20070676 Ver 1_401 Application_20070407

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• P.O. Box 466 Phone: [phone]
~ N G I N ~ ~ R I N G ~ P• C• Kitty Hawk, NC 27949 Fax: [phone]
email: [e-mail]
April 13, 2007
Division of Water Quality
401 Wetlands Unit
1650 Mail Service Center
Raleigh, NC 27699-1650
Telephone: [phone]
Fax: [phone]
07 •0676
Re: Cedar Hammock Resort Travel Trailer Park-25671 NC12 Highway-Waves-
Dare County-North Carolina
Included in this transmittal are the following:
- (7) copies of the completed Pre-Construction Notification Form
- (7) copies of the Cedar Hammock Resort Agent Authorization Form
- (7) copies of the NCEEP acceptance letter
- (7) copies of the Dare County Authorization for Wastewater System Construction
Permit
- (7) copies of the Proposed Stormwater Management Plan
Thank you for your time and attention to this matter. Please feel free to contact me with
any questions or concerns you may have.
Respectfully su miffed,
4
Cary V. House, EIT
House Engineering, P.C.
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. ~ ~ ~ ~ P.O. Box 466 Phone: [phone]
~E N G I N ~ ~ R I N G , P C. Kitty Hawk, NC 27949 Fax: [phone]
email: [e-mail]
0 ? 0 ~ 7 ~
March 24, 2007
Re: Cedar Hammock Resort Travel Trailer Park-25671 NC 12 Highway-Waves-Dare
County-North Carolina
To all permitting agencies:
House Engineering, P.C., has been retained by the property owner, Asa H. Gray III, to help
obtain all permitting for the travel trailer park located at the above referenced property.
This correspondence gives owner authorization to House Engineering, P.C., to act as their
agent.
Thank you for your time and attention to this matter. Please feel free to contact me with any
questions or concerns you may have.
Respectfully submitted,
~~~
~~ ~ r
Frederick A. House, P.E.
President-House Engineering, P.C.
I/we authorize House Engineering, P.C., to act as an agent on my/our behalf for securing all
permits for the purpose of constructing a travel trailer park located at 25671 NC 12 Highway-
Waves-Dare County-North Carolina.
C~~ ~ ~~~,~~ ._", t~ _ Owner
Asa H. Gray III
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House Engineering, P.C. file# 052274_agentauthorization.doc

Office Use Only: Fonv Version Match OS
USACI; Action ID No, 0 7 0 6 7 6
DWQ No.
itv., ..,: .~..
-- -•-, r~•••~•••••~ •••••~~ ~~ •w~ nNNucauic w uus pto~ecti, please enter °NOt applicable" or "N/A".)
I. Processing PAYMENT
1. Cl ~ck all of the approval(s) requested for this project: RECEIVED
~] Section 404 Permit ^ Riparian or Watershed Buffer Rules
^ ection 10 Permit ^ Isolated Wetland Permit from DWQ
~O1 Water Quality Certification ^ Express 401.Water Quality Certification
2• ationwide Regional or General Permit Number(s) Requested: (~~
3. If this notification is solely a courtesy copy because written approval for the 401 Certification
is not required, check here: ^
4. If payment into the North Carolina Ecosystem Enhancement Program (NCEEP) is proposed
for mitigation of ii acts, attach the acceptance letter from NCEEP, complete section VIII,
and check Here:
5. If your project is located in any of North Carolina's twenty coastal counties (listed on page
4), and the project is within a North Carolina Division of Coaa~t~l -~sr~ Ien~ ;~r'e~ 1pf
Environmental Concern (see the top of page 2 for fiu-ther details), ~~~~ ~~'~ ~ ~ •~
;.>
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II. Applicant Information
1. Owner/Applicant Information
Name: l~S ~ I-~ ~ (..7 R /k
~aP~': 1 ~, 201,
,~~
,~~,rc~+r' ~;-
2. Agent/Consultant Information (A signed and dated copy of the Agent Authorization letter
must be attached if the .A etrt has signatory authority for the owner/applicant.)
