EX #17 - Henry, Kathleen and Terrance

County of Dare
P.O. Box 859 1 Buxton, North Carolina 27920 1 252.475.5878
6/4/24
Exemption Number-#17
Kathleen & Terrance Henry
4665 Corinth Rd
Moncure, N.C. 27559
RECEIVED
J U N 0 4 2024
DCM-EC
RE: EXEMPTED PROJECT (Statutory Exclusion) - MAINTENANCE AND REPAIR
OF EXISTING STRUCTURES - [G.S. 113-103(5)(B)(5) and [15A NCAC
7K.0103(a)]
PROJECT ADDRESS — 46221 Tower Circle Rd, N.C. 27920
AREA OF ENVIRONMENTAL CONCERN — Ocean Hazard
Dear Two Sons Buxton LLC:
I have reviewed the information submitted to this office in your inquiry concerning the
necessary filing of an application for a minor development permit under the Coastal
Area Management Act. After making a site inspection on 3-27-2024, 1 have determined
that the activity you propose is exempt from needing a minor development permit as
long as it remains consistent with your site drawing and materials list submitted on 5-30-
2024, and meets the conditions specified below. If your plans should change and your
project will no longer meet these conditions, please contact me before proceeding.
MAINTENANCE AND REPAIR — [G.S. 113-103(5)(B)(5) and 15A NCAC 7K.0103(a)] -
Maintenance and repairs (excluding replacement) necessary to repair damage to
structures caused by the elements are specifically excluded from the definition of
development under the conditions and in the circumstances set out in G.S.
113A-103(5)(b)(5). Individuals required to take such measures within an AEC shall
contact the local CAMA representative for consultation and advice before beginning
work.
Structures may be repaired in a similar manner, size and location as the original
structure. No expansions or additions are permissible. The repairs are limited to 50%
of the market value of the existing structure and the following specific conditions.
1) The project consists of the Repairing existing septic tank with new Drain field as
needed, as shown on the attached drawing and materials list at cost of $15,000
Which is only 5% of current tax value which is at $213,000 which is under the
50% rule.
2) The proposed repairs shall be consistent with all other applicable local
ordinances and North Carolina Building Code standards.
1367 US 17 South, Elizabeth City, NC 27909
Phone: [phone] FAX: [phone] ; Internet www,nocoastalmanagement.net
LAND OF BEGINNINGS
An Equal O�Npogp&\ Affirmative Actin Employer
PR TE RECYCLED PA ER

6/4/2024
Page 2of 2
J U N 0 4 2024
3) In order to minimize adverse impacts to nesting sea turtles, the following (�CM_E ;
guidance from the U.S. Fish and Wildlife Service and Wildlife Resources Commission
should be followed
4) Sea turtle sightings: If any nesting turtles are sighted on the beach during
construction, construction activities must cease immediately until the turtle has returned
to the water, and the sea turtle permit holder has marked for avoidance any nest(s) that
may have been laid.
5) No Relief from Take Provisions of Endangered Species Act Section 9 (ESA):
This permit does not provide relief from liability under provisions of the ESA.
Pursuant to Section 9 of the ESA, it is unlawful for any person to take any listed
endangered species within the United States or the territorial sea of the United
States. The term "take" means to harass, harm, pursue, hunt, shoot, wound, kill,
trap, capture, or collect, or to attempt to engage in any such conduct.
6) Reporting Requirement: If a sea turtle nest is uncovered or a dead, injured, or
sick individual of an endangered or threatened species is discovered, initial
notification must be made to the Service's Law Enforcement Office below. Additional
notification must be made to the Raleigh Ecological Services Field Office identified
above and to the NCWRC at [phone]. Care should be taken in handling sick
or injured individuals and in the preservation of specimens in the best possible state
for later analysis of cause of death or injury.
Kathy Matthews 919-856-4520 ext 27
U.S. Fish and Wildlife Biologist
551-F Pylon Drive Raleigh, NC 27606
katluyn matthews([e-mail]
This exemption to CAMA permit requirements does not alleviate the necessity of your
obtaining any other State, Federal or Local authorization and N.C. Building Permits.
This exemption expires 90 days from the date of the letter.
Sincerely,
NAME: K.D. Jackson
TITLE: LPO
Cc: Yvonne Carver
LAND OF BEGINNINGS
PRINTED ON RECYCLED PAPER

