NTB_15-31_Backer

Issued by WiRO NTB15-31
North Topsail Beach Permit Number
CAMA
MINOR DEVELOPMENT -�
PERMIT
as authorized by the State of North Carolina, Department of Environmental Quality
and the Coastal Resources Commission for development in an area of environment
concern pursuant to Section 113A-118 of the General Statutes, "Coastal Area
Management"
Issued to Dennis and Marcy Backer authorizing development in the Ocean Hazard (AEC) at 614 Hampton Colony
Circle, in North Topsail Beach, Onslow County as requested in the permittee's application, received by DCM on
November 11, 2015. This permit, issued on November 30, 2015, is subject to compliance with the application and
drawing dated and received by DCM on November 13 (where consistent with the permit), all applicable regulations and
special conditions and notes set forth below. Any violation of these terms may subject the permittee to a fine,
imprisonment or civil action, or may cause the permit to be null and void.
This permit authorizes: Construction of a single family residence with associated decking, driveway, parking and
walkway.
(1) All proposed development and associated construction must be done in accordance with the permitted survey drawing
mapped by Charles F. Riggs and Assoc. dated mapped on November 11, 2015 and received by DCM on November 13,
2015.
(2) All construction must conform to the N.C. Building Code requirements and all other local, State and Federal regulations,
applicable local ordinances and FEMA Flood Regulations.
(3) Any change or changes in the plans for development, construction, and/or land use activities will require re-evaluation and
modification of this permit.
(4) A copy of this permit shall be posted or available on site throughout the construction process. Contact this office at (910)
766-7221 for a final inspection at completion of work.
(Additional Permit Conditions on Page 2)
This permit action may be appealed by the pernittee or other qualified persons
within twenty (20) days of the issuing dale. This permit must be on the project r
site and accessible to the permit officer when the project is inspected for
compliance. Any maintenance work or project modification not covered under
this permit, require further written permit approval. All work must cease when this Jason Dail
permit expires on: CAMA LOCAL PERMIT OFFICIAL
December31, 2018 127 Cardinal Drive Extension
In issuingthis permit it is reed that this project is consistent with the local Land Wilmington, NC 28405-3845
Pe a9 P 1 RECEIVED
Use Plan and all applicable ordinances. This permit may not be transferred to DCM WILMIN ON, NC
another party without the written approval of the Division of Coastal
Management. nfc
PERMITTEE
(Signature required if conditions above apply to permit)

Name: Dennis and Marcy Backer
Minor Permit # NTB15-31
Date: November 30, 2015
Page 2 of 1.
(5) The permittee is required to contact the Local Permit Officer [phone], shortly before he plans to begin
construction to arrange a setback measurement that will be effective for sixty (60) days barring a major shoreline
change. Construction must begin within sixty (60) days of the determination or the measurement is void and must
be redone.
(6) Any structure(s) constructed within the Ocean Hazard area shall comply with the NC Building Code, including the
Coastal and Flood Plain Construction Standards of the N. C. Building Code, and the Local Flood Damage
Prevention Ordinance as required by the National Flood Insurance Program. If any provisions of the building code
or a flood damage prevention ordinance are inconsistent with any of the following AEC standards, the more
restrictive provision shall control.
(7) All buildings must be elevated on pilings with a diameter of at least 8 inches in diameter if round, or 8 inches to a
side if square; and the first floor level of the sills and joists must meet the 100-year flood level elevation.
(8) All pilings shall have a tip penetration greater than eight feet below the lowest ground elevation under the structure.
(9) All unconsolidated material resulting from associated grading and landscaping shall be retained on site by effective
sedimentation and erosion control measures. Disturbed areas shall be vegetatatively stabilized (planted and
mulched) within 14 days of construction completion.
(10) With exception of the beach access walkway, 10' x 36' structurally independent uncovered deck, 12' x 12' gazebo
and 12' x 12' deck, all other development shall be located a minimum distance landward of 60' from the First Line of
Stable Natural Vegetation (FLSNV).
(11) Any decking located within 60 feet from the FLSNV shall not exceed a combined footprint of 500 sq. ft. and shall be
structurally independent of the residential or primary structure. The decking may be cosmetically attached, but shall
remain free standing as a single unit.
(12) 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 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 renoudshment takes place within two years of the time the structure becomes
imminently threatened, so that the structure is 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 authorization of temporary
protective measures allowed under CRC rules.
(13) Pursuant to 15A NCAC, Subchapter 7J.0406(b), this permit may not be assigned, transferred, sold or otherwise
disposed of to a third -party.
SIGNATURE: DATE.
PERMITTEE
RECEIVED
DCM WILMINGTON, NC
2- z .z0 /- 25 2016

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(Sf
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Coastal Management
ENVIRONMENTAL QUALITY
December 1, 2015
Dennis and March Backer
5855 North Kolb Road
Tucson, AZ 85750
Dear Mr. & Mrs. Backer:
PAT MCCRORY
Governor
DONALD R. VAN DER VAART
secretory
BRAXTON DAVIS
Dueceor
Attached is CAMA Minor Development Permit # NTB 15-31 for work to be done at 614 Hampton
Colony Circle, in North Topsail Beach, Onslow County.
In order to validate this permit, please sign both copies of the permit as indicated for our records.
Please retain the orange copy for your files, sign the front and back sides of the white copy and
return to us within 20 days of receipt in the enclosed, self-addressed envelope. An electronic copy
has been sent to your agent.
This is not a valid permit until it is signed and returned to our office.
Thank you for your prompt attention to this matter.
Enclosures
Cc: WiRO files
Charles F. Riggs
Smcceerr{'eel
Shaun K. Simpson
Permit Support Technician .
Nothing Compares
State of North Carolina I Environmental Quality I Coastal Maagement
127 Cardinal Drive Ext., Wilmington, NC 28405
910-796-7215

Locality / 6 Permit Number b 766
6
Ocean Hazard _ Estuarine Shoreline ORW Shoreline _ Public Trust Shoreline_ Other
(For official use only)
LAND OWNER
Name Dennis Backer ors! wile Marcy R. Backer
Address 58
City Tuceon
State az Zip 85750 phone [phone]
Email [e-mail]
AUTHORIZED AGENT
Charles F. Rican & Associates. Inc.
Address P. O. Box 1570
City Jacksonville
State NC Zip 28541 Phone [phone]
Email [e-mail]
LOCATION OF PROJECT: (Address, street name and/or directions to site. If not oceanfront, what is the name of the
adjacent wshabody.) 614 Hampton Colony Cirde, North Topsail Beach 6l 1,_ ,S !. A
DESCRIPTION OF PROJECT: (List all proposed construction and land disturbance.) Proposed Three -Story
Dwelling on Pilings Over Concrete Slab Enclosed Below for Entry, Storage & Garage with
SIZE OF LOT/PARCEL: '16,337 squarefe& 0.375 acres Decks, Drive, Wood Walk, Gazebo
PROPOSED USE: Residential © (Single-family 0 Multi -family ) Commercial/Industrial ❑ Outer ❑
COMPLETE EITHER (1) OR (2) BELOW (Contact your Local Permit Ofl¢er ifyou arc not sum which AEC Applies
m your property):
(1) OCEAN BAZARD AECs: TOTAL FLOOR AREA OF PROPOSED STRUCTURE: 4,977 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: square 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 issued by the NC Division of Water Quality?
YES= NC=
If yes, list thel.rgtal built upon mrahmpervious surface allowed for your lot or parcel: square feet.
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OTHER PERMITS MAY BE REQUIRED: The activity you are planning may require permits other than the CAMA
minor development permit, including, but not limited to: Drinking Water Well, Septic Tank (or other sanitary waste
treatment system), Building, Electrical, Plumbing, Heating and Air Conditioning, Insulation and Energy Conservation, FIA
Cenification, Sand Dune, Sediment Control, Subdivision Approval, Mobile Home Park Approval, Highway Connection, and
others. Check with your Local Permit Officer for more infornation.
STATEMENT OFOWNERSHIP:
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)
Elanowner or record title, Title is vested in , see Deed Book
Page in the County Registry of Dads.
Danowner by virtue of inheritance. Applicant is an heir to the estate of
probate was in County.
❑✓ f other interest, such as wnnen contract or lease, explain below or use a separate sheet & attach to this application
Contract to Purchase
NOTIFICATION OF ADJACENT PROPERTY OWNERS:
I furthermore certify that the following persons are owners of properties adjoining this property. 1 affirm that I have given
ACTUAL NOTICE to each of them concerning my intent to develop this property and to apply for a CAMA permit
(Name) (Address)
(1) Marilyn N. Call Heirs C/O Ms. Barbara N. Ritchie, 630 Seabury Drive, Worthington, OH 43085
(2) Hampton Colony Homeoemere Association, 143 Lakeshore Drive, Rockaway, NJ 07866
(3)
(4)
1, 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.) acknowledge that the Local Permit Officer has explained to me the particu-
lar hazard problems associated with this lot. This explanation was accompanied by recommendations concerning slabiliva-
tion and floodproci ng techniques.
I furthermore certify that I am authorized to grant and do in fact grant, permission to Division of Coastal Management staff,
the Local Permit Officer and their agents to enter on the aforementioned lands in connection with evaluating information
related to this permit application. /, /
/1) / ? This the 77T day ofJPtrdr 6,VO L<
Landowner or person authorized act as hi er of filing a CAMA permit application
This application includes: ge seat info lion (t is form), a site drawing as described on the back ofthis application, the
ownership smtemem, the (0c an H AEC N ice where necessary, a checkfor $100.00 made payable to the locality, and
any information as may be p ed fly by a applicant. The details ofthe application as described by these sources are
incorporated without tefeten a any per ' which may be issued. Devtatfon from these details will constitute a violation of
any permit. Any person its loping AEC irdhoul permit is subject to civil, criminal and adnamsvative action.

