20051894 Ver 3_401 Application_20110316

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List of attachments
1. Application
2. Project plan
3. Variance
4. Septic Permit
5. Note showing legislative extension
6. Plat from original vari. showing reverse angle of septic field

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MAR 1 6 2011
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Office Use Only:
Corps action ID no.
DWQ project no.
Form Version 1.3 Dec 10 2008
Pre-Construction Notification PCN Form
A. Applicant Information ?-4
1. Processing, --°
1 a. Type(s) of approval sought from the
Corps:
®Section 404 Permit ? Section 10 Permit -
1b. Specify Nationwide Permit (NWP) number: 14 or General Permit (GP) number:
1c. Has the NWP or GP number been verified by the Corps? ®Y Is ? No
1 d. Type(s) of approval sought from the DWQ (check all that apply):
® 401 Water Quality Certification - Regular ? Non-404 Jurisdictional General Permit
? 401 Water Quality Certification - Express ? Riparian Buffer Authorization
1 e. Is this notification solely for the record
because written approval is not required? For the record only for DWQ 401
Certification:
? Yes ® No For the record only for Corps Permit:

? Yes ® No
If. Is payment into a mitigation bank or in-lieu fee program proposed for mitigation
of impacts? If so, attach the acceptance letter from mitigation bank or in-lieu
fee program. ? Yes ® No
1 g. Is the project located in any of NC's twenty coastal counties. If yes, answer 1 h
below. ® Yes ? No
1h. Is the project located within a NC DCM Area of Environmental Concern (AEC)? ? Yes ® No
2. Project Information
2a. Name of project: LOT 10 DOGWOOD LANDING
2b. County: PAMLICO
2c. Nearest municipality / town: MERRITT
2d. Subdivision name: DOGWOOD LANDING lip) L9 (P? [4 11
2e. NCDOT only, T.I.P. or state
project no:
3. Owner Information
3a. Name(s) on Recorded Deed: RICHARD A. VERRIEST NR - TVA
3b. Deed Book and Page No. DB 542 PG706
3c. Responsible Party (for LLC if
applicable):
3d. Street address: 10 TERRACE CT.
3e. City, state, zip: ALBERTSON.NEW YORK 11507
3f. Telephone no.: 516-526-9226
3g. Fax no.:
3h. Email address: [e-mail]
Page I of 2
PCN Form - Version 1.3 December 10, 2008 Version
4. Applicant Information (if different from owner)
4a. Applicant is: ? Agent ? Other, specify:
4b. Name:
4c. Business name
(if applicable):
4d. Street address:
4e. City, state, zip:
4f. Telephone no.:
4g. Fax no.:
4h. Email address:
5. Agent/Consultant Information (if applicable)
5a. Name:
5b. Business name
(if applicable):
5c. Street address:
5d. City, state, zip:
5e. Telephone no.:
5f. Fax no..
5g. Email address:
Page 2 of 2
PCN Form - Version 1.3 December 10, 2008 Version
B. Project Information and Prior Project History
1. Property Identification
1a. Property identification no. (tax PIN or parcel ID): K052-25-10
Latitude: 35.144500 Longitude: -
1 b. Site coordinates (in decimal degrees): 76.639987
(DD.DDDDDD) (-DD.DDDDDD)
1 c. Property size: 1.89 acres
2. Surface Waters
2a. Name of nearest body of water (stream, river, etc.) to BALL CREEK
proposed project:
2b. Water Quality Classification of nearest receiving water: SA HQW NSW ID# 27-150-20
2c. River basin: NEUSE RIVER BASIN
3. Project Description
3a. Describe the existing conditions on the site and the general land use in the vicinity of the project at the time of this
application:
UNDEVELOPED PARTIALLY CLEARED RESIDENTIAL HOMES
3b. List the total estimated acreage of all existing wetlands on the property:
0.4233
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property:
0
3d. Explain the purpose of the proposed project:
INSTALL DRIVEWAY AND CREATE ACCESS TO SECTION OF PROPERTY BEYOND LOW AREA 2
3e. Describe the overall project in detail, including the type of equipment to be used:
AREA 1 :FILL WITH CLEAN FILL SAND AND STONE AS NEEDED FROM LOCAL SOURCE WITH INTERLOCKING
BLOCK RETAINING WALL AND 20' OF 18" PIPE TO PROVIDE FOR POSSIBLE UPLAND DRAINAGE EQUIP.
TERAMITE AND DUMPTRUCK AREA 2: FILL WITH CLEAN SAND FILL FORM LOCAL SOURCE AND 18' OF 18"
PIPE TO PROVIDE FOR POSSIBLE UPLAND DRAINAGE EQUIP. TERAMITE AND DUMP TRUCK
4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property /
t
i
l
®Yes ? No ? Unknown
projec
(
nc
uding all prior phases) in the past?
Comments:
4b. If the Corps made the jurisdictional determination, what type
? Preliminary ®Final
of determination was made?
4c. If yes, who delineated the jurisdictional areas? Agency/Consultant Company: ACE
Name (if known): WILLIAM WESCOTT Other:
4d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation
.
SEPT. 21,2010
5. Project History
5a. Have permits or certifications been requested or obtained for
thi ? Yes ® No ? Unkn

