lines, and other appropriate utilities shall be the
responsibility of the installer.
7. Other
OPERATION PERMIT REQUIREMENTS
1. An Operation Permit shall be issued by the BCHD prior to placing the system into use, or making any connections to the
system.
2. Prior to issuance of the Operation Permit:
- the system shall be completed, installed, and tested in accordance with the approved design, including proper
abandonment of tanks existing wells, and other components. The certified subsurface system operator for the
system shall be present for the testing and startup of the installation.
- final landscaping, water diversion devices, and vegetative cover requirements and pressure adjustment shall be
completed,
- the Engineer, Designer or applicable responsible parties shall submit as -built plans to the BCHD, the plans shall
reflect any changes or alterations from the as -approved plans. The final pump delivery rate for the installation shall
also be determined and provided to BCHD as part of the final certification.
3. For sites that required evaluation by a certified soil scientist or professional geologist, a written certification shall be
submitted that the site / system installation was / is in accordance with their specified site/installation requirements.
4. For systems that have been engineered or designed by a private consultant, the desig r gineer (as applicable)
shall certify in writing to the Brunswick County Health Department that he has inspect et It tt has
been installed according to the approved plans and specifications.
- Any necessary easements, plats, or other documents shall be recorded with the ter#,Qeeds and coo
submitted to the BCHD, H 1 i 9
- The owner and a Public Management Entity/Subsurface System Certified Ope ,� haGpp"Qa contract w c
addresses all of the requirements for maintenance, monitoring, and reporting in Sectl�rTAIP6� 'A&@p
requirements of the Schedule of Operation and Maintenance to be a part of the Operation Permi idi dv
Provisions of said contract shall be in effect for as long as the system is in use.NT
NOTICE OF E)GWATION4M AUTHORIZATION EXPIRES SYEARS (60 MONTHS) FROM DATE OF ISSUE F EXPRATION
OCCURS, THE CLIENT SHALL COMPLYWTHALLCHANGES INAPPLICABLE REGULATIONS, LAM TECHNICALASPECTS,
ETC,THATMAYBE FFFECTIVEATTHATT7NE(fl-9SMAYREQUIREADDffpNALPREPARATION,MORE COMPLEX
VMTEVVATER SYSTEMS. OPERAT)ONAND MAINTENANCE REQUIREMENTS, PRE-TREATMENT, ETC. THIS COULD RESULT IN
LESSAREA FORTHE HOME, PARtaNG LOVVER WATER I MAGEAND FURTHER DEVELOPMENT LlmrrATIONS.
permitaut
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BRUNSWICK COUNTY HEALTH DEPARTMENT ALTERNATIVE SYSTEM
Authorization For Wastewater System Construction Permit
BCHD # S'L --`/sNz3�l
Plan review by C k DATE J'%`
Site evaluation by: DATE 1 - 9 - 7
Site modifications, completed and inspected by DATE
AUTHORIZATION TO CONSTRUCT ISSUED THIS fig DAY
OF .��.,.•,�. ,do 19
BRUNSWICK COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH DIVISION
R.S.
'Required""
Pre -construction conference for site by:
Date:
Present for conference(list):
Pre -construction conference for construction of system by:
Date:
Present for conference (list):
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permit.aut 4
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