DmuSign Envelope ID: EFF3510E-8278-40Dt-9BA6-064BA0589898
OFFER TO PURCHASE AND CONTRACT - VACANT LOT/LAND
(Consult "Guidelines" (form 12G) for guidance in completing this form]
NOTE: This contract is intended for unimproved real property that Buyer will purchase only for personal use and does not have
immediate plans to subdivide. It should not be used to sell properly that is being subdivided unless the property has been platted,
properly approved and recorded with the register of deeds as of the date of the contract. If Seller is Buyer's builder and the sale involves
the construction of a new single family dwelling prior to closing, use the standard Offer to Purchase and Contract —New Construction
(Form 800-T) or, if the construction is completed, use the Offer to Purchase and Contract (Form 2-T) with the New Construction
Addendum (Form 2A3-T).
For valuable consideration, the receipt and legal sufficiency of which are hereby acknowledged, Buyer offers to purchase and Seller upon
acceptance agrees to sell and convey the Property on the terms and conditions of this Offer To Purchase and Contract and any addendum
or modification made in accordance with its terms (together the "Contract").
1. TERMS AND DEFINITIONS: The terms listed below shall have the respective meaning given them as set forth adjacent to each
term.
(a) "Seller": Vincent Pappagallo Debra J. Pappagallo
(b) "Buyer": Marcella R. Backer
—(e)—Property°-The-Property-shall-inetude�Bthat-real-estate-deseribed-below-together--with-aN-appuft nonees-thereto-ineluding-the
improvements located thereon. NOTE: If the Property will include a manufactured (mobile) home(s), Buyer and Seller should
consider including the Manufactured (Mobile) Home provision in the Additional Provisions Addendum (Standard Form 2AI1-T)
with this offer.
Street Address: 614 Hampton Colony Cir. (Lot 10)
City: North Topsail Beach Zip: 28460
County: Onslow , North Carolina
(NOTE: Governmental authority over taxes, zoning, school districts, utilities and mail delivery may differ from address shown.)
Legal Description: (Complete ALL applicable)
Plat Reference: Lot/Unit. Lot 10
, Bim k/Section , Subdivision/Condominium Hampton Colony
, as shown on Plat Book/Slide 25 at Page(s) 199
_
The PIN/PiD or other identification number of the Property is: PIN 427718328417 /PID 048036
Other description: MAP #768A-120
/ HAMPTON COLONY L10
Some or all of the Property may be described in Deed Book 1902 at Page 376
(d) 'Purchase Price":
$ glillill!�
paid in U.S. Dollars upon the following terms:
$
BY DUE DILIGENCE FEE made payable and delivered to Seller by the Effective Date.
$
BY INITIAL EARNEST MONEY DEPOSIT made payable and delivered to Escrow
_
Agent named in Paragraph 1(f) by ❑ cash x0 personal check ❑ official bank check
❑ wire transfer, EITHER ❑ with this offer OR ® within five (5) days of the Effective
Date of this Contract.
BY (ADDITIONAL.) EARNEST MONEY DEPOSrr made payable and delivered to
Escrow Agent named in Paragraph I(t) by cash or immediately available funds such as
2015
official bank check or wire transfer no later than ,TIME
BEING OF THE ESSENCE with regard to said date.
$ t ice—
BY ASSUMPTION of the unpaid principal balance and all obligations of Seller on the
�tAGju,
existing loan(s) secured by a deed of trust on the Property in accordance with the attached
Loan Assumption Addendum (Standard Form 20-T).
' $
BY SELLER FINANCING in accordance with the attached Seller Financing Addendum
(Standard Form 2A5-T).
$ —
BALANCE of the Purchase Price in cash at Settlement (some or all of which may be paid
with the proceeds of a new loan)
This form jointly approved by: Page I of 11 STANDARD FORM 12-T
North Carolina Bar Association Revised 7/2015
North Carolina Association of REALTORS®, Inc. W m 0 7/2015
VP i9P
Buyer initials M' Seller initials
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DocuSgn Envelope ID: EFF3510E-8278-40D1-9BA6-064BA0589898
Should Buyer fail to deliver either the Due Diligence Fee or any Initial Earnest Money Deposit by their due dates, or should any
check or other funds paid by Buyer be dishonored, for any reason, by the institution upon which the payment is drawn, Buyer shall
have one (1) banking day after written notice to deliver cash or immediately available funds to the payee. in the event Buyer does
not timely deliver cash or immediately available funds, Seller shall have the right to terminate this Contract upon written notice to
Buyer.
(e) "Earnest Money Deposit": The Initial Earnest Money Deposit, the Additional Earnest Money Deposit and any other earnest
monies paid in connection with this transaction, hereinafter collectively referred to as "Earnest Money Deposit", shall be deposited
and held in escrow by Escrow Agent until Closing, at which time it will be credited to Buyer, or until this Contract is otherwise
terminated. In the event: (1) this offer is not accepted; or (2) a condition of any resulting contract is not satisfied, then the Earnest
Money Deposit shall be refunded to Buyer. In the event of breach of this Contract by Seller, the Earnest Money Deposit shall be
refunded to Buyer upon Buyers request, but such return shall not affect any other remedies available to Buyer for such breach. In the
event of breach of this Contract by Buyer, the Earnest Money Deposit shall be paid to Seller as liquidated damages and as Seller's
sole and exclusive remedy for such breach, but without limiting Seller's rights under Paragraphs 2(e) and 2(d) for damage to the
Property or Seller's right to retain the Due Diligence Fee. It is acknowledged by the parties that payment of the Earnest Money
Deposit to Seller in the event of a breach of this Contract by Buyer is compensatory and not punitive, such amount being a
reasonable estimation of the actual loss that Seller would incur as a result of such breach. The payment of the Earnest Money
Deposit to Seller shall not constitute a penalty or forfeiture but actual compensation for Sellers anticipated loss, both parties
acknowledging the difficulty determining Seller's actual damages for such breach. If legal proceedings are brought by Buyer or
--- eelle�against-the-othecto-recover_the-ErrnesL.MoneyJ:Ieposit,-the-pre-vailittg.parlyLinlhe proceeding shall be entitled to recoycrfrQ_n___. _
the non -prevailing party reasonable attorney fees and court costs incurred in connection with the proceeding.
(f) "Escrow Agent" (insenname):. Treasure Rea1:tV.Inc.
NOTE: In the event of a dispute between Seller and Buyer over the disposition of the Earnest Money Deposit held in escrow, a
licensed real estate broker ("Broker') is required by state law (and Escrow Agent, if not a Broker, hereby agrees) to retain the
Earnest Money Deposit in the Escrow Agent's trust or escrow account until Escrow Agent has obtained a written release from the
parties consenting to its disposition or until disbursement is ordered by a court of competent jurisdiction. Alternatively, if a Broker or
an attorney licensed to practice law in North Carolina ("Attorney") is holding the Earnest Money Deposit, the Broker or Attorney
may deposit the disputed monies with the appropriate clerk of court in accordance with the provisions of N.C.G.S. §93A-12.
THE PARTIES AGREE THAT A REAL ESTATE BROKERAGE FIRM ACTING AS ESCROW AGENT MAY PLACE THE
EARNEST MONEY DEPOSIT IN AN INTEREST BEARING TRUST ACCOUNT AND THAT ANY INTEREST EARNED
THEREON SHALL BE DISBURSED TO THE ESCROW AGENT MONTHLY IN CONSIDERATION OF THE EXPENSES
INCURRED BY MAINTAINING SUCH ACCOUNT AND RECORDS ASSOCIATED THEREWITH.
(g) "Effective Date": The date that: (1) the last one of Buyer and Seller has signed or initialed this offer or the final counteroffer, if
any, and (2) such signing or initialing is communicated to the party making the offer or counteroffer, as the case may be. The parties
acknowledge and agree that the initials lines at the bottom of each page of this Contract are merely evidence of their having
reviewed the terms of each page, and that the complete execution of such initials lines shall not be a condition of the effectiveness of
this Agreement.
(h) "Due Diligence": Buyer's opportunity during the Due Diligence Period to investigate the Property and the transaction
contemplated by this Contract, including but not necessarily limited to the matters described in Paragraph 2 below, to decide whether
Buyer, in Buyer's sole discretion, will proceed with or terminate the transaction.
(i) "Due Diligence Fee": A negotiated amount, if any, paid by Buyer to Seller with this Contract for Buyer's right to conduct Due
Diligence during the Due Diligence Period. It shall be the property of Seller upon the Effective Date and shall be a credit to Buyer at
Closing. The Due Diligence Fee shall be non-refundable except in the event of a material breach of this Contract by Seller, or if this
Contract is terminated under Paragraph 6(m) or Paragraph 9, or as otherwise provided in any addendum hereto. Buyer and Seller
each expressly waive any right that they may have to deny the right to conduct Due Diligence or to assert any defense as to the
enforceability of this Contract based on the absence or alleged insufficiency of any Due Diligence Fee, it being the intent of the
parties to create a legally binding contract for the purchase and sale of the Property without regard to the existence or amount of any
Due Diligence Fee.
6) "Due Diligence Period": TR �OIS� n the Effective Date and extending through 5:00 p.m. on
November TIME BEING OF THE ESSENCE
with regard to said date. NOV 13 2015
Page 2 of 1 I
STANDARD FORM 12-T
b 0"' WILLING PN {y Vp 09P Revised?/2015
Buyer initial,Seller imtia s 0 7/2015
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DocuSlgn Envelope ID: EFF3510E-8278-40D1-9BA6-064BA0589898
(k) "Settlement": The proper execution and delivery to the closing attorney of all documents necessary to complete the transaction
contemplated by this Contract, including the deed, settlement statement, deed of trust and other loan or conveyance documents, and
the closing attorney's receipt of all funds necessary to complete such transaction.
(1) "Settlement Date": The parties agree that Settlement will take place on November 20, 2015
(the "Settlement Date"), unless otherwise agreed in writing, at a time and place designated by Buyer.
(m) "Closing": The completion of the legal process which results in the transfer of title to the Property from Seller to Buyer, which
includes the following steps: (1) the Settlement (defined above); (2) the completion of a satisfactory title update to the Property
following the Settlement; (3) the closing attorney's receipt of authorization to disburse all necessary funds; and (4) recordation in the
appropriate county registry of the deed(s) and deed(s) of most, if any, which shall take place as soon as reasonably possible for the
closing attorney after Settlement. Upon Closing, the proceeds of sale shall be disbursed by the closing attorney in accordance with
the settlement statement and the provisions of Chapter 45A of the North Carolina General Statutes. If the title update should reveal
unexpected liens, encumbrances or other title defects, or if the closing attorney is not authorized to disburse all necessary funds, then
the Closing shall be suspended and the Settlement deemed delayed under Paragraph 10 (Delay in Settlement/Closing).
WARNING: The North Carolina State Bar has determined that the performance of most acts and services required for a closing
constitutes the practice of law and must be performed only by an attorney licensed to practice law in North Carolina. State law
prohibits unlicensed individuals or firms from rendering legal services or advice. Although non-attomey settlement agents may
perform limited services in connection with a closing, they may not perform all the acts and services required to complete a closing. '
-------lzlosinginvolves-significanHega}-issues-that-should-be-handled-by-an-attomey�4eeordingly4t-is4he-position-oLthe-North-Carolina
Bar Association and the North Carolina Association of REALTORS® that all buyers should hire an attorney licensed in North
Carolina to perform a closing.
(n) "Special Assessments": A charge against the Property by a governmental authority in addition to ad valorem taxes and recurring
governmental service fees levied with such taxes, or by an owners' association in addition to any regular assessment (dues), either of
which may be a lien against the Property. A Special Assessment may be either proposed or confirmed.
"Proposed Special Assessment": A Special Assessment that is under formal consideration but which has not been approved prior
to Settlement.
"Confirmed Special Assessment": A Special Assessment that has been approved prior to Settlement whether or not it is fully
payable at time of Settlement.
2. BUYER'S DUE DILIGENCE PROCESS:
(a) Loan: During the Due Diligence Period, Buyer, at Buyer's expense, shall be entitled to pursue qualification for and approval of
the Loan if any.
(NOTE: Buyer is advised to consult with Buyer's lender prior to signing this offer to assure that the Due Diligence Period allows
sufficient time for the appraisal to be completed and for Buyer's lender to provide Buyer sufficient information to decide whether to
proceed with or terminate the transaction since the Loan is not a condition of the Contract.)
(b) Property Investigation: During the Due Diligence Period, Buyer or Buyer's agents or representatives, at Buyer's expense,
shall be entitled to conduct all desired tests, surveys, appraisals, investigations, examinations and inspections of the Property as
Buyer deems appropriate, including but NOT limited to the following:
(i) Soil And Environmental: Reports to determine whether the soil is suitable for Buyers intended use and whether there is
any environmental contamination, taw, role or regulation that may prohibit, restrict or limit Buyers intended use.
(ii) Septic/Sewer System: Any applicable investigation(s) to determine: (1) the condition of an existing sewage system, (2)
the costs and expenses to install a sewage system approved by an existing Improvement Permit, (3) the availability and
expense to connect to a public or community sewer system, and/or (4) whether an Improvement Permit or written
evaluation may be obtained from the County Health Department for a suitable ground absorption sewage system.
(ui) Water: Any applicable investigation(s) to determine: (1) the condition of an existing private drinking water well, (2) the
costs and expenses to install a private drinking water well approved by an existing Construction Permit, (3) the
availability, costs and expenses to connect to a public or community water system, or a shared private well, and/or (4)
whether a Construction Permit may be obtained from the County Health Department for a private drinking water well.
(iv) Review of Documents: Review of the Declaration of Restrictive Covenants, Bylaws, Articles of Incorporation, Rules and
Regulations, and other governrl-Ag documents of any applicable owners' association and/or subdivision. If the Property is
NOV ! P46e 3 of I I
STANDARD FORM 12-T
Revised 7/2015
Buyer initial ���
17t Seller initia Ne
®7/2015
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DocuSign Envelope ID: EFF3510E-8278-40Dt-9BA6-064BA0589898
subject to regulation by an owners' association, it is recommended that Buyer review the completed Owners' Association
And Addendum (Standard Form 2Al2-T) provided by Seller prior to signing this offer. It is also recommended that the
Buyer determine if the owners' association charges fees for confirming owners association information and restrictive
covenant compliance.
(v) Appraisals: An appraisal of the Property.
(vi) Survey: A survey to determine whether the property is suitable for Buyers intended use and the location of easements,
setbacks, property boundaries and other issues which may or may not constitute title defects.
(vii) Zoning and Governmental Regulation: Investigation of current or proposed zoning or other governmental regulation
that may affect Buyers intended use of the Property, adjacent land uses, planned or proposed road construction, and
school attendance zones.
(viii) Flood Hazard: Investigation of potential flood hazards on the Property, and/or any requirement to purchase flood
insurance in order to obtain the Loan.
(ix) Utilities and Access: Availability, quality, and obligations for maintenance of utilities including electric, gas,
communication services, stormwater management, and means of access to the Property and amenities.
(x) Streets/Roads: Investigation of the status of the street/road upon which the Property fronts as well as any other
street/road used to access the Property, including: (1) whether any street(s)/road(s) are public or private, (2) whether any
street(s)/road(s) designated as public are accepted for maintenance by the State of NC or any municipality, or (3) if private
or not accepted for public maintenance, the consequences and responsibility for maintenance and the existence, terms and
funding of any maintenance agreements.
NOTE: NC General Statutes Section 136-102.6(f) (the 'Statute") requires that under circumstances described in the
Statute, a buyer must be provided a subdivision streets disclosure statement prior to entering into an agreement to buy
subdivided property described in the Statute. If Buyer or Seller are uncertain whether the sale of the Property described in
this Contract is subject to the Statute, consult a NC real estate attorney.
(c) Buyer's Obligation to Repair Damage: Buyer shall, at Buyer's expense, promptly repair any damage to the Property
resulting from any activities of Buyer and Buyers agents and contractors, but Buyer shall not be responsible for any damage caused
by accepted practices applicable to any N.C. licensed professional performing reasonable appraisals, tests, surveys, examinations and
inspections of the Property. This repair obligation shall survive any termination of this Contract.
(d) Indemnity: Buyer will indemnify and hold Seller harmless from all loss, damage, claims, suits or costs, which shall arise out
of any contract, agreement, or injury to any person or property as a result of any activities of Buyer and Buyers agents and
contractors relating to the Property except for any loss, damage, claim, suit or cost arising out of pre-existing conditions of the
Property and/or out of Sellers negligence or willful acts or omissions. This indemnity shall survive this Contract and any termination
hereof.
(e) Buyer's Right to Terminate: Buyer shall have the right to terminate this Contract for any reason or no reason, by delivering to
Seller written notice of termination (the 'Termination Notice') during the Due Diligence Period (or any agreed -upon written
extension of the Due Diligence Period), TIME BEING OF THE ESSENCE. If Buyer timely delivers the Termination Notice, this
Contract shall be terminated and the Earnest Money Deposit shall be refunded to Buyer.
WARNING: If Buyer is not satisfied with the results or progress of Buyer's Due Diligence, Buyer should terminate this Contract,
prior to the expiration of the Due Diligence Period, unless Buyer can obtain a written extension from Seller. SELLER IS NOT
OBLIGATED TO GRANT AN EXTENSION. Althought Buyer may continue to investigate the Property following the expiration of
the Due Diligence Period, Buyers failure to deliver a Termination Notice to Seller prior to the expiration of the Due Diligence
Period shall constitute a waiver by Buyer of any right to terminate this Contract based on any matter relating to Buyers Due
Diligence. Provided however, following the Due Diligence Period, Buyer may still exercise a right to terminate if Seller fails to
materially comply with any of Sellers obligations under paragraph 6 of this Contract or for any other reason permitted under the
terms of this Contract or North Carolina law.
(f) CLOSING SHALL. CONSTITUTE ACCEPTANCE OF THE PROPERTY IN ITS THEN EXISTING CONDITION
UNLESS PROVISION IS OTHERWISE MADE IN WRITING.
3. BUYER REPRESENTfRf
(a) Loan: Buyer ® does does no av t n a new loan in order to purchase the Property. If Buyer is obtaining a new
loan, Buyer intends to obtain a 1 f 11 ws: ❑ Conventional I@ Other: construction loan loan at a
Nor 1 3 2015
Page 4 of I I
DCM WILMINGTON, NC STANDARD FORMI2-T
Revised 7/2015
Buyer initial Seller initials .�®7/2015
FrrWacea xis zWFomDLy zpLoPx 180M Fela We wad, Fraser, Mialagan aA3M6 , acLm x corn 614 Hainpton