s project (including all prior phases) in the past? own
5b. If yes, explain in detail according to "help file" instructions.
Page 3 of 3
PCN Form - Version 1.3 December 10, 2008 Version
6. Future Project Plans
6a. Is this a phased project? ? Yes ® No
6b. If yes, explain.
Page 4 of 4
PCN Form - Version 1.3 December 10, 2008 Version
C. Proposed Impacts Inventory
1. Impacts Summary
1 a. Which sections were completed below for your project (check all that apply):
® Wetlands ? Streams - tributaries ® Buffers
? Open Waters ? Pond Construction
2. Wetland Impacts
If there are wetland impacts proposed on the site, then complete this question for each wetland area impacted.
2a. 2b. 2c. 2d. 2e. 2f.
Wetland impact Type of jurisdiction
number - Type of impact Type of wetland Forested (Corps - 404, 10 Area of impact
Permanent (P) or (if known) DWQ - non-404, other) (acres)
Temporary T
W1 ®P ? T FILL FOR
DRIVEWAY FORESTED ® Yes
? No ® Corps
? DWQ 0.00955
W2 ®P ? T FILL FOR
ACCESS FORESTED ® Yes
? No ® Corps
® DWQ 0.01368
W3 ? P ? T ? Yes ? Corps
? No ? DWQ
W4 ? P ? T ? Yes ? Corps
? No ? DWQ
W5 ? P ? T ? Yes ? Corps
? No ? DWQ
W6 ? P ? T ? Yes ? Corps
? No ? DWQ
2g. Total wetland impacts 0.02323
2h. Comments:
3. Stream Impacts
If there are perennial or intermittent stream impacts (including temporary impacts) proposed on the site, then complete this
question for all stream sites impacted.
3a. 3b. 3c. 3d. 3e. 3f. 3g.
Stream impact Type of impact Stream name Perennial Type of jurisdiction Average Impact
number - (PER) or (Corps - 404, 10 stream length
Permanent (P) or intermittent DWQ - non-404, width (linear
Temporary (T) (INT)? other) (feet) feet)
S1 ? P ? T ? PER ? Corps
? INT ? DWQ
S2 ? P ? T ? PER ? Corps
? INT ? DWQ
S3 ? P ? T ? PER ? Corps
? INT ? DWQ
S4 ? P ? T ? PER ? Corps
? INT ? DWQ
S5 ? P ? T ? PER ? Corps
? INT ? DWQ
S6 ? P ? T ? PER ? Corps
? INT ? DWQ
3h. Total stream and tributary impacts
N. Comments:
Page 5 of 5
PCN Form - Version 1.3 December 10, 2008 Version
4. Open Water Impacts
If there are proposed impacts to lakes, ponds, estuaries, tributaries, sounds, the Atlantic Ocean, or any other open water of
the U.S. then individually list all open water impacts below.
4a. 4b. 4c. 4d. 4e.
Open water Name of waterbody
impact number - (if applicable) Type of impact Waterbody type Area of impact (acres)
Permanent (P)
or Temporary T
01 ?P?T
02 ?P?T
03 ?P?T
04 ?P?T
4E Total open water impacts
4g. Comments:
6. Pond or Lake Construction
If and or lake construction proposed, then complete the chart below.
5a. 5b. 5c. 5d. 5e.