Name: ~ P~ ~-~1~~'4~ ,
Company Affiliation: I-~CJI~~~ ~(~1G1 I•I~~~'-tt~~, ~', C,
~---
Mailing Address: ~P. ~, gf~K ~-~~ _
'helephone Num
E-mail Address:
.) Lks I •- (~ [.`~~ Pax Nulmber: ("L5L
Page 5 of l2
Telephone Number: 2.e7 - C~ Z. Fax Number:
E-mail Address:

III. Project Informatiou
Attach a vicinity map clearly showing the location of the property with respect to local
landmarks such as towns, rivers, and roads. Also provide a detailed site plan showing property
boundaries and development plans in relation to surrounding properties. Both the vicinity map
and site plan must include a scale acid north arrow. The specific footprints of all buildings,
impervious surfaces, or other facilities must be included. If possible, the maps and plans should
include the appropriate USGS Topographic Quad Map and NRCS Soil Survey with the property
boundaries outlined. Plan drawings, or other maps may be included at the applicant's discretion,
so long as the property is clearly defined. For administrative and distribution purposes, the
USAGE requires information to be submitted on sheets no larger than 11 by 17-inch format;
however, DWQ may accept paperwork of any size. DWQ prefers full-size construction
drawings rather than a sequential sheet version of the full-size plans. If full-size plans are
reduced to a small scale such that the final version is illegible, the applicant will be informed that
the project has been placed on hold until decipherable maps ace provided.
1. Name of project: C~6'~R- l-~t4~1~'if~k-~l?5f~t~"`~~yFL•~f~l~I ~- ~'P~~-l~*
2. T.LP. Project Number or State Project Number (NCDOT Only):_ ~~~
3. Property Identification Number (Tax PIN): ~6~11 ~d~~ ~e>~
Location
County: pA~C Nearest Town: ~ n`J~'`-~
Subdivision name (include phase/lot numbet•): N©~ ~t~ - ~" EL !T
Directio is to site (include road numbers/names, landmarks, etc.): ~ lZ ~~ ~' .y
vJ~J~~s •~ ~a~ ~®t,1rJTy -- Ana Ca~u rtl~, -s-~~~r~a y~
5. Site coordinates (For linear projects, such as a road or utility line, attach a sheet that
separately lists the coordinates for each crossing of a distinct waterbody. ~ ,~
Decimal Degrees (6 digits minimum): ~~~ ~~~ ~~~i °N ~.5 Z~ ®~ oW
6. Property size (acres):_ 2.1~
vat 7. Name of nearest receiving body of water: ~'~1~ ~-t ~ ~d~~
8. River Basin: PA"'~ ~'lL~ ~~~~ ~ ~A~Si "'
(Note -this must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at htt~•//h2o etu• state.nc.us/admin/malls/.)
9. Describe the existing conditions on the site and general land use in the vicin
at the time of this application: ~ ik~~ 5 i'"I~1i/ l `~ _~=-t7~f~-~~~-`~ ~~
°~-t'.t-1;~ ~a0~~ t5 T~~P-~ t'it~tt.~t~~i 5~~'Pt~i. t 1~
"("tom ~~ i t~ .,~.t,l~ SEQ. t i.5~ ~~ i t~l,S a191?~Ui ~t ~
v~l~`~ I~ I~C• ~~~L~ iZ,
of the project
~~ ~/ir~ ~
,~ tS
~~ ~
-~ '~~-
Page 6 of 12

IO
STGVJ~Aeb
11. Explain the purpose of the pt•oposecl work: ~f~ I~~k=~ ~~~ •~k'-•Tt-~~
IV. Prior Project History
If jurisdictional determinations and/or permits have been requested and/or obtained for this
project (inchtding all prior phases of the same subdivision) in the past, please explain. hlclude
the USAGE Action ID Number, DWQ Project Number, application date, and date permits and
certifications were issued or withdrawn. Provide photocopies of previously issued pernits,
certifications or other use;fiil information. Describe previously approved wetland, stream and
buffer impacts, along with associated mitigation (where applicable). If this is a NCDOT project,
list and describe permits issued for prior segments of the same T.LP. project, along with
construction schedules.