DocuSign Envelope ID: EFF3510E-8278-40D1-9BA6-064BA0589898
❑ Fixed Rate ❑ Adjustable Rate in the principal amount of n/a for a term of n/a _.... year(s), at
an initial interest rate not to exceed n/a % per annum (the "Loan").
(NOTE: Buyer's obligations under this Contract are not conditioned upon obtaining or closing any loan. If Buyer represents that
Buyer does not have to obtain a new loan in order to purchase the Property, Seller is advised, prior to signing this offer, to obtain
documentation from Buyer which demonstrates that Buyer will be able to close on the Property without the necessity of obtaining a
new loan.)
(b) Other Property: Buyer ❑ does © does not have to sell or lease other real property in order to qualify for a new loan or to
complete purchase. (NOTE: if Buyer does have to sell, Buyer and Seller should consider including a Contingent Sate Addendum
(Standard Form 2A2-1) with this offer.)
(c) Performance of Buyer's Financial Obligations: To the best of Buyers knowledge, there are no other circumstances or
conditions existing as of the date of this offer that would prohibit Buyer from performing Buyers financial obligations in accordance
with this Contract, except as may be specifically set forth herein.
(d) Authorization to Disclose Information; Buyer authorizes the Buyers lender(s), the parties' real estate agent(s) and closing
attorney: (1) to provide this Contract to any appraiser employed by Buyer or by Buyer's lender(s); and (2) to release and disclose any
buyer's closing disclosure, settlement statement and/or disbursement summary, or any information therein, to the parties to this
transaction, their real estate agent(s) and Buyer's lender(s).
(a) Owners' Association Fees/Charges: Buyer shall be responsible for the payment of any fees charged by an owners' association
for information relating to Buyers Due Diligence other than those fees to be paid by Seller under Paragraph 80).
(b) Responsibility for Proposed Special Assessments: Buyer shall take title subject to all Proposed Special Assessments.
(c) Responsibility for Certain Costs: Buyer shall be responsible for all costs with respect to any loan obtained by Buyer,
appraisal, title search, title insurance, recording the deed and for preparation and recording of all instruments required to secure the
balance of the Purchase Price unpaid at Settlement.
5. SELLER REPRESENTATIONS:
(a) Ownership: Seller represents that Seller:
M has owned the Property for at least one year.
❑ has owned the Property for less than one year.
❑ does not yet own the Property.
(b) Assessments: To the best of Sellers knowledge there are no Proposed Special Assessments except as follows (Insert "None" or
the identification of such assessments, if any): none
Seller warrants that there are no Confirmed Special Assessments except as follows (Insert "None" or the identification of such
assessments, if any):
(c) Owners' Association(s) and Dues: To best of Sellers knowledge, ownership of the Property M subjects ❑ does not subject
Buyer to regulation by one or more owners' association(s) and governing documents, which impose various mandatory covenants,
conditions and restrictions upon the Property and Buyers enjoyment thereof, including but not limited to obligations to pay regular
assessments (dues) and Special Assessment%. If there is an owners' association, then an Owners' Association Disclosure and
Addendum For Properties Exempt from Residential Property Disclosure Statement (Standard Form 2AI2-T) shall be completed by
Seller, at Seller's expense, and must be attached as an addendum to this Contract.
(d) Sewage System Permit: (❑ Applicable M Not Applicable) Seller warrants that the sewage system described in the
Improvement Permit attached hereto has been installed, which representation survives Closing, but makes no further representations
as to the system.
(e) Private Drinking Water Well Permit: (❑ Applicable © Not Applicable) Seller warrants that a private drinking water well
has been installed, which represenmtio!� fives Closing, but makes no further representations as to the well. (If well installed after
July 1, 2008, attach Improvement Pern 0-
NOV 13 2015
m DCM "MiNGTONge S�of I� as STANDARD FORM 12-T
Revised 7/2015
Buyer initials Seller initials D9P 0 7/2015
NOM .0 zpFarm66y ziptoga IMM Me"Mee Road, Fraser, Al ".a 026 www.z ogrE,4gQ 614 Hampton