Pond ID
Proposed use or purpose of Wetland Impacts (acres) Stream Impacts (feet) Upland

number (acres)
pond
Flooded Filled Excavated Flooded Filled Excavated Flooded
P1
P2
5E Total
5g. Comments:
5h. Is a dam high hazard permit required?
? Yes ? No If yes, permit ID no:
5i. Expected pond surface area (acres):
5j. Size of pond watershed (acres):
5k. Method of construction:
6. Buffer Impacts (for DWQ)
If project will impact a protected riparian buffer, then complete the chart below. If yes, then individually list all buffer impacts
below. If an impacts require mitigation, then you MUST fill out Section D of this form.
6a. E] Neuse
[I Ta
? Other:
Project is in which protected basin?
dlem n
El Catawba ?
Randleman
6b. 6c. 6d. 6e. 6f. 6g.
Buffer impact
number -
Permanent (P) Reason
for
Stream name Buffer
mitigation Zone 1 impact
(square feet) Zone 2 impact
(square feet)
or Tem ora T impact required?
B1 ® P ? T ACCESS UT ? Yes 0

PATH
® No 883
62 ?P?T ?Yes
? No
83 ?P?T ?Yes
? No
6h. Total buffer impacts 883
6i. Comments:
Page 6 of 6
PCN Form - Version 1.3 December 10, 2008 Version
D. Impact Justification and Mitigation
1. Avoidance and Minimization
1 a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
SMALLEST FOOTPRINT USED TO ACCOMPLISH TASK RETAINING WALL IN AREA 1 TO CONTAIN TO MINIMUM
IMPACT AREA 2 SMALLEST FOOTPRINT USING ZONE 1 AND AEC LINES AS LIMITS OF IMPACT
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
AREA1: USE RETAINING WALL TO MAXIMIZE USE OF CONTAINED AREA OF FOOT PRINT AREA 2: STAKE AREA OF
FOOTPRINT AND USE OF SILT FENCE TO CONTAIN UNTIL GROUNDCOVER IS ESTABLISED
2. Compensatory Mitigation for Impacts to Waters of the U.S. or Waters of the State
2a. Does the project require Compensatory Mitigation for
impacts to Waters of the U.S. or Waters of the State? ? Yes ® No
2b. If yes, mitigation is required by (check all that apply): ? DWQ ? Corps

2c. If yes, which mitigation option will be used for this project? ? Mitigation bank
? Payment to in-lieu fee program
[] Permittee Responsible Mitigation
3. Complete if Using a Mitigation Bank
3a. Name of Mitigation Bank:
3b. Credits Purchased (attach receipt and letter) Type Quantity
3c. Comments:
4. Complete if Making a Payment to In-lieu Fee Program
4a. Approval letter from in-lieu fee program is attached. ? Yes
4b. Stream mitigation requested: linear feet
4c. If using stream mitigation, stream temperature: ? warm ? cool []cold
4d. Buffer mitigation requested (DWQ only): square feet
4e. Riparian wetland mitigation requested: acres
4f. Non-riparian wetland mitigation requested: acres
4g. Coastal (tidal) wetland mitigation requested: acres
4h. Comments:
5. Complete if Using a Permittee Responsible Mitigation Plan
5a. If using a permittee responsible mitigation plan, provide a description of the proposed mitigation plan.
Page 7of7
PCN Form - Version 1.3 December 10, 2008 Version
6. Buffer Mitigation (State Regulated Riparian Buffer Rules) - required by DWQ
6a. Will the project result in an impact within a protected riparian buffer that requires
buffer mitigation? ? Yes ® No
6b. If yes, then identify the square feet of impact to each zone of the riparian buffer that requires mitigation. Calculate the
amount of mitigation required.