V. Future Project Plats
Are any firture permit requests anticipated for this project? If so, describe the anticipated work,
and provide justification ~'or the exclusion of this work from the current application.
VI. Proposed Itupacts to Waters of the United States/Waters of the State
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
wetlands, open water, and stream channels associated with the project. Each impact must be
listed separately in the tables below (e.g., culvert installation should be listed separately from
riprap dissipater pads). lie sure to indicate if an impact is temporary. All proposed impacts,
permanent and temporary, must be listed, and must be labeled and clearly identifiable on an
accompanying site plan. All wetlands and waters, and all streams (intermittent and perennial)
should be shown on a delineation map, whether or not impacts are proposed to these systems.
Wetland and stream evaluation and delineation forms should be included as appropriate.
Photographs may be included at the applicant's discretion. If this proposed impact is strictly for
wetland or stream mitigation, list and describe the impact in Section VIII below. If additional
space is needed for listing; or description, please attach a separate sheet.
1. ~rovide a written description of the propo eel impacts: ~~~?~%~C~'~ ~j~~A~Li1~
~N I LL. R-E GZ t~ t ~. T' N ~ Fl lu t;~ C~ ~ ~T~ C O
Page 7 of 12

2. Individually list wetland impacts. Types of impacts include, but are not limited to
mechanized clearing, grading, fill, excavation, flooding, ditching/drainage, etc. For dams,
CPtIAYatPiV lief imnactc rl~iP to tenth .atrnCtul'e and f700d11]tZ.
.,.. ...~.
Wetland Im act
p
Site Number
(indicate on map) _. __~_.---t~---- --- --

Type of Impact ----
Type of Wetland

(e.g., forested, marsh,
herbaceous, bog, etc.)
Located within
100-year
Ploodplain
(yes/no
Distance to
Nearest
Stream
(linear feet)
Area of
Impact
(acres)
I~~j~2G~5 1175 ~ I.,r_., ~~ E5 C~~ ~' ~ ~ ` ~ ~

1bta1 Wetland Impact (acres)
,.
3. List the total acreage (estimated) of all existing wetlands on the property: I~ ~ ~~ `'~
4. Individually list all intermittent and perennial stream impacts. Be sure to identify tempot•ary
impacts. Stream impacts include, but are not limited to placement of fill or culverts, dam
construction, flooding, relocation, stabilization activities (e.g., cement walls, rip-rap, crib
walls, gabions, etc.), excavation, ditching/straightening, etc. If stream relocation is proposed,
plans and profiles showing the linear footprint for both the original and relocated streams
t b 1 d d To calculate acreage multi ly length X width; then divide b 43,560.
mus
Stream Impact
Number
indica a on ma e tnc u e _

Stream Name ,

Type of Impact
Perennial or
Intermittent?
Average
Stream Width
Before Im act
Impact
Length
(linear feet
Area of
Impact
acres
_

Total Stream Impact (by length and acreage)
5. Individually list all open water impacts (including lakes, ponds, estuaries, sounds, Atlantic
Ocean and any other water of the U.S.). Open water impacts include, but are not limited to
fill, excavation, dredgin , flooding, drama e, bulkheads, etc.