DocuSign Envelope ID: EFF3510E-8278-40Dl-9BA6-064BA0589898
6. SELLER OBLIGATIONS:
(a) Evidence of Title and Payoff Stalement(s): Seller agrees to use best efforts to deliver to Buyer as soon as reasonably possible
after the Effective Date, copies of all title information in possession of or available to Seller, including but not limited to: title
insurance policies, attorney's opinions on title, surveys, covenants, deeds, notes and deeds of trust, leases, and easements relating to
the Property., Seller shall provide to the closing attorney all information needed to obtain a written payoff statement from any
lenders) regarding any security interest in the Property as soon as reasonably possible after the Effective Date, and Seller designates
the closing attorney as Sellers agent with express authority to request and obtain on Seller's behalf payoff statements and/or
short -pay statements from any such lender(s).
(b) Authorization to Disclose Information: Seller authorizes: (1) any attorney presently or previously representing Seller to
release and disclose any title insurance policy in such attorney's file to Buyer and both Buyers and Seller's agents and attorneys; (2)
the Property's title insurer or its agent to release and disclose all materials in the Property's title insurers (or title insurer's agent's) file
to Buyer and both Buyer's and Seller's agents and attorneys, and (3) the closing attorney to release and disclose any seller's closing
disclosure, settlement statement and/or disbursement summary, or any information therein, to the parties to this transaction, their real
estate agent(s) and Buyer's lender(s).
(c) Access to Property/Walk-Through Inspection: Seller shall provide reasonable access to the Property (including working,
existing utilities) through the earlier of Closing or possession by Buyer, including, but not limited to, allowing the Buyer an
opportunity to conduct a final walk-through inspection of the Property. To the extent applicable, Seller shall also be responsible for
timely clearing that portion of the Property required. by the County to perform tests, inspections and/or evaluations to determine the
suitability of the Property for a sewage system and/or private drinking water we .
(d) Removal of Seller's Property: Seller shall remove, by the date possession is made available to Buyer, all personal property
which is not a part of the purchase and all garbage and debris from the Property.
(e) Affidavit and Indemnification Agreement: Seller shall fumish at Settlement an affidavit(s) and indemnification agreement(s)
in form satisfactory to Buyer and Buyer's title insurer, if any, executed by Seller and any person or entity who has performed or
famished labor, services, materials or rental equipment to the Property within t20 days prior to the date of Settlement and who may
be entitled to claim a lien against the Property as described in N.C.G.S. §44A-8 verifying that each such person or entity has been
paid in full and agreeing to indemnify Buyer, Buyer's lender(s) and Buyer's title insurer against all loss from any cause or claim
arising therefrom.
(f) Designation of Lien Agent, Payment and Satisfaction of Liens: If required by N.C.G.S. §44A-11.1, Seller shall have
designated a Lien Agent, and Seller shall deliver to Buyer as soon as reasonably possible a copy of the appointment of Lien Agent.
All deeds of trust, deferred ad valorem taxes, liens and other charges against the Property, not assumed by Buyer, must be paid and
satisfied by Seller prior to or at Settlement such that cancellation may be promptly obtained following Closing. Seller shall remain
obligated to obtain any such cancellations following Closing.
(g) Good Title, Legal Access: Seller shall execute and deliver a GENERAL WARRANTY DEED for the Property in recordable
form no later than Settlement, which shall convey fee simple marketable and insurable title, without exception for mechanics' liens,
and free of any other liens, encumbrances or defects, including those which would be revealed by a current and accurate survey of
the Property, except: ad valorem taxes for the current year (prorated through the date of Settlement); utility easements and unviolated
covenants, conditions or restrictions that do not materially affect the value of the Property; and such other liens, encumbrances or
defects as may be assumed or specifically approved by Buyer in writing. The Property must have legal access to a public right of
way.
(NOTE: Buyers failure to terminate this Contract prior to the expiration of the Due Diligence Period as a result of any encumbrance
or defect that is or would have been revealed by a title examination of the Property or a current and accurate survey shall not relieve
Seller of any obligation under this subparagraph)
(NOTE: If any sale of the Property may be it "short sale," consideration should be given to attaching it Short Sale Addendum
(Standard Form 2A14-T) as an addendum to this Contract.)
(h) Deed, Taxes, and Fees: Seller shall pay for preparation of a deed and all other documents necessary to perform Seller's
obligations under this Contract, and for state and county excise taxes, and any deferred, discounted or rollback taxes, and local
conveyance fees required by law. The deed is robe made to: Dennis J. Backer a Marcella R. Backer
NOV 1 Page 6 of I 1
3 2015 STANDARD FORM 12-T
� Revised 712015
Buyer initial. i Vs wtt¢q}pj�Se)I itials( C7/2015
NWwt&a eeh zipForm b/ zipLogx IM70 Fillew Mile Road Fraser, Mlc W 0026 aaia.Wm, 614 Hampton

