Douglas and Therese Goldsmith Application (BC22-25)

Locality-1��►� Svc'' c.� `'�` Permit Number 2 2 - 25
Ocean Hazard Estuarine Shoreline ORW Shoreline Public Trust Shoreline Other
(For official use only) 24 y f eu U
tf
GENERAL INFORMATION
LAND OWNER
Name
Address
City �Vtoo-* State NV Zip Phone � 10 zbb � 71
Email
AUTHORIZED AGENT
Name
Addre
City
Email
LOCATION OF PROJECT: (Address, street name and/or directions to site. If not oceanfront, what is the name of the
adjacent waterbody.)L1Lo5& (rrTOOK L YkQ S\^J j (e, -Qct-pO­n Crey-y—
DESCRIPTION OF PROJECT: (List all proposed construction and land disturbance.) J� V'!/►� ��d
SIZE OF LOT/PARCEL: CAS LQ' l Z square feet 0 3 acres
PROPOSED USE: Residential (Single-family [R Multi -family [] ) Commercial/I.ndustrial E] Other
COMPLETE EITHER (1) OR (2) BELOW (Contact your Local Permit Officer if you are not sure which AEC applies
to your property):
(1) OCEAN HAZARD AECs: TOTAL FLOOR AREA OF PROPOSED STRUCTURE: square feet (includes
air conditioned living space, parking elevated above ground level, non -conditioned space elevated above ground level but
excluding non -load -bearing attic space)
(2) COASTAL SHORELINE AECs: SIZE OF BUILDING FOOTPRINT AND OTHER IMPERVIOUS OR BUILT
UPON SURFACES: i , 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 NO
If yes, list the total built upon area/impervious surface allowed for your lot or parcel: square feet.
RECEIVED
OCT 0 6 2022

OTHER PERMITS MAY BE REQUIRED:The activity you are planning may require pen -nits other than the CAMA
minor development permit, including, but not limited to: Drinking hater Well, Septic Tank (or other sanitary waste
treatment system), Building, Electrical, Plumbing, Heating and Air Conditioning, Insulation and Energy Conservation, FIA
Certification, Sand Dune, Sediment Control, Subdivision Approval, Mobile Home Park Approval, Highway Connection, and
others. Check with your Local Permit Officer for more infonnation.
STATEMENT OF OWNERSHIP:
1, 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 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) r_t YVI
l7•
an owner or record title, Title is vested in � QZ o y-e , see Deed Book _)
page i S-_C9in the &Lh-tSW l OC— CounfY Registry of Deeds.
an owner by virtue of inheritance..Applicant is an heir to the estate of
probate was in
County.
Xif other interest, such as written contract or lease, explain below or use a separate sheet & attach to this application.
NOTIFICATION OF ADJACEN 17PROPERTY OWNERS:
I furthermore certify that the following persons are owners of properties adjoining this property. I affirm that I have given
ACTUAL NOTICE to each of them concerning my intent to develop this property and to apply for a CAMA permit.
(1)
(2)
(3)
(4)
ACKNOWLEDGEMENTS:
I, the undersigned, acknowledge that the land owner is aware that the proposed development is planned for an area which
may be susceptible to erosion and/or flooding. I acknowledge that the Local Permit Officer has explained to me the particu-
lar hazard. problems associated with this lot. This explanation was accompanied by recommendations concerning stabiliza-
tion and floodproofing techniques.
I furthermore certify that I am authorized to grant, and do in fact grant, 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.
-- SVL kb'\
This the
q 0 U
or person authorized Act as his/her agent for purpose offiling
Yin
day of 20 ZZ
application
This application includes: general information (this form), a site drawing as described on the back of this application, the
ownership statement, the Ocean Hazard AEC Notice where necessary, a check for $100.00 made payable to the localiol and
any information as may be provided orally by the applicant. The details of the application as described by these sources are
incorporated without reference in any permit which may be issued. Deviation from these details will constitute a violation of
anypermit. Anyperson developing in an AEC withoutpermit is subject to civil, criminal and administrativeREGEIV ED
OCT 16 W

9/28/22, 2:56 PM Agent Authorization. JPG
hops://mail.google.com/mail/u/0/#inbox/FMfcgzGgQmP[x]MclTxXWgvwdHFMWdWS?projector=l 1/1

IIIIIIIIIHIIIIIIIIIIIIIIIIIIilllllll �6� V31 °�-�-49?��
Brunswick County, NC Register of Deeds page t s 2
tetu0-0a3h
' T
rptaRev,,,,—, Int.
,k $ elt $
;efuHnsnce
.I Por"M of dooun ont are 111sgUe due to a tfion
'0 atp
w*t- low F►%f, Pttc Oonktei.
a f1 inaleont+ rre a�ej VWMRt4 by 9091nai
?IvS i tiyt/vn•a a tf hf✓at {"1 ° , 4 1AMMOM 1W i "P9 f# WOW 8F fflft-
Ircp,sd q/aIN.eoRNnP Pi*►en•+,J."Deh Mb� t� fiu be � tw%s ai�/Ry 104
4/anM�c+i Pd (br►.�ipr pan ts6�rsYYnc►+r cics�as /l�a►s.
Parcel IN r: 244EE004 & 244EE005
Instrument Prepared By: Hewett Law Firm, PLLC, 712 Village Rd, Suite 205, Shallotte,
NC 28470
Return to: Hewett Law Firm, PLLC, 712 Village Rd., Suite 205, Shallotte, NC 28470
PREPARED WITHOUT OPINION OF TITLE
QUITCLAIM DEED
STATE OF NORTH CAROLINA
COUNTY OF BRUNSWICK
THIS DEED, made this jq_ day of June, 20210, by Ralph Leon Hewett and wife,
Patricia Gail Hewett, whose mailing address is 930 Copas Road SW, Shallotte, NC 28470
(hereinafter referred to as "Grantor") to Douglas Vincent Goldsmith and wife, Therese
Marie Goldsmith (hereinafter referred to as "Grantee"), whose mailing address is: 191
South Middleton Drive NW, Calabash, NC 28467.
The designation Grantor and Grantee as used herein shall include said parties, their
heirs, successors, and assigns, and shall include singular, plural, masculine, feminine or
neuter as required by context.
WITNESSETH:
That said Grantor, for and in consideration of the sum of Ten Dollars ($10.00) to them in
hand paid, the receipt of which is hereby acknowledged, have remised and by these
presents do remise, release, and forever quitclaim unto the Grantee all right, title, claim,
and interest of the said Grantor in and to a certain tract or parcel of land lying and being
in the County of Brunswick, and State of North Carolina, and more particularly described
as follows:
Being all of Lots 4 & 5 as shown on that certain map prepared by Randy D. Ward, PLS
and recorded in Map Cabinet 129 at Page 49, Brunswick County Registry.

IIIIIIIIIIIIIIIIIIIIIII NC R.,jst I Pi3V:r,.,�.1.014
grunsuick County NC Raglster of PROP
Oaeds 6 49 014P2
TO HAVE AND TO HOLD the aforesaid tract or parcel of land and all privileges
thereunto belonging to the Grantee, free and discharged of all right, title, claim, or
interest of the Grantor or anyone claiming by, through, or under said Grantor.
IN WITNESS WHEREOF, Grantor has duly executed the foregoing as of the day and year
first above written.
u Xr J r i�`�' (SEAL)
Mph teon Hewett
(SEAL)
Patricia Gail Hewett
(SEAL)
STATE OF NORTH CAROLINA
COUNTY OF BRUNSWICK
I certify that the following person(s) personally appeared before me this day, and
(I have personal knowledge of the identity of the principal(s)) (I have seen satisfactory
evidence of the principal's identity, by current state or federal identification with the
principal's photograph in the form of a Vk- ); each acknowledging to me
that he/she/they voluntarily signed the foregoing document for the purpose stated therein
and in the capacity indicated: Ralph Leon Hewett and wife, Patricia Gail Hewett
Date: (/2M 1-2 o-Z 1 CC
l.CAA(v5 to Emit-e_ Notary Public
)fficial Sears My Commission Expires: %o 1 %q 1 Z-0,2,,,
,tXpSAR Yit
s
PUB% -No a

PID: 244EE004
Lots 4 & 5 Goose Lane
Septic Puns
.. f. Scale. 1 " ". 4 '
p A logo
:7 1
N•�
z
tNtfi L ? NFIW Located Beyond
0 Edge of Marsh s
o �1
Poa! Lac&%11r.
�'= 51` �7' ^"'-----1:• `.».:'..e..,.�' /'...ta tla PSEem.xmvs �i� `
§L
ME
f. xr.�ra pMMne
4 �
6r t 3
tttt9
— 4 Bedroom Nome. 480 gal/day flow rate
—1000 gal septic tank
Rranai• — —f haCtlb nr E Zi OW c t -
>60" soil wetness condition
--1.2 gall day/ sq ft LTAR
-- 480/1.2 = 400 sq ft
400 sgft / T wide laterals = 133.4 linear feet
— 2 x 67' laterals on 9' centers
— 12' x 67' system area
System area is level, within 2"
Install with 24" to 30" trench bottom$
4
v�'
4
25b � ATE E � � r`T TANS' O
AND PUIVIp VSE REQUIRED.
�
I
REIDEIVE
18 GULLEY ENVIRONMENTAL, PLLC OCT 0 6 202' .