Open Water Impact Type of Waterbody Area of
Name of W aterbody T e of Im act (lake, pond, estuary, sound, bay, Impact
Site Number if a licable yp p ) acres
(indicaf~e on map) ( pp ) ocean, etc. ( )
Total Open W ater Impact (acres)
Page 8 of 12

6. List the cumulative impact to all Waters of the U.S. resulting from the project:
Stream Impact (acres):
Wetland Impact (acres):
O en Water h~act acres):
Total Impact to Waters of the U.S. (acres)
Total Stream Im pact (linear feet):
7. Isolated Waters
Do any isolated waters exist on the property? ^ Yes [V] No
Describe all impacts to isolated waters, and include the type of water (wetland or stream) and
the size of the proposed impact (acres or linear feet). Please note that this section only
applies to waters that have specifically been determined to be isolated by the USACE.
Pond Creation
If construction o a pond is proposed, associated wetland and stream impacts should be
included above in the wetland and stream impact sections. Also, the proposed pond should
be described here and illustrated ou any maps included with this application.
Pond to be created in (check all that apply): ^ uplands ^ stream ^ wetlands
Describe the method of construction (e.g., dam/embanlanent; excavation, installation of
dl•aw-down valve ol• spillway, etc.):
Proposed use or purpose of pond (e.g., livestock watering, irrigation, aesthetic, trout pond,
local stormwater requirement, etc.):
Current land use in the vicinity of the pond:
Size of watershed draining to pond: Expected pond surface area:
VII. Lnpact Justification (Avoidance and Minimization)
Specifically describe measures taken to avoid the proposed impacts. It may be useful to provide
information related to site constraints such as topography, building ordinances, accessibility, and
financial viability of the project. The applicant may attach drawings of alternative, lower-impact
site layouts, and explain why these design options were not feasible. Also discuss how impacts
were minimized once the desired site plan was developed. If applicable, d1SCl1SS Co11St1'UChon
techniques to be followed during construction to reduce impacts. j ~~~ ~`• ~~-~ ~~"~ TVP-fJ~~{~
~5 /~.R.E~vt e~~~Jr'e;~ ~+G ccxa~~1 dl?~tt~A~Cly 'C~i11~:c. i P-Aa t ~-~-~~'/~R.K-
VIII. Mitigation
DWQ - In accordance with 15A NCAC 2H .0500, mitigation may be required by the NC
Division of Water Quality for projects involving greater than or equal to one acre of impacts to
freshwater wetlands or greater than or equal to I50 linear feet of total impacts to perennial
streams.
Page9of12

USACE - In accordance with the Final Notice of Issuance and Modification of Nationwide
Permits; published in the Federal Register on January 15, 2002, mitigation will be required when
necessary to ensure that adverse effects to the aquatic environment are minimal. Factors
including size and type of proposed impact and function and relative value of the impacted
aquatic resource will be considered in determining acceptability of appropriate and practicable
mitigation as proposed. Examples of mitigation that may be appropriate and practicable include,
but are not limited to: reducing the size of t:he project; establishing and maintaining wetland
and/or upland vegetated buffers to protect open waters such as streams; and replacing losses of
aquatic resource functions and values by creating, restoring, enhancing, or preserving similar
functions and vahies, preferable in the same watershed.
If mitigation is required for this project, a copy of the mitigation plan must be attached in order
for USACE or DWQ to consider the application complete for processing. Any application
lacking a required mitigation plan or NCEEP concurrence shall be placed on hold as incomplete.
An applicant may also choose to review the current guidelines for stream restoration in DWQ's
Draft Technical Guide for Stream Work in North Carolina, available at
http://h2o.em•atate.nc.us/ncwetlands/strmgide.htmL
I. Provide a brief description of the proposed mitigation plan. The description should provide
as much information as possible, including, but not limited to: site location (attach directions
and/or map, if offsite), affected stream and river basin, type and amount (acreage/linear feet)
of mitigation proposed (restoration, enhancement, creation, or preservation), a plan view,
preservation mechanism (e.g., deed restrictions, conservation easement, etc.), and a
description of the current. site conditions and proposed method of construction. Please attach
a ~ ~a~•ate sheet if more space is needed.