DocuSlgn Envelope ID: EFF3510E-8278-40Dl-9BA6-064BA0589898
(i) Agreement to Pay Buyer Expenses: Seller shall pay at Settlement $ -0- toward any of Buyer's
expenses associated with the purchase of the Property, less any portion disapproved by Buyers lender.
NOTE: Examples of Buyers expenses associated with the purchase of the Property include, but are not limited to, discount points,
loan origination fees, appraisal fees, attorney's fees, inspection fees, and "pre-paids" (taxes, insurance, owners' association dues, etc).
0) Owners' Association Fees/Charges: Seller shall pay: (i) any fees required for confirming Sellers account payment
information on owners' association dues or assessments for payment or proration; (it) any transfer or similar fee imposed by the
owners association; and (iii) fees incurred by Seller in completing the Residential Property and Owners' Association Disclosure
Statement.
(k) Payment of Confirmed Special Assessments: Seller shall pay all Confirmed Special Assessments, if any, provided that the
amount thereof can be reasonably determined or estimated.
(1) Late Listing Penalties: All property tax late listing penalties, if any, shall be paid by Seller.
(m) Owners' Association Disclosure and Condominium Resale Statement Addendum (Standard Form 2Al2-T): If applicable,
Seller shall provide the completed Owners' Association Disclosure and Condominium Resale Statement Addendum to Buyer on or
before the Effective Date.
(n) Seller's Failure to Comply or Breach: If Seiler fails to materially comply with any of Sellers obligations under this
_ , b,.or;Seiler.matcdaliy,;breeches_this_Cotttratt _ariti.BYXer electS_Bt_terminate this Conttad_as a result of sadh faihire or
breach, then the Earnest Money Deposit and the Due Diligence Fee shall be refunded to Buyer and Seller shall reimburse to Buyer
the reasonable costs actually incurred by Buyer in connection with Buyer's Due Diligence without affecting any other remedies. If
legal proceedings are brought by Buyer against the Seller to recover the Earnest Money Deposit, the Due Diligence Fee and/or the
reasonable costs actually incurred by Buyer in connection with Buyer's Due Diligence, the prevailing parry in the proceeding shall
be entitled to recover from the non -prevailing party reasonable attorney fees and court costs incurred in connection with the
proceeding.
7. PROBATIONS AND ADJUSTMENTS: Unless otherwise provided, the following items shall be prorated through the date of
Settlement and either adjusted between the parties or paid at Settlement:
(a) Taxes on Real Property: Ad valorem taxes and recurring governmental service fees levied with such taxes on real property
shall be prorated on a calendar year basis;
(b) Rents: Rents, if any, for the Property;
(e) Dues: Owners' association regular assessments (dues) and other like charges.
8. CONDITION OF PROPERTY AT CLOSING: Buyer's obligation to complete the transaction contemplated by this Contract
shall be contingent upon the Property being in substantially the same or better condition at Closing as on the date of this offer, reasonable
wear and tear excepted.
9. RISK OF LOSS: The risk of loss or damage by fire or other casualty prior to Closing shall be upon Seller. If the improvements on
the Property,are destroyed or materially damaged prior to Closing, Buyer may terminate this Contract by written notice delivered to
Seller or Sellers agent and the Earnest Money Deposit and any Due Diligence Fee shall be refunded to Buyer. In the event Buyer does
NOT elect to terminate this Contract, Buyer shall be entitled to receive, in addition to the Property, any of Sellers insurance proceeds
payable on account of the damage or destruction applicable to the Property being purchased. Seller is advised not to cancel existing
insurance on the Property until after confirming recordation of the deed.
10. DELAY IN SETTLEMENT/CLOSING: Absent agreement to the contrary in this Contract or any subsequent modification
thereto, if a party is unable to complete Settlement by the Settlement Date but intends to complete the transaction and is acting in good
faith and with reasonable diligence to proceed to Settlement ("Delaying Ptmy'), and if the other party is ready, willing and able to
complete Settlement on the Settlement Date ("Non -Delaying Party") then the Delaying Party shall give as much notice as possible to the
Non -Delaying Party and closing atwrngy and shall he entitled to a delay in Settlement. If the parties fail to complete Settlement and
Closing within fourteen (14) days o m tt V uding any amended Settlement Date agreed to in writing by the parties) or
to otherwise extend the Settlement Date by w n g t, then the Delaying Party shall be in breach and the Non -Delaying Party
may terminate this Contract and shall bNWled to enforce any remedies available to such party under this Contract for the breach.
13 2015
r)Cnr 'MiAA1NG'ro t. NC
Page 7 of I I
STANDARD FORM 12•T
�9P Revised 7/2015
Buyer iniliaL�b Seller initials 0 7/2015
Nocup w ZPFo by zipLogix 18070 Rleen We Road Raser, Whlgan 48026 -aww.Nom.opix W 614 Hampton

DocuSign Envelope ID: EFF3510E-8278-40Dt-9BA6-064BA0589898
11. POSSESSION: Unless otherwise provided herein, possession shall be delivered at Closing as defined in Paragraph 1(m). No
alterations, excavations, tree or vegetation removal or other such activities may be done before possession is delivered.
12. OTHER PROVISIONS AND CONDITIONS: CHECK ALL STANDARD ADDENDA THAT MAY BE A PART OF THIS
CONTRACT, IF ANY, AND ATTACH HERETO. ITEMIZE ALL OTHER ADDENDA TO THIS CONTRACT, IF ANY, AND
ATTACH HERETO.
(NOTE: UNDER NORTH CAROLINA LAW, REAL ESTATE BROKERS ARE NOT PERMITTED TO DRAFT CONDITIONS OR
CONTINGENCIES TO THIS CONTRACT.)
❑ Additional Provisions Addendum (Form 2A11-T) ® Owners Association Disclosure And Addendum For Properties
❑ Additional Signatures Addendum (Form 3-T) Exempt from Residential Property Disclosure Statement (Form
❑ Back -Up Contract Addendum (Form 2A1-T) 2Al2-1)
❑ Contingent Sale Addendum (Form 2A2-T) ❑ Seller Financing Addendum (Form 2A5-T)
❑ Loan Assumption Addendum (Form 2A6-T) ❑ Short Sale Addendum (Form 2AI4-T)
® OTHER; Coastal Hazard Addendum sewer tap attached as exhibit 1
13. ASSIGNMENTS: This Contract may not be assigned without the written consent of all parties except in connection with a tax-
deTei�ezchange, but if assigned liy agroemeiit, then tfiit-"CS 9e Mnding-o tlte-aWgfte-llnd assignee's heirs and'succcsstr
14. TAX -DEFERRED EXCHANGE: In the event Buyer or Seller desires to effect a tax -deferred exchange in connection with the
conveyance of the Property, Buyer and Seller agree to cooperate in effecting such exchange; provided, however, that the exchanging
party shall be responsible for all additional costs associated with such exchange, and provided further, that a non -exchanging party shall
not assume any additional liability with respect to such tax -deferred exchange. Buyer and Seller shall execute such additional documents,
including assignment of this Contract in connection therewith, at no cost to the non -exchanging party, as shall be required to give effect
to this provision.
15. PARTIES: This Contract shall be binding upon and shall inure to the benefit of Buyer and Seller and their respective heirs,
successors and assigns. As used herein, words in the singular include the plural and the masculine includes the feminine and neuter
genders, as appropriate.
16. SURVIVAL: If any provision herein contained which by its nature and effect is required to be observed, kept or performed after
the Closing, it shall survive the Closing and remain binding upon and for the benefit of the parties hereto until fully observed, kept or
performed.
17. ENTIRE AGREEMENT: This Contract contains the entire agreement of the parries and there are no representations,
inducements or other provisions other than those expressed herein. All changes, additions or deletions hereto must be in writing and
signed by all parties. Nothing contained herein shall alter any agreement between a REALTOR@ or broker and Seller or Buyer as
contained in any listing agreement, buyer agency agreement, or any other agency agreement between them.
18. CONDUCT OF TRANSACTION: The parties agree that any action between them relating to the transaction contemplated by
this Contract may be conducted by electronic means, including the signing of this Contract by one or more of them and any notice or
communication given in connection with this Contract. Any written notice or communication may be transmitted to any mailing address,
e-mail address or fax number set forth in the "Notice Information' section below. Any notice or communication to be given to a party
herein, any any fee, deposit of other payment to he delivered to a party herein, may be given to the party or to such parry's agent. Seller
and Buyer agree that the "Notice Information" and "Acknowledgment of Receipt of Monies" sections below shall not constitute a
material part of this Contract, and that the addition or modification of any information therein shall not constitute a rejection of an offer
or the creation of a counteroffer.
19. EXECUTION: This Contract may be signed in multiple originals or counterparts, all of which together constitute one and the
same instrument. P F C E I VE D
NOV 13 2%
Wi Page 8 of I I
CMINGTONi Ne a oe STANDARD FORMI2-T
Revised 7/2015
Buyer initialsKg Seller initials © 7/2015
Pre1ueedwthz4Pom0teyzr1L.ea, lBolo Flnean Mile Read, Fraser, Micragan 4802E "w.ilnloos_c"m 614 Hampton

DocuSign Envelope ID: EFF3510E-8278-40D1-9BA6-064BA0589898
20- COMPUTATION OF DAYS/TIME OF DAY: Unless otherwise provided, for purposes of this Contract, the term "days" shall
mean consecutive calendar days, including Saturdays, Sundays, and holidays, whether federal, state, local or religious. For the purposes
of calculating days, the count of "days' shall begin on the day following the day upon which any act or notice as provided in this
Contract was required to be performed or made. Any reference to a date or time of day shall refer to the date and/or time of day in
the State of North Carolina.
THE NORTH CAROLINA ASSOCIATION OF REALTORSO, INC. AND THE NORTH CAROLINA BAR ASSOCIATION MAKE
NO REPRESENTATION AS TO THE LEGAL VALIDITY OR ADEQUACY OF ANY PROVISION OF THIS FORM IN ANY
SPECIFIC TRANSACTION- IF YOU DO NOT UNDERSTAND THIS FORM OR FEEL THAT IT DOES NOT PROVIDE FOR YOUR
LEGAL NEEDS, YOU SHOULD CONSULT A NORTH CAROLINA REAL ESTATE ATTORNEY BEFORE YOU SIGN IT.
This offer shall become a binding contract on the Effective Date. Unless specifically provided otherwise, Buyer's failure to timely deliver
any fee, deposit or other payment provided for herein shall not prevent this offer from becoming a binding contract, provided that any
such failure shall give Seller certain rights to terminate the contract as described herein or as otherwise permitted by law.
9/21/2015
Date:
oecvehwsr:
Buyer ra; f.
Xaxm4,VkR,,Backer
Date:
Buyer —
Entity Buyer:
By: _
Name:
Title:
Date:
(Name of LLC/Corpomtion/Partnership/fmsdetc.)
9/22/2015
Date:
ur:
Seller UTA AIJ PAff d46
V9/22/2015_._�......_---
Date:
— m«asianed 6y.
Sellerff� m 3. PAff&y; .e
Debumeopmevappagallo
Entity Seller.
(Name of LLC/Corporation/Partnership/Tmst/etc.)
By:
Name:
Title:
Date:
[THIS SPACE INTENTIONALLY LEFT BLANK]
RECEIVED
NOV 13 2015
acnf Vrltdl7trlyu7otU_ VC
Page 9 of 11
STANDARD FORM 12-T
Revised 7/2015
® 7/2015
Produ�Wi Zi Fq�WpYzirinpIX l887BFiaeenM Poad,Fraser,Ml NQM48C26 wwa.MLWiN,= 61411amplon