Zone 6c.
Reason for impact 6d.
Total impact
(square feet)
Multiplier 6e.
Required mitigation
(square feet)
Zone 1 3 (2 for Catawba)
Zone 2 1.5
6f. Total buffer mitigation required:
6g. If buffer mitigation is required, discuss what type of mitigation is proposed (e.g., payment to private mitigation bank,
permittee responsible riparian buffer restoration, payment into an approved in-lieu fee fund).
6h. Comments:
Page 8 of 8
PCN Form - Version 1.3 December 10, 2008 Version
E. Stormwater Management and Diffuse Flow Plan (required by DWQ)
1. Diffuse Flow Plan
1 a. Does the project include or is it adjacent to protected riparian buffers identified ® Yes ? No
within one of the NC Riparian Buffer Protection Rules?
1 b. If yes, then is a diffuse flow plan included? If no, explain why.
Comments: NO OTHER PIPING IN RAPARIAN BUFFERS ? Yes ®No
2. Stormwater Management Plan
2a. What is the overall percent imperviousness of this project? 8.25%
2b. Does this project require a Stormwater Management Plan? ? Yes ® No
2c. If this project DOES NOT require a Stormwater Management Plan, explain why: TOTAL AREA OF DEVELOPMENT IS
LESS THAN REQUIRED THERSHOLD
2d. If this project DOES require a Stormwater Management Plan, then provide a brief, narrative description of the plan:
? Certified Local Government
2e. Who will be responsible for the review of the Stormwater Management Plan? ? DWQ Stormwater Program
? DWQ 401 Unit
3. Certified Local Government Stormwater Review
3a. In which local government's jurisdiction is this project? PAMLICO CTY.
? Phase II
3b. Which of the following locally-implemented stormwater management programs ® NSW
? USMP
apply (check all that apply): ? Water Supply Watershed
® Other: HQW
3c. Has the approved Stormwater Management Plan with proof of approval been ? Yes ® No
attached?
4. DWQ Stormwater Program Review
® Coastal counties