2. Mitigation ma.y also lie made by payment into the North Carolina Ecosystem Enhance-nent
Program (NCEEP). Please note it is the applicant's responsibility to contact the NCEEP at
[phone] to determine availability, and written approval from the NCEEP indicating
that they are will to accept payment for the mitigation must be attached to this form. For
additional information regarding the application process for the NCEEP, check the NCEEP
website at hCth•//h2o enr state.uc.us/wrp/index.htm, If use of the NCEEP is proposed, please
check the appropriate box on page f ve and provide the following information:
Amount of sh•eam mitigation requested (linear feet):
Amount of buffer mitigation requested (square feet):
Amount of Riparian wetland mitigation requested (acres):
Amount ofNon-riparian wetland mitigation requested (acres):
Amount of Coastal wetland mitigation t•equested (acres):
Yage 10 of 12

IX. Environmental Documentation (required by DWQ)
1. Does the project involve an expenditure of public (federal/st e/local) funds or the use of
public (federal/state) land? Yes ^ No
~~~ If yes, does the project require preparation of an environmental document pursuant to the
,requirements of the National or North Carolina Environmental Policy Act (NEPA/SEPA)?
Note: If you .are not sure whether aNEPA/SEPA document is required, call the SEPA
coordinator at [phone] to review current thresholds for environmental documentation.
Yes ^ No ^
~f ~ If yes, has the document t•eview been ftnalized by the State Clearinghouse? If so, please
attach a copy of the NLPA of SEPA final approval letter. Yes ^ No ^
X. r~oposed Impacts ou Riparian and Watershed Buffers (required uy DWQ)
t is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
required state and local buffers associated with the project. The applicant must also provide
justification for these impacts in Section VII above. All proposed impacts must be listed herein,
and must be clearly identifiable on the accompanying site plan. All buffers must be shown on a
map, whether or not impacts are proposed to the buffers. Correspondence from the DWQ
Regional Off ce tnay be included as appropriate. Photographs may also be included at the
applicant's discretion.
Will the project impact protected riparian buffers identified. within 15A NCAC 2B .0233
(Neuse), 15A NCAC 2B .0259 (Tar-Pamlico), 15A NCAC 02B .0243 (Catawba)15A NCAC
2B .0250 (Randleman Rules and Water Supply Buffer Requirements), or other (please
identify )? Yes ^ No ^
If "yes", identify the square feet and acreage of impact to each zone of the riparian buffers.
If buffer mitigation is required calculate the required amount of mitigation by applying the
buffer multi liens.
e*
Z Impact Multiplier Required
on (square feet) Miti anon
_
1 3 (2 for Catawba)
2 I.5
Total
* Zone 1 extends out 30 feet petpendieulat• from die top of the neap bank of channel; Zone 2 extends an
additional 20 feet from the edge of Zone 1.
• If buffer mitigation is required, please discuss what type of mitigation is proposed (i.e.,
Donation of Property, Riparian Buffer Restoration /Enhancement, or Payment into the
Riparian Buffer F.estoration rand). Please attach all appropriate information as identified
within 15A NCAC 2B .0242 or .0244, or .0260.
Page 11 of 12

XI. Stormwater (required by DWQ)
Describe impervious acreage (existing and proposed) versus total acreage on the site. Discuss
stormwater controls proposed in order to protect surface waters and wetlands downstream from
the property. Il' percent impervious surface exceeds 20% lease,provide calculations
demonstrating total proposed impervious level. ~1~1- SIG ~~tiiU~ F'~~ ~~'~i~ ~~~'-a~
T6-~~
XII. Sewage Disposal (required uy DWQ)
Clearly detail the ultimate treatment methods and disposition (non-discharge or discharge) of
wastewater generated frotrt the proposed protect, or av ilable cap city of the subject f ctlity.
`Ti•tE P~r~~ TP~k~~T~~FFi?c~,- ~t ~~. t-~h~E ~t~t"~r/k', ~~
XIII. Violations (required by DWQ) ~7A~ C,GI?~+.1'T~I ~t~ttit~l'i-~ ~,'~{"z2-f~'
Is this site in violation of D~Wetland Rules (15A NCAC 2H .0500) or any Buffer Rules?