DocuSign Envelope ID: EFF3510E-8278.40Dl.9BA6-064BA0589898
NOTICE INFORMATION
NOTE: INSERT THE ADDRESS AND/OR ELECTRONIC DELIVERY ADDRESS EACH PARTY AND AGENT APPROVES FOR
THE RECEIPT OF ANY NOTICE CONTEMPLATED BY THIS CONTRACT. INSERT "N/A" FOR ANY WIBCH ARE NOT
APPROVED.
BUYER NOTICE ADDRESS:
Mailing Address: n/a, ,
Buyer Fax#:
Buyer E-mail:
SELLING AGENT NOTICE ADDRESS:
SELLER NOTICE ADDRESS:
Mailing Address: n/a, ,
Seller Fax#:
Seller E-mail:
LISTING AGENT NOTICE ADDRESS:
Firm Name: Treasure Realty, Inc. Finn Name: Treasure Realty, Inc.
--- A'ctt`ng'asQBuycr s Agent(2 SeBdrs (sub)AgenTM[Dual-Agent Acting as 0 Setters Agent-1M Dual Agent----- —
Mailing Address: lO BOX 389, Sneads Ferry, NC 28460
Individual Selling Agent: Fletcher eairr^ Baker
❑ Acting as a Designated Dual Agent (cheek only if applicable)
License #: 233793
Selling Agent Phone#: [phone]
Selling Agent Fax#: [phone]
Selling Agent E-mail: biraetre nsureteatty. rood
RECEIVED
NOV 13 2015
Mailing Address: 80 Box 389, Sneads Ferry, NC 28460
Individual Listing Agent: Fletcher ^Birr^ Baker
❑ Acting as a Designated Dual Agent (check only if applicable)
License #: 233793
Listing Agent Phone#: [phone]
Listing Agent Fax#: -[phone]
Listing Agent E-mail: brraatwaaurarealty-cood
[THIS SPACE INTENTIONALLY LEFT BLANK]
Dco, dvtinnotv,�c�nl ivc
Page 10 of I 1
STANDARD FORM 12-T
Revised 7/2015
® 7/2015
Produced am zlpForme dy zlFLoge 10070 Fill and, We Road. Fraser, 64ctigan 48M earerairLdont com 614 Hampton

DocuSign Envelope ID: EFF3510E-8278-40DI-9BA6-064BA0589898
ACKNOWLEDGMENT OF RECEIPT OF MONIES
Seller: Vincent Pawagallo Debra J. Pappagallo ("Seller")
Buyer:Narcella R. Backer ("Buyer")
Property Address: 614 Hampton Colony Cir. (Lot 10) North Topsail Beach, NC 28460 ("Property")
❑ LISTING AGENT ACKNOWLEDGMENT OF RECEIPT OF DUE DILIGENCE FEE
Paragraph l(d) of the Offer to Purchase and Contract between Buyer and Seller for the sale of the Property provides for the payment to
Seller of a Due Diligence Fee in the amount of $ , receipt of which Listing Agent hereby acknowledges.
Date:
Firth: Treasure Realty, Inc.
By:
(Signature)
Fletcher "Bizz" Baker
(Print name)
❑ Wiylili ACKNOWLEDGMENT OF RECEIPT OF DUE DILIGENCE FEE
Paragraph 1(d) of the Offer to Purchase and Contract between Buyer and Seller for the sale of the Property provides for the payment to
Seller of a Due Diligence Fee in the amount of $ , receipt of which Seller hereby acknowledges.
Date: Seller:
(Signature)
Vincent Pappagallo
Date: Seller:
(Signature)
Debra J. Pappagallo
❑ ESCROW AGENT ACKNOWLEDGMENT OF RECEIPT OF INITIAL EARNEST MONEY DEPOSIT
Paragraph I(d) of the Offer to Purchase and Contract between Buyer and Seller for the sale of the Property provides for the payment to
Escrow Agent of an Initial Earnest Money Deposit in the amount of $ 1,000.00 . Escrow Agent as identified in Paragraph
I (f) of the Offer to Purchase and Contract hereby acknowledges receipt of the Initial Earnest Money Deposit and agrees to hold and
disburse the same in accordance with the terms of the Offer to Purchase and Contract.
Date:
Firm: Treasure Realty, Inc.
By:
(Signature)
(Print name)
........................................................... ..................._-......_......
❑ ESCROW AGENT ACKNOWLEDGMENT OF RECEIPT OF (ADDITIONAL) EARNEST MONEY DEPOSIT
Paragraph l(d) of the Offer to Purchase and Contract between Buyer and Seller for the sale of the Property provides for the payment to
Escrow Agent of an (Additional) Earnest Money Deposit in the amount of $ . Escrow Agent as identified in
Paragraph 1(f) of the Offer to Purchase and Contract hereby acknowledges receipt of the (Additional) Earnest Money Deposit and agrees
to hold and disburse the same in accordance with the terms of the Offer to Purchase and Contract.
Date:QQ�� Firm: Treasure Realty, Inc.
PF-CE1,/rED By:
NOV 13 2015 (Signature)
(Print name)
DCM WILMINGTON, NC Page I 1 of 11 STANDARD FORMI2-T
Revised 7/2015
0712015
No od w;Mv Fo,r6b, IpLt .180'N Fdt.. tee Road. F'.., Michigan 48g2a ..z,pLw,com 614 Hampton

DocuSign Envelope ID: EFF3510E-8278-4001-9BA6-064BA0589898
STATE OF NORTH CAROLINA
MINERAL AND OIL AND GAS RIGHTS MANDATORY DISCLOSURE STATEMENT
Instructions to Property Owners
I. The Residential Property Disclosure Act (G.S. 47E) ("Disclosure Act") requires owners of certain residential real estate such as
single-family homes, individual condominiums, townhouses, and the like, and buildings with up to four dwelling units, to furnish
purchasers a Mineral and Oil and Gas Rights Disclosure Statement ("Disclosure Statement"). This form is the only one approved
for this purpose.
2. A disclosure statement is not required for some transactions. For a complete list of exemptions, see G.S. 47E-2(a). A
DISCLOSURE STATEMENT IS REOUMM FOR TIIE TRANSFERS D3ENTIFIED IN G.S 47E-2(bl including transfers
involving the East sale of a dwelling never inhabited, lease with option to purchase contracts where the lessee occupies or intends
to occupy the dwelling, and transfers between parties when both parties agree not to provide the Residential Property and Owner's
Association Disclosure Statement.
3. You must respond to each of the following by placing a check J in the appropriate box.
MINERAL AND OIL AND GAS RIGHTS DISCLOSURE
Mineral rights and/or oil and gas rights can be severed from the title to real property by conveyance (deed) or the mineral
rights and/or oil and gas rights from the owner or by reservation of the mineral rights and/or oil and gas rights by the
owner. If mineral rights and/or oil and gas rights are or will be severed from the property, the owner of those rights may
have the perpetual right to drill, mine, explore, and remove any of the subsurface mineral and/or oil or gas resources on or
from the property either directly from the surface of the property or from a nearby location. With regard to the severance
- ---moo mineral rights or o an g- as rights, Setter makes the following dtsclosures:--
Yes No No Representation
MK6 1. Mineral rights were severed from the property by a previous owner. ❑ ❑
Initials
Atlb 2. Seller has severed the mineral rights from the property. ❑
Initials
3. Seller intends to sever the mineral rights from the property prior to ❑
Initials transfer of title to the Buyer.
M Kh
Initials 4. Oil and gas rights were severed from the property by a previous owner. ❑ Cl
Mrf
Initials S. Setter has severed the oil and gas rights from the property. ❑
M.Kh 6. Seller intends to sever the oil and gas rights from the property prior ❑
Initials to transfer of title to Buyer.
Note to Purchasers
If the owner does not give you a Mineral and Oil and Gas Rights Disclosure Statement by the time you make your offer to
purchase the property, or exercise an option to purchase the property pursuant to a lease with an option to purchase, you
may under certain conditions cancel any resulting contract without penalty to you as the purchaser. To cancel the contract,
you must personally deliver or mail written notice of your decision to cancel to the owner or the owners agent within three
calendar days following your receipt of this Disclosure Statement, or three calendar days following the date of the contract,
whichever occurs first. However, in no event does the Disclosure Act permit you to cancel a contract after settlement of the
transaction or (in the case of a sale or exchange) after you have occupied the property, whichever occurs first.
Property Address: 614 Hampton Colony Cir. (Lot 10) North Topsail Beach, NC 28460
Owner's Name(s): Vincent Pa pauallo Debra J. Pa pagallo
Ownet(s) aclo=owledge how examined this Disclosure Statement before signing and that all information is true and correct as of
the date signed. 66AA4 POfr ° Vincent Pa a alto 9/22/2015
Owner Signature: PP 4 Date
9/22/2015
Owner Signature: v_'4 i--&aa" Debra J. Pappagallo Date
Purchaser r knn`w7MML0$t of a ropy of this Disclosure Statement, that they have examined it before signing; that they
this is not a warranty by owner or owner's agent; and that the representations are made by the owner and not the
IY2 nt(s)orsubagau(s Oev41pnf°°s" 9/21/2015
Purchaser �Oignature: � � �• � � Marcella B. sacker Date
er '1'U�tl i EOBraCWSCBE<BB,_
asSignature: Dale
C REC 4.25
ppqq��ppr� s ex�l'i>o c, PO Box 389 Sneads Ferry, NC 29460 1/1 t 15
'1011llks.9T0-358d708 Fax: [phone] Fletcher B,zz Baker 6141 tampion
P.oaucea min zalronne by nPLain m070 FIIieen We Road, Fraser, Whom"026 mnW 410L00*oom