4a.
Which of the following state-implemented stormwater management programs apply ® HQW
? ORW
(check all that apply): ? Session Law 2006-246
? Other:
4b. Has the approved Stormwater Management Plan with proof of approval been
attached? ? Yes ® No
5. DWQ 401 Unit Stormwater Review
5a. Does the Stormwater Management Plan meet the appropriate requirements? ? Yes ? No
5b. Have all of the 401 Unit submittal requirements been met? ? Yes ? No
Page 9 of 9
PCN Form - Version 1.3 December 10, 2008 Version
F. Supplementary Information
1. Environmental Documentation (DWQ Requirement)
1 a. Does the project involve an expenditure of public (federal/state/local) funds or the ? Yes ® No
use of public (federal/state) land?
1 b. If you answered "yes" to the above, does the project require preparation of an
environmental document pursuant to the requirements of the National or State ? Yes ? No
(North Carolina) Environmental Policy Act (NEPA/SEPA)?
1 c. If you answered "yes" to the above, has the document review been finalized by the
State Clearing House? (If so, attach a copy of the NEPA or SEPA final approval
letter.) ? Yes ? No
Comments:
2. Violations (DWQ Requirement)
2a. Is the site in violation of DWQ Wetland Rules (15A NCAC 2H .0500), Isolated
Wetland Rules (15A NCAC 2H.1300), DWQ Surface Water or Wetland Standards, ? Yes ® No
or Riparian Buffer Rules (15A NCAC 2B .0200)?
2b. Is this an after-the-fact permit application? ? Yes ® No
2c. If you answered "yes" to one or both of the above questions, provide an explanation of the violation(s):
3. Cumulative Impacts (DWQ Requirement)
3a. Will this project (based on past and reasonably anticipated future impacts) result in ? Yes ® No
additional development, which could impact nearby downstream water quality?
3b. If you answered "yes" to the above, submit a qualitative or quantitative cumulative impact analysis in accordance with the
most recent DWQ policy. If you answered "no," provide a short narrative description.
4. Sewage Disposal (DWQ Requirement)
4a. Clearly detail the ultimate treatment methods and disposition (non-discharge or discharge) of wastewater generated from
the proposed project, or available capacity of the subject facility.
SEE ATTACHED VARIANCE WITH SURVEY AND SEPTIC PERMIT PLAN
Page 10 of 10
PCN Form - Version 1.3 December 10, 2008 Version
5. Endangered Species and Designated Critical Habitat (Corps Requirement)
5a. Will this project occur in or near an area with federally protected species or
h
bit
t? ® ? Yes No
a
a
5b. Have you checked with the USFWS concerning Endangered Species Act
i
t
?
®
® Yes No
mpac
s
5c. If yes, indicate the USFWS Field Office you have contacted. ® Raleigh
? Asheville
5d. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
DISCUSSED WITH ACE and USFWS,NATURAL HERITAGE DATA BASE
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as essential fish habitat. ? Yes ® No
6b. What data sources did you use to determine whether your site would impact Essential Fish Habitat?
DISCUSSED WITH ACE,ALSO DISCUSSED WITH NOAA MARINE FISHERIES NO IMPACT
7. Historic or Prehistoric Cultural Resources (Corps Requirement)
7a. Will this project occur in or near an area that the state, federal or tribal
governments have designated as having historic or cultural preservation
status
N
ti
l
?Yes N
(e.g.,
a
ona
Historic Trust designation or properties significant in o
North Carolina history and archaeology)?
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?
DISCUSSED WITH ACE ALSO DISCUSSED WITH SHPO HAVE SENT PROJECT INFO FOR REVIEW AND AWAITING
COMMENTS NO LISTING ONLINE IN NATIONAL REGISTRY
8. Flood Zone Designation (Corps Requirement)

8a. Will this project occur in a FEMA-designated 100-year floodplain?
-T -
® Yes ? No
8b. If yes, explain how project meets FEMA requirements: NO EFFECT ON FLOODING OR CAUSE OFADDITIONAL
FLOODING ON THIS OR AJACENT PROPETIES
8c. What source(s) did you use to make the floodplain determination? SURVEY AND SUBDIVISION PLAT
a ?
RICHARD A. VERRIEST 3/7/11