Yes ^ No
Is this an after-the-fact permit application? Yes ^ No
XIV. Cumulative Impacts (required by llWQ)
Will this project (based on past and reasonably anticipated future impacts) result in addit' gal
development, which could impact nearby downstream water quality? Yes ^ No
If yes, please submit a qualitative or quantitative cumulative impact analysis in accordance with
the most recent North Carolina Division ol.' Water Quality policy posted on our website at
http://h2o.enr.state.nc.us/ncwetlands. If no, please provide a short narrative description:
XV. Other Circumstances (Optional):
It is the applicant's responsibility to submit the application sufficiently. in advance of desired
construction dates to allow processing time for these permits. However, an applicant tnay
choose to list constraints associated with construction or sequencing that may impose limits on
work schedules (e.g., draw-down schedules for lakes, dates associated with Endangered and
Thrle~tened Species, accessibility problems, or other issues outside of the applicant's control).
I~,~-~~~.~F
Vic- -~I~3
-~ Applicant/Agent's Signature`• ~~ ~ ll~ate
(Agent's signature is valid only. if an authorization letter from the applicant is provided.)
5~~ h.`6~P~ ~~fJ I /~t7ft~U~.I.7~1 IC~1
Page 12 of 12

1A
,i as~stem .~_
PROORAM
March 8, 2007
Asa H. Gray III
PO Box b19
Rodanthe, NC 27968
Project: Cedar Hammock Resort Travel Trailer Park
07 •0676
County: Dare
The purpose of this letter is to notify you that the North Carolina Ecosystem Enhancement Program (NCEEP) is willing to
accept payment for impacts associated with the above referenced project. Please note that this decision does not assure that
the payment will be approved by the permit issuing agencies as mitigation for project impacts. It is the responsibility of the
applicant to contact these agencies to determine if payment to the NCEEP will be approved.
This acceptance is valid for six months from the date of this letter and is not transferable. IF we have not received a copy of
the issued 404 Permit/401 Certification(CAMA permit within this time frame, this acceptance will expire. It is the
applicant's responsibility to send copies of the permits to NCEEP. Once NCEEP receives a copy of the permit(s) an invoice
will be issued based on the required mitigation in that permit and payment must be made prior to conducting the authorized
work. The amount of the In Lieu Fee to be paid to NCEEP by an applicant is calculated based upon the Fee Schedule and
policies listed at www.nceep.net.
Based on the information supplied by you the impacts that may require compensatory mitigation are summarized in the
followine table.
Tar-Pamlico
03020105 Stream (feet} Wetlands {acres) Buffer I
(Sq. Ft.) Buffer II
(Sq. Ft.)
Cold Cool Warm Ri orlon Nan-Ri orlon Coastal Marsh
Impacts 0 0 0 0 0.09 0 0 0
Credits 0 0 0 0 0.18 0 0 0
Upon receipt of payment, EEP will take responsibility for providing the compensatory mitigation. If the regulatory agencies
require mitigation credits greater than indicated above, and the applicant wants NCEEP to be responsible for the additional
mitigation, the applicant will need to submit a mitigation request to NCEEP for approval prior to permit issuance. The
mitigation will be performed in accordance with the Memorandum of Understanding between the N. C. Department of
Environment and Natural Resources and the U. S. Army Corps of Engineers dated November 4, 1998.
If you have any questions or need additional information, please contact Kelly Williams at {919) 716-1921.