Ol � Tj �-; U-4, - I - M

CHARLES F. RIGGS & ASSOCIATES, INC.
Charles F. Riggs, P.L.S. L-2981
502 New Bridge Street
Jacksonville, North Carolina 28540
[phone]
chwlesriggs@riggslandnacom
November 10, 2015
Land Surveyors
Corporate License (C-730)
502 New Bridge Street
P.O. Box 1570
Jacksonville, North Carolina 28541
[phone]
To: Mr. Jason Dail
Division of Coastal Management
North Carolina Department of Environmental Quality
127 Cardinal Drive
Wilmington, North Carolina 28405
James A. Lewis, P.L.S. L-4562
Landfall Executive Suite 217
1213 Culbreth Drive
Wilmington, North Carolina 28405
[phone]
[e-mail]
Re: Dennis Backer and wife, Marcy R. Backer Minor CAMA Application
Dear Mr. Dail:
On behalf of Dennis Backer and wife, Marcy R. Backer, Charles F. Riggs & Associates, Inc. submits
for your review the enclosed Minor CAMA Application for the property at 614 Hampton Colony Circle,
North Topsail Beach, Stump Sound Township, Onslow County, North Carolina.
Respectfully,
�4%VA:1.%
ames L. Riggs
RECEIVED
DCM WILMINGTON, NC
NOV 1_ 3 2011

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner: Dennis Backer and wife, Marcy R. Backer
Address of Property:
614 Hampton Colony Circle, North Topsail Beach
(Lot or Street #, Street or Road, City & County)
Agent's Name #: Charles F. Riggs & Assoc.
Agent's phone #: [phone]
Mailing Address: P. O. Box 1570
Jacksonville, NC 28541
I hereby certify that I own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing the development
they are proposing. A description or drawing, with dimensions, must be provided with this letter.
I have no objections to this proposal. I have objections to this proposal.
If you have objections to what is being proposed, you must notify the Division of Coastal Management
(DCM) in writing within 10 days of receipt of this notice. Contact information for DCM offices is
available at www.nccoastaimanagement.net/contact dcm.htm or by calling 1-888-4RCOAST. No
resnonse is considered the same as no obiection if you have been notified by Certified Mail.
I understand that a pi , ck,
back a minimum distance of
wish to waive the setback, you
I do wish to
Signature
Charles . Riggs,
Pnnt or Type
P. O. Box 1570
WAIVER SECTION
mooring pilings, breakwater,
i fF nny area of riparian a(
setback
boathous , or groin must be set
Ness waived by me. (If you
blank below.)
not wish to waive the 15' setback requirement.
Mailing Address
Jacksonville, NC 28541
City/State/Zip
[phone]
Telephone Number
Date
for application
(Adjacent Property Owner Information)
Signature
Print or Type Name
Mailing Address
City/StatelZip
Telephone Number
Date j CEIVED
Revised fNi P1-MINGTON, NC
NOV 13 2015

CHARLES F. RIGGS & ASSOCIATES, INC.
Charles F. Riggs, P.L.S. L-2981
502 New Bridge Street
Jacksonville, North Carolina 28540
[phone]
[e-mail]
November 10, 2015
Marilyn N. Call Heirs
C/O Ms. Barbara N. Ritchie
630 Seabllry Drive
Worthington, OH 43085
Land Surveyors
Corporate License (C-730)
502 New Bridge Street
P.O. Box 1570
Jacksonville, North Carolina 28541
[phone]
James A Lewis, P.L.S. L-4562
Landfall Executive Suite 217
1213 Culbreth Drive
Wilmington, North Carolina 28405
[phone]
[e-mail]
Re: Dennis Backer and wife, Marcy R. Backer Minor CAMA Application
Dear Ms. Ritchie:
On behalf of Dennis Backer and wife, Marcy R. Backer, Charles F. Riggs & Associates, Inc. is
submitting to the Division of Coastal Management, North Carolina Department of Environmental Quality
the enclosed Minor CAMA application for the property located at 614 Hampton Colony Circle, North
Topsail Beach, Stump Sound Township, Onslow County. We are required to notify the adjoiners of this
CAMA application. Please review the package and sign the form provided, placing a check beside
whether you have objections or no objections to this. If you have no objections, please return the form to
us in the self-addressed stamped envelope provided. If you have objections, please send the form along
with your comments to Mr. Jason Dail, Division of Coastal Management, N.C. Department of
Environmental Quality, 127 Cardinal Drive, Wilmington, NC 28405 within 10 days of receipt of this
notice.
Respectfully,
U.S. Postal Service'"
n
cc
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ames L. Riggs
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RECEIVED
DCM WILMINGTON, NC
NOY 13 2015

CHARLES F. RIGGS & ASSOCIATES, INC.
Charles F. Riggs, P.L.S. L-2981
502 New Bridge Street
Jacksonville, North Carolina 28540
[phone]
[e-mail]
November 10, 2015
Land Surveyors
Corporate License (C-730)
502 New Bridge Street
P.O. Box 1570
Jacksonville, North Carolina 28541
[phone]
Hampton Colony Homeowners Association
143 Lakeshore Drive
Rockaway, NJ 07866
James A. Lewis, P.L.S. L-4562
Landfall Executive Suite 217
1213 Culbreth (hive
Wilmington, North Carolina 28405
[phone]
[e-mail]
Re: Dennis Backer and wife, Marcy R. Backer Minor CAMA Application
To whom it may concern:
On behalf of Dennis Backer and wife, Marcy R. Backer, Charles F. Riggs & Associates, Inc. is
submitting to the Division of Coastal Management, North Carolina Department of Environmental Quality
the enclosed Minor CAMA application for the property located at 614 Hampton Colony Circle, North
Topsail Beach, Stump Sound Township, Onslow County. We are required to notify the adjoiners of this
CAMA application. Please review the package and sign the form provided, placing a check beside
whether you have objections or no objections to this. If you have no objections, please return the form to
us in the self-addressed stamped envelope provided. If you have objections, please send the form along
with your comments to Mr. Jason Dail, Division of Coastal Management, N.C. Department of
Environmental Quality, 127 Cardinal Drive, Wilmington, NC 28405 within 10 days of receipt of this
notice.
L. Riggs
U.S. NOstai aervive
CERTIFIED MAIL® RECEIPT
I Domestic Mail Only
•� For delivery information, visit our website at www.usps.com
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RECEIVED
DCM WILMINGTON, NC
NOV 13 2015

N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date / -�L
Name of Property Owner Applying for Permit:
DzootS * Mad2ella 56t'CkPf
Maaging Address:
GU. A"A
I certd'y that I have authorized (agent) 1. i!me 5 &.S to act on my
behalf; for the purpose ofapplybg for and Obtaining all'CAMA Permits necessary to
installor construct (activity) Q &S-'61& &a
at (my property located at)
kor'A '1610stil &c4 o PC -�8-ew
This certification is valid thra (date) fi
P Owner Signature Date
RECEIVED
00M WILMINGTON, NG
NOV 13 203

OCEAN HAZARD AEC
Project is in an: —4— Ocean Erodible Area High H
1
Property Owner:
Property Address: 1111—E I.'uv°�'t"r'
Date Lot Was Platted: �� ' u rn ' q F8,
1 his notice is intended in make you. the applicant Marc of the
special risks and conditions associated with development in this
area. ram hich is subject to natural hazards such as storms. crosion
and currents. The rules of the Coastal Resources Commission
require that you receive an AEC Hazard \otice and
acknowledge that notice in writing h6on: a permit for
development can be issued.
'The Commission's rules on building standards, tceanfont
setbacks and dune alterations arc designed in minimize. but not
eliminate. property loss from hazards By gramim_ permits. the
Coastal Resources Commission does not guarantee the safety at'
the development and assumes no liability for future damage to
the development. Permits issued in the Ocean I laeard Area of
Environmental Concern include the condition that structures be
relocated or dismantled if they become imminently threatened
by changes in shoreline configuration. The stretursis) must be
relocated or dismantled within two (_') years of becoming
imminently threatened. and in any case upon its collapse or
subsidence.
The best available information. as accepted by the Coastal
Resources Comm scion, indicates that the annual long-term
menage ottm sun rate for the area %there your propene is
located is . teen per year.
'[he rate was established by careful analysis of aerial
photographs of the coastline taken over the past 50 year%.
:Stl�ies also indicate that the shoreline could mon'c as much as
p�XJ feet landward in a major storm-
It-
x Vaters in a maior storm are predicted to be about
i 1 •t deep in this area.
Preferred oceanfront protection measures are beach nourishment
and relocation of threatened structures. Hard erosion control
structures such as bulkheads, seawalls. revetments _minx jetties
and breakwaters are prohibited. Temporary sand bags may be
authorized under certain conditions.
The applicant must acknowledge this information and
requirements by signing this notice in the space below. Without
the proper signature_ the application evill not be complete.
1. tI V►,�i l'=I/-
NOTICE
Flood Area Inlet Hazard Area
SPECIAL NOTE: This hazard notice is required for
development in areas subject to sudden and massive storms and
erosion. Permits issued for development in this area expire on
necembev 31 of the third year follmving the year in which the
permit was issued. Shortly before vwrk begins on the project
site, the I.rcalPermit Officer must he contacted to determine the
vegetation line and setback distance at your site. If the propene
has seen little change since the time of permit issuance. and the
proposed dccek)pment can still meet the setback requirement.
the I.PO will inform you that you may begin work. Substantial
progress on the project must he made within 60 days of this
setback determination. or the setback must be re -measured. Also.
the oecurencc of a major shoreline change as the result of u
stonn within the 60-day period will necessitate re -measurement
of the setback. It is important that you check with the I.PO
belbre the permit expires for official approval to continue the
work after the permit has expired. Generally. it' fi+undation
pilings have been placed and substantial progress is continuing.
permit renewal can be authorized. It is unlawful to continue
work after permit expiration.
Ear more infiarararion, canract.
Local Pend Officer
Address
Ale—i_ /,< AI�Cl—
Localify
q,,Id -- ?�� 702/
Phone Number
Revised May 2010
DCM WILM NGTON, NC
NOV 13 20151