Applicant/Agent's Printed Name Applicant/Agent's Signature Date
(Agent's signature is valid only if an authorization letter from the applicant
is provided.)
Page 11 of 11
PCN Form - Version 1.3 December 10, 2008 Version
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North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins Dee Freeman
Governor Director Secretary
January 10, 2011
DWQ Project # 2005-1894 v2
Richard A. Verriest
10 Terrace Court
Albertson, NY 11507
Subject Property: Lot 10, Dogwood Landing
Ball Creek, Neuse River Basin
Class SA, HQW, NSW; Sub-basin 030413; Index # 27-150-20
Pamlico County
Pagel of 3
Authorization of Neuse River Riparian Buffer Protection Rules Minor Variance [15A NCAC
2B .0233(9)(b)]
Dear Mr. Verriest:
You have our authorization, in accordance with the conditions listed below, to impact
approximately 1584 square feet (ft ) of Zone 2 of the protected buffers to construct your single-
family residence at the subject property as described within your variance request dated
November 1, 2010 and received by the Division of Water Quality (DWQ) on November 22,
2010. This letter shall act as your Minor Variance authorization as described within 15A NCAC
2B .0233(9)(b). In addition to this authorization, you should obtain or otherwise comply with
any other required federal, state or local permits before you go ahead with your project including
(but not limited to) Erosion and Sediment Control regulations.
This minor variance authorization shall remain valid until the approved impacts have occurred.
This minor variance authorization is valid for the purpose and design that you described in your
variance request. If you modify your project in any way, you must notify us and you may be
required to send us a new request for approval.
If the property is sold, the new owner is covered by this minor variance authorization and is
thereby responsible for complying with all conditions. The new owner must be given a copy of
this minor variance authorization. The new owners must notify DWQ in writing of the
ownership change.
This authorization requires you to follow any conditions listed below.
The Additional Conditions of the Certification are:
1. No Zone 1 Impacts
401 Oversight/Epress Review Permitting Unit
2321 Crabtree Blvd, Suite 250, Raleigh, North Carolina 27604
Phone: [phone] FAX: [phone]
Internet: httpJ1portel.nodenr.og4eb/wglws
None Carolina
a UM AY
An Equal Opportunity 1 Affirmative Action Employer
Applicant:
Page 2 of 3
Date:
No impacts (except for "exempt" uses as identified within 15A NCAC 2B .0233) shall occur to
Zone 1 of the protected riparian buffers unless otherwise approved by the DWQ. No impervious
surfaces shall be added to Zone 1, unless otherwise approved by the DWQ.
2. Erosion & Sediment Control Practices
Erosion and sediment control practices must be in full compliance with all specifications
governing the proper design, installation and operation and maintenance of such Best
Management Practices in order to protect surface waters standards:
a. The erosion and sediment control measures for the project must be designed, installed,
operated, and maintained in accordance with the most recent version of the North Carolina
Sediment and Erosion Control Planning and Design Manual.
b. The design, installation, operation, and maintenance of the sediment and erosion control
measures must be such that they equal, or exceed, the requirements specified in the most
recent version of the North Carolina Sediment and Erosion Control Manual. Thg devices
shall be maintained on all construction sites, borrow sites, and waste pile (spoil) projects,
including contractor-owned or leased borrow pits associated with the project.
c. For borrow pit sites, the erosion and sediment control measures must be designed, installed,
operated, and maintained in accordance with the most recent version of the North Carolina
Surface Mining Manual.
d. The reclamation measures and implementation must comply with the reclamation in
accordance with the requirements of the Sedimentation Pollution Control Act.
5. No Waste, Spoil, Solids, or Fill of Any Kind
No waste, spoil, solids, or fill of any kind shall occur in wetlands, waters, or riparian areas beyond
the footprint of the impacts depicted in the Pre-Construction Notification. All construction
activities, including the design, installation, operation, and maintenance of sediment and erosion
control Best Management Practices, shall be performed so that no violations of state water quality
standards, statutes, or rules occur.
6. Diffuse Flow
An additional condition is that all stormwater shall be directed as diffuse flow at non-erosive
velocities through the protected stream buffers and will not re-concentrate before discharging into
the stream as identified within 15A NCAC 2B . 0233 (5).
7. Protective Fencing
The outside buffer, wetland or water boundary and along the construction corridor within these
boundaries approved under this authorization shall be clearly marked with orange warning fencing
(or similar high visibility material) for the areas that have been approved to infringe within the
buffer, wetland or water prior to any land disturbing activities to ensure compliance with 15A
NCAC 2B. 0233.
8. Certificate of Completion
Upon completion of all work approved within this authorization, and any subsequent
modifications, the applicant is required to return the attached certificate of completion to the 401
Oversight/Express Review Permitting Unit, North Carolina Division of Water Quality, 1650 Mail
Service Center, Raleigh, NC, 27699-1650.
Applicant:
Page 3 of 3
Date:
If you wish to contest any statement in this Minor Variance you must file a petition for an administrative
hearing. You may obtain the petition form from the office of Administrative hearings. You must file the
petition with the office of Administrative Hearings within sixty (60) days of receipt of this notice. A
petition is considered filed when it is received in the office of Administrative Hearings during normal
office hours. The Office of Administrative Hearings accepts filings Monday through Friday between the
hours of 8:00am and 5:00pm, except for official state holidays. The original