Sincerely,
~ . ~'l
yam D. Gilmore, PE
Director
cc: Cyndi Karoly, Wetlands/401 Unit
Tom Steffens, USACE- Washington
Kyle Barnes,DWQ-Washington
Doug Huggett, NCDCM-Morehead City
Cary House, agent (email}
File
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North Carolina Ecosystem Enhancement Program, 1652 Mai! Service Center, Raleigh, NC 27659-1 652 / 91 9-71 5-0476 / www.nceep.net

C d7 ~
~~Y OFd
Im ovement Permit ~
County of Dare ~ •~„~' 14226
PO Box Drawer 1000
Manteo, North Carolina 27954 ~°'~TN ~AR~`•~~P Phone: [phone]
Dare County Health Department
Improvement Permit (Septic Tanlc Sewage Disposal)
Non-Transferable ~ 7 0 6 7 g
PIN: 065705095695
Owner Name: GRAY, ASA H III
Owner Address: P O BOX 619
RODANTHE NC 27968
DBA: CEDAR HAMMOCK RESORT
Location: 25671 NC 12 HWY
Subdivision: SUBDIVISION -NONE
Permit. Date:
Comm / Res:
Owner Phone:
Permit#: 14226
2/9/2007
Commercial
[phone]
LotBlockSect: Lot: PARCEL TWO Blk: Sec:
Category of System: New
Type of Tank:
Type of System: Precast Size of ~fanlc: .1,500
Type IV-A
Amount of Tile (feet): 1,056 Width of Ditch: 1
5
Rock Under (znches); 6 Rock Above (inches): .
2
No. of Bedrooms: 0
Sleeping Capacity (persons): 0 Gallons per Day:

Type of Water:
Public Previous Permit#: 2 880
Feet from Water Supply:
Feet from Property Line: 10 Feet from Body of Water: 50
l0 Feet from Building:
Comments: FILL CHECK REQUIRED PRIOR TO DRAINFIELD CONSTRU 5
CTION.
INSTALL AS DESIGNED BYHOUSE ENGR
° '~ ~
~ ~~~
.
SYSTEM REQUIRES A CERTIFIED OPERATOR ~ ~
~ ~'~ ~~$ f.r:
t
~
:
,
:
,,; ,..~ 2Q~, l
.:.
~;~~, a~ ~; ~ ~ ~1
Note: This Permit is issued subject to all provisions of the ordinance 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 Health Officer at the expense of the one responsible for making the installation.
Issued By•
~. ~ -
Environmental Health Specialist Date
l:':itl'x;l~f>'ll~ ~'~i'Fi'i;'~'
Parcel: 014307000
Sewer Per ~i sFee: $600 2/9/2007
'~
Applicant Date
~.. f~€~ 6,~~~ ~,, I..l~~~~ ~ l:~~tst~:~~:~~€Itz~:

Authorization for Wastewater System Construction
J~~Y CFO
County of Dare o ~, -v
PO Box Drawer 1000 U ,~~' 14226
Manteo, North Carolina 27954
ao ~~~
RTH cnR~~
Permit Date: 2/9/07 Permit#: 14226
Parcel 014307000 PIN: 065705095695
Owner Name: GRAY, ASA H III District: 19
Owner Address: P O BOX 619
RODANTHE NC 27968 Owner Phone: {252)473-0872
Location: 25671 NC 12 HWY -City/State: WAVES, NC
Subdivision: SUBDIVISION -NONE
LotBlockSect: Lot: PARCEL TWO Bllc Sec:
~ ~
Authorization By: Elizabeth More '~~\ Date: 2/9/2007
1. Original Improvement Permit Number: -_
2. Wastewater inspected by: ..~..__.._..~....~.............__..,,...._....._......._...~..........~~....____~~..~~._..._....___._...___...._~....,.
3. Any alteration in soil conditions (including~locat~on of structures and appurtenances) or
modification in use, design wastewater flow or wastewater characteristics as specified in the
associated improvement permit and application, may subject this authorization and
associated permit(s) to revocation.
Other Conditions:
SEE IP COMMENTS.
Disclaimer: This permit does not relieve you of the responsibility t:o obtain any other necessary
Federal, State or Local permit(s).
Owner Certification
~C __
r ~r G~~
Applicant or caner Date Authorized by County of Dare