U.S. DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE
FEDERAL EMERGENCY MANAGEMENT AGENCY '
Nmlonal Flood Insurance Program Important: Read the instructions on pages 1-9.
OMB No. 1660-0008
Expiration Date: July 31, 2015
SECTION A — PROPERTY INFORMATION i_ FOR INSURANCE EOMPANY USE i
Al. Building Owner's Name DENNIS BACKER & WIFE, MARCY R. BACKER i Iroricy, Nuumver., i
A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. I. Company NAIL; Nurloec
614 HAMPTON COLONY
City NORTH TOPSAIL BEACH State NC ZIP Code 28460
A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.)
LOT 10. HAMPTON COLONY
A4. Building Use (e.g., Residential, Non -Residential, Addition, Accessory, etc.) RESIDENTIAL
A5. Latitude/Longitude: Lat. 34d29'19"N Long. 77d25'40'W Horizontal Datum: ❑ NAD 1927 E NAD 1983
AS. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance.
AT Building Diagram Number 6
AS. For a building with a crawlspace or enclosure(s): A9. For a building with an attached garage:
a) Square footage of crawlspace or enclosure(s) 1296 sq ft a) Square footage of attached garage N/A sq It
b) Number of permanent flood openings in the crawlspace b) Number of permanent flood openings in the attached garage
or enclosure(s) within 1.0 foot above adjacent grade 0 within 1.0 foot above adjacent grade 0
c) Total net area of flood openings in A8.1b 0 sq in c) Total net area of flood openings in A9.b 0 sq in
d) Engineered flood openings? ❑ Yes ® No d) Engineered flood openings? ❑ Yes E No
SECTION B — FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
Bt. NFIP Community Name & Community Number B2. County Name B3. State
NORTH TOPSAIL BEACH 370466 ONSLOW NORTH CAROLINA
B4. Map/Panel Number
BE. Suffix
BE. FIRM Index Date
B7. FIRM Panel
BE. Flood
B9. Base Flood Elevation(s) (Zone
3720427700
J
02/16/07
Effective/Revised Date
Zone(s)
AO, use base flood depth)
11/03/05
VE
15.0'
B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item B9.
❑ FIS Profile E FIRM ❑ Community Determined ❑ Other/Source: _
B11. Indicate elevation datum used for BFE in Item B9: ❑ NGVD 1929 ® NAVD 1988 ❑ Other/Source:
B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? ® Yes ❑ No
Designation Date: 10/1/1983 E CBRS ❑ OPA
SECTION C — BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
Cl. Building elevations are based on: E Construction Drawings' ❑ Building Under Construction* ❑ Finished Construction
'A new Elevation Certificate will be required when construction of the building is complete.
C2. Elevations — Zones Al—A30, AE, AH, A (with BFE), VE, VI—V30, V (with BFE), AR, AR/A, AR/AE, AR/Al—A30, AR/AH, AR/AO. Complete Items C2.a—h
below according to the building diagram specified in Item AT In Puerto Rico only, enter meters.
Benchmark Utilized: NC CORS Vertical Datum: NAVD 1988
Indicate elevation datum used for the elevations in items a) through h) below. ❑ NGVD 1929 E NAVD 1988 11 Other/Source:
Datum used for building elevations must be the same as that used for the BFE.
Check the measurement used.
a) Top of bottom floor (including basement, crawlspace, or enclosure floor)
b) Top of the next higher floor
c) Bottom of the lowest horizontal structural member (V Zones only)
d) Attached garage (top of slab)
e) Lowest elevation of machinery or equipment servicing the building
(Describe type of equipment and location in Comments)
f) Lowest adjacent (finished) grade next to building (LAG)
g) Highest adjacent (finished) grade next to building (HAG)
h) Lowest adjacent grade at lowest elevation of deck or stairs, including structural support
9.5
E feet
❑ meters
19.5
E feet
❑ meters
17.5
E feet
❑ meters
N.A
❑ feet
❑ meters
17.1
E feet
❑ meters
8.0
E feet
❑ meters
10.0
E feet
❑ meters
N.A
❑ feet
❑ meters
SECTION D— SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION
This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation
information. I certify that the information on r the data available.
I understand that any false statement may bepunlshable by fine or imprisonment underr18 U. S.lCode, Section 1001. %%P•(N C+A/ ? "10
E Check here if comments are provided oQ,a4f<;rjn pckra. Were latitude and longitude in Section A provided by a �.` �'FF.&3j0 • �/�•.�
❑ Check here if attachments. %`��IH CAq;; �licensed land surveyor? E Yes ❑ No _�'- -QQ' SEAL
Certifier's Name JAMES A LEWIS. P'L • _oEt5S/p; •VA i. License Number L-4562
Title PROJECT MANAGER
Address 502 NEW BRIDGE
F. RIGGS & ASSOCIATES, INC.
State NC ZIP Code 28t4W
y r��
Telephone [phone]
Form 086-0-33 (7/12) A. 1-� ,. `�See reverse side for continuation. Replaces all previous editions.

IMPORTANT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE
Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Policy Number. ..
614 HAMPTON COLONY `
Ci(v NORTH TOPSAIL BEACH State NC ZIP Code 28460 ( Company-NAICNumber.
SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED)
Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agent/company, and (3) building owner.
Comments PROPOSED DWELLING IS THREE STORY ON PILINGS, ENCLOSED BELOW (FOR ENTRY, PARKING, AND STORAGE). SURVEYOR HAS
NOT REVIEWED FINAL CONSTRUCTION PLANS. THE TOWN OF NORTH TOPSAIL BEACH HAS ADOPTED V-ZONE CONSTRUCTION STANDARDS
THROUGHOUT AND REQUIRES A 2' FREEBOARD DURING CONSTRUCTION THEREFORE THE BOTTOM OF THE LOWEST HORIZONTAL
STRUCTURAL MEMBER MUST HAVE AN ELEVATION OF AT LEAST 15.0' + 2.0' = 17.0' (PROPOSED ELEVATION = 17.5')
SECTION E- BUILDING ELEVATION INFOR®ATIDR (S1IRVEY Ir(O�RTUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE)
For Zones AO and A (without BFE), complete Items E1-15. 14th %Cintedded I support a LOMA or LOMR-F request, complete Sections A, B.
and C. For Items El-E4, use natural grade, if available. checkmeasureme�l/sed..fn Puerto Rico only, enter meters.
•
El. Provide elevation information for the following and clleNrtNQ�3��'9tj show whether the elevation is above or below the highest adjacent
grade (HAG) and the lowest adjacent grade (LAG). ��i �• ��•
a) Top of bottom floor (including basement, crawlspace, &,gl�o�'srp+@) i �� ._ ❑ feet ❑ meters ❑ above or ❑ below the HAG.
b) Top of bottom floor (including basement, crawlspace, or eAiLidauaapS�- ❑ feet ❑ meters ❑ above or ❑ below the LAG.
E2. For Building Diagrams 6-9 with permanent flood openings provided in Section A Items 8 and/or9 (see pages 8-9 of Instructions), the next higher floor
(elevation C2.b in the diagrams) of the building is _ _ ❑ feet ❑ meters ❑ above or ❑ below the HAG.
E3. Attached garage (top of slab) is _ _ ❑ feet ❑ meters ❑ above or ❑ below the HAG.
E4. Top of platform of machinery and/or equipment servicing the building is _ _ ❑ feet ❑ meters ❑ above or ❑ below the HAG.
E5. Zone AO only: If no flood depth number is available, is the top of the bottom floor elevated in accordance with the community's floodplain management
ordinance? ❑ Yes ❑ No ❑ Unknown. The local official must certify this information in Section G.
SECTION F - PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION
The property owner or owner's authorized representative who completes Sections A, B, and E for Zone A (without a FEMA-issued or community -issued BFE)
or Zone AO must sign here. The statements in Sections A, B, and E are correct to the best of my knowledge.
Property Owner's or Owners Authorized Representative's Name
Address City State ZIP Code
Signature Date Telephone
Comments
❑ Check here if attachments.
SECTION G - COMMUNITY INFORMATION (OPTIONAL)
The local official who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete Sections A, B. C (or E), and G
of this Elevation Certificate. Complete the applicable item(s) and sign below. Check the measurement used in Items G8-G10. In Puerto Rico only, enter meters.
G1. ❑ The information in Section C was taken from other documentation that has been signed and seated by a licensed surveyor, engineer, or architect who
is authorized by law to certify elevation information. (Indicate the source and date of the elevation data in the Comments area below.)
G2. ❑ A community official completed Section E for a building located in Zone A (without a FEMA-issued or community -issued BFE) or Zone AO.
G3. ❑ The following information (Items G4-G10) is provided for community floodplain management purposes.
G4. Permit Number I G5. Date Permit Issued I G6. Date Certificate Of Compliance/Occupancy Issued
G7. This permit has been issued for: ❑ New Construction ❑ Substantial Improvement
G8. Elevation of as -built lowest floor (including basement) of the building: _ _ ❑ feet ❑ meters Datum
G9. BFE or (in Zone AO) depth of flooding at the building site: _ _ ❑ feet ❑ meters Datum
G10. Community's design flood elevation: _ _ ❑ feet ❑ meters Datum
Local Official's Name Title
Community Name Telephone
Signature Date
Comments
C T &51 Fa'TaNchments.
I U, NC
NOV 13 2015
FEMA Form 086-0-33 (7/12) Replaces all previous ediflons.

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