Authorization for Wastewater
System Construction
County of Dare
PO Box 669
Manteo NC 27954
sN.f5FELVED7V1
JUN 0 4 M4
d' one: [phone]
DARE COUNTY DEPARTMENT OF PUBLIC HEALTH DCM- C
Authorization for Wastewater System Construction
This CA is valid as long as the IP remains valid (SL 2014-120), Disclaimer:
This permit does not relieve you of the responsibility to obtain any other necessary Federal, State or Local permit(s).
Parcel: 023834000
LOT: BLK: SEC: Permit: S10-25901
Location:
46221 TOWER CIRCLE RD— BUXTON
Subdivision;
SUBDIVISION - NONE
Owner Namei
KATHLEEN M HENRY Permit Date: 05/28/2024
Owner Address:
4665 CORINTH RD Permit Type: WASTEWATER REPAIR
MONCURE, NC 27559
Phone: [phone] email: wehenrvsCdgmail com
Gallons per day: 480
Number of bedrooms:
4 Long term accept rate: 1.20
Occupancy:
8 Tanktype: PRECAST
Water Supply:
PUBLIC Tank size: 1000
Amount of drain field:
200 Pump tank size: 0
Number of lines:
5 Grease trap size: 0
Trench length (feet): 40 Septic type: Type 11-A - Conv. (any SFR)
Trench width (inches): 36 Septic code: RESIDENTIAL
Trench depth (Inches): 18 Distribution: DISTRIBUTION BOX
Gravel depth (inches): 12 Distance from building: 5
Rock Under (inches): 6 Distance from water supply: 10
Rock Above (inches): 2 Distance from property line: 10
Bed system dimensions: 15'x40' Distance from open water: 50
Design Specifications:
BPJ Repair-.0508 Available Space - Prior to installation, ensure any other permits required are obtained from CAMA or NPS.
Permit to repair 48R septic system. Pump, crush, and remove the existing septictank. Dig up and remove any old/damaged
drainfield materials - thoroughly turn over soil in this area. Dispose of all old septic materials off -site, do not bury on -site.
Install a new 1000 gal septic tank as shown on the site plan. Install 5 new 40' drainiines, Ton center, with a maximum depth of
30" below the existing grade. Setbacks to the property lines, home, HVAC platform, and water line must be maintained. This
site Is exempt of the requirement for repair area with no additional usable space to claim.
wine: i ms rermit Is suDJect to all provisions of the 1SA NCAC 18E rules governing the Installation of septic systems.
The person making the installation must notify the Health Department when the septic tank system is ready for
inspection. If any septic tank system or part thereof is covered before being inspected and approved, it shall be
uncovered at the direction of the Heal icer he expense of the one responsible for making the installation.
Issued 05/28/2024 Permit Fee: $ 75,00
Jim
Specialist
Application Reference# 14728
KATHLEEN M HENRY
Applicant Signature

qft, 2,f * 14728
LH➢ PERMIT-N0, OR FILE REF;
srq BEST PROFESSIONAL JUDGMENT
.oq� foi
LOCAL HEALTH DEPARTMENTS
NC DEPARTMENT OF
HEALTH AND
or
HUMAN SERVICES
PRIVATE LICENSED PROFESSIONALS
Division of Public Health
IN ACCORDANCE WITH 15A NCAC 18E .1306
*This page to be completed by LHD or private licensed professional
SITE LIMITATIONS — Check the specific rules that prevent the site from being repaired and permitted in accordance with
G.S. 130A, Article 1 I and 15A NCAC 18E.
❑ Rule .0502 — Topography & Landscape Position
❑ Rule .0503 — Soil Morphology
❑ Rule .0504 — Soil Wetness Condition
❑ Rule .0505 —Soil Depth
❑ Rule .0506 — Saprolite RECEIVED
❑ Rule .0507 —Restrictive Horizons
❑■ Rule,0508—Available Space IUN 0 4 2024
❑ Other Rule(s) (please specify):
DCM-EC
PLEASE CHECK THE FOLLOWING WHEN COMPLETED:
(till boxes mist be reviewed, and applicable boxes checked before issuance of repafrperndt)
❑ Wastewater system troubleshooting complete. Household/facility water use has been reviewed
❑■ Wastewater system repair does not reduce the required horizontal setbacks to drinking water wells as indicated in 15A
NCAC 18E .0601.
On Wastewater system repair does not reduce the required horizontal setbacks to surface water bodies greater than 50 percent of
the horizontal setbacks indicated in 15A NCAC 18E .0601,
Q Wastewater system repair has a reasonable expectation to function in accordance with 15A NCAC 18E ,1306(c)(2)(D)
REHS SIGNATURE (if applicable)
Sigh atf ure O[ ihorizcJ A
AOWEIPE SIGNATURE (if applicable)
Signature of AOWE/PE
Lieenso Number
Date
*This iurinen agreement shall be aanNjed io the Construction Authorization, Operation Permit, Notice of Intent to Construct, or
Authorization to Operate, as applicable.
Fenn nP1-24.1 Page I oft January 2024