OCT 112021
Of NC LSS Permit option COVID-19
LHD Reference, J
This section for Local Health Department tee truly
LLD Catrrpleteness Review of the Notice of intent to Construct
"(c) Completeness Review far Notice of intent to Construct; -The loon' health dePartmfen t shall determine whether the no*e of
Intent to oanstruct required pursuant to subsection (b) of this section is Complete within five business days after reeeWngs the
notice of intent to construct; A determination of completeness means that the notice of intent to construct includes all of the
M?Uh'ed Components, if the local health department determines that the notice of'intent to construct is inc, plet,_ the local
health department shall notify the owner arnd list the information needed to complete the notice. The awvner may then submit
oddit'anol information to the local health department to cure the deficiencies in the initial notice. The local health department
shall make a f lixrt dstermr"nation as to whether the notice oaf intent to eanstmct I$ complete within fiug business day$ after the
depiartment receives the additional information, if the local health department fails to act within any time pad set a 'n this
subsection, the owner may treat the failure to act as a determination of completenesThe owner shtril be able to apply for the
building permitfor the project upon the decision of completeness of the notice of intent by the local health department or tf the
local health derurrtment fails to act within the five business daytime period.'
The review for completeness of this Notice of Intent was conducted in accordance with C.S.1.3OA-336.2(c). This
NOI Is determined to be;
El INCOMPLETE (if box is checked, information in this section is required.)
Based upon review of information submitted In Part 1, the following items are missing
COO les of this form listing missing items were sent to the LSS and the Owner on
via Date
with directions to re -submit missing items using Page 5 of this form.
final, FAX, USFs, hor4-de iWto
Z
tName OfAuthorired Aomtof d LH 54ngture ofAutiat ked Agent of theLHL)
OMPLY (if box is checked, information in this section Is required..)
Based upon review of information submitted in Part 1 of this form, this NOI Is deemed COMPLETE.
Copies O Of this signed form were sent to the LSS and the Owner on via
A;W Emalir FAX, USK ha""vend
A copy of this'NOi and tracking information was sent to the State on
A 6tv-
via
Hate Enid llSP lrand-akl'vered
"t'VGW OfAutharited AAA
QBnt d1 the LNQ S` tore Authwrzed Agent of the Li D
to
DiINVERVOS"S LSS Ct1WD-19 COMMON coRM Effective September 8, 2020
Page 4of6

$ CHECIKO $ CASH...
1J�'T iiATE.
w
dNDFCATI CASH
"MRMEO I�OR
AOJW T TO
fflaAMOUNTCW
ACTUAL PAYMSN Y
aPav,
THIS RECEIPT
Ww
6
NAMM MSCREE+MIN4 Ml==FYVtC
d
►NVA jo
NOUT
33286 S ATURi
C
VtAE9fIB URE

PID: 244EE004
Lots 4 & 5 Goose Lane
Septic Plans
Scale: 1 40'
"43'
t�o OR rQ
NHW Located Beyond
X1,
Edge of Marsh
0
k. 6
OME
41 1�-11,11
•
71
-X, 0
P11,
Wn.qtPw;;tPr Treatment RyStenl-Cleg
4 Bedroom Home; 480 gal/day flow rate
— 1000 gal septic tank
PKI
— >60" soil wetness condition
-- 1.2 gal/ day/ sq ft LTAR
-- 480/1.2 = 400 sq ft
— 400 sqft / Twide laterals = 133.4 linear feet
2 x 67' laterals on 9' centers
— 12' x 67'system area
System area is level, within 2"
— Install with 24" to 30" trench bottoms
X# = SOIL PROFILE DESCRIPTIONS (SEE ATTACHED)
NEEDHAM & GULLEY ENVIRONMENTAL, PLLC

Sol
AOA�O" IP,
�Kv� GUI
F V
$J17
PID: 244EE004
Lots 4 & 5 Goose Lane
Septic Plans
x'
Scale: 1 = 40'
Wastewater TrPntmPnt R�4
, Meml)esip
— 4 Bedroom Home; 480 gal/day flow rate
— 1000 gal septic tank
Initial'& Repair - Chamber or E7-F1_0VV System
— >60" soil wetness condition
-- 1.2 gal/ day/ sq ft LTAR
-- 480/1.2 = 400 sq ft
— 400 sqft / Twide laterals = 133.4 linear feet
2 x 67'laterals on 9' centers
— 12' x 67'system area
System area is level, within 2"
— Install with 24" to 30" trench bottoms
XI"
f4, = , SOIL PROFILE DESCRIPTIONS (SEE ATTACHED)
NEEDHAM & GULLEY ENVIRONMENTAL, PLLC

Hagood Homes Inc.
1908 Eastwood Rd. STE 328
Wilmington NC 28403
Office: 910-256-8284
[e-mail]
Hobbs Residence of 4646 Goose Lane SW,
I would like to address that we are required to inform you by Brunswick County that we are
contracted by Doug & Therese Goldsmith to build a residential single-family home in the vicinity of
your property. We have required a Local CAMA Permit for the intended project in the near future.
We have also attached a plan of the intended project for your knowledge.
If you may have any objections or comments to submit to the county, you may submit them to:
Connie Marlowe
Brunswick County Planning Department
PO Box 249
Bolivia NC 28422
Thank you kindly,
Shelbi Young
— Office Manager of Hagood Homes
M
C3
C3
Ci
rl

10/6/22, 8:03 AM
USPS.com® - USPS Tracking® Results
USPS Tracking'
Tracking Number:
70220410000046341369
Copy Add to Informed Delivery
(https://informeddelivery.usps.com/)
FAOs >
Remove X
Latest Update
Your item was delivered to an individual at the address at 11:02 am on October 5, 2022 in SHALLOTTE,
NC 28470.
Delivered
Delivered, Left with Individual
SHALLOTTE, NC 28470
October 5, 2022, 11:02 am
See All Tracking History
Text & Email Updates
USPS Tracking Plus®
Product Information
See Less ^
Track Another Package
Enter tracking or barcode numbers
U
m
CD
m
Q
m
https://tools. usps.com/go/TrackConfirmAction?tRef=full page&tLc=3&text28777=&tLabels=70220410000046341369%2C%2C&tABt=false 1 /2

Ha800dHomes Inc.
19OQEastwood Rd. STE32O
Wilmington N[284D3
OfOce:91O-Z56-DZ84
offioe@haQoodhomeszom
Fish Residence of 4676 Goose Lane SW,
I would like to address that we are required to inform you by Brunswick County that we are
contracted by Doug 8,Therese Goldsmith to build a residential single-family home in the vicinity of
your property. We have required a Local CAMA Permit for the intended project in the near future.
VVehave also attached aplan nfthe intended project for your knowledge.
If you may have any objections or comments to submit to the county, you may submit them to:
Connie Marlowe
Brunswick County Planning Department
POBox 249
Bolivia NC28422
Thank you kindly,
Shelbi Young
— Office Manager of Hagood Homes
C3
Postage
zt
Total Postage 2 d
ru

10/4/22, 8:28 AM
USPS.com@ - USPS Tracking® Results
Tracking Number:
7.1MIAM" AXI'll 11 A."R. ILLM'Tj
Copy Add to Informed Delivery
(hftps:Hinformeddelivery.usps.com/)
Latest Update
FAQs >
Remove X
Your item was delivered to an individual at the address at 11:32 am on October 3, 2022 in SHALLOTTE,
NC 28470.
Delivered
Delivered, Left with Individual
SHALLOTTE, NC 28470
October 3, 2022, 11:32 am
See All Tracking History
Text & Email Updates
USPS Tracking Plus®
Product Information
See Less /\
Track Another Package
Enter tracking or barcode numbers
OWA
https:lltools-usps.com/golTrackConfirmAction?tRef=fulipage&tLc=2&text28777=&tLabels=70220410000046341376%2C&tABt=false 112

Brunswick County Central Permitting
75 Courthouse Drive, Bolivia, NC 28422
[phone]
Receipt for Permits/ Planning
Project Number
548471
Payment Date
10/6/2022
Payment Method
CHECK
Payment Amount
$100.00
Check Number
21102
Permit Number Description Permit Amount
1000 CAMA Fee - Budget Line Item Number: 383912 S100.00
Total S100.00