J U N 0 4 2024
OCM-EC

LHD PERMIT NO. OR FILE REF: 141 ZO
®RN
OWNER REQUEST
for
BEST PROFESSIONAL JUDGMENT
NC nEPARTHENT OF
HEALTH AND
HUMAN SERVICES
070Ss not Public Hpaitp
for the repair of
WASTEWATER TREATMENT AND DISPERSAL SYSTEMS
IN ACCORDANCE WITH 15A NCAC 18E .1306
*This page to be completed by owner of property or owner's legal representative
DATE: May 29 20 24
RECEIVED
WASTEWATER SYSTEM OWNER — For a place of residence list the property owner(s). For all others, list name of the
business or organization and person delegated signature authority: 1UN 0 4 2024
Print PropertyOwner(s): Kathleen Henry DCnn FC
Business/Organization/Contact:
Mailing Address: 4665 Corinth Rd
City, Moncure
Telephone
Email Add
State: NC Zip Code: 27559 County:
PHYSICAL LOCATION OF WASTEWATER SYSTEM
Parcel Identification Number rnIN1:023834000
Physical Address (if different than mailing address): 46221 Tower Circle Rd
City: Buxton State: NC Zip Code: 27920
OWNER ATTESTATION
I X Kathleen Henry hereby request the use of best professional judgment in accordance
Owner's Printed Name
with 15A NCAC 18E .1306. I understand that the use of best professional judgment may be used to develop a
repair that should enable my malfunctioning subsurface wastewater system to comply with 15A NCAC 18E
.1303(a)(1) and give the system a reasonable expectation to function correctly. I agree to comply with all terms and
conditions set forth on the associated repair permit, including any operation and maintenance requirements. By
signing this document, I understand that I shall be liable for any damages associated with the use of best professional
judgment to repair this malfunctioning subsurface wastewater system.
Owner's Signature:
Date:
*This written agreement shall be attached to the Construction Authorization, Operation Permit, Notice oflntent to Construct, or
Authorization to Operate, as applicable.
Form M-24.1 Page 2 of 2 January 2024

SURVEY NOTES:
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RRE SP.Vl01 AW OO6 NOT consTroun A TILE SEARW DY r5a.. KATHLEEN V. HURRY. .4 op.
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AfATHLEEN U & 7ERRANCE HENRY T P,
46221 TOWER CIRCLE ROAD POOP�gµu'
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04 2024
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614/24, 10:12 AM Housecall
UELITY SERVICE AND PRODUCTS
3 I R I C. I U I 1 Y o. i oY
You have a new estimate from Lee Septic &
Land Co
® Address: 46221 N Tower Cir, Buxton, NC 27920
Option #1
$15,000.00
DECLINE
RECEIVED
Estimate Details
Service Unit Price Qty Total
Service- Drain Field repair- $15,000.00 1 $15,000.00
46221 N Tower Cir - Buxton
Drain Field repair - 46221 N Tower Cir - Buxton
Dig up and remove any old/damaged arainfeld materials
Thoroughly turn over soil i this area. Dispose of all old septic material off site - do
not bury
SHOW MORE
Service subtotal
$15,000.00
JUN 0 4 2024
DCM-EC
httpsllclient.housecallpro.com/estimates/O0328abed6f6444497al67lbOOe6aft>4e695cf61bca9O8b23f9l371754blle66 d7ebD53334895cd27c32881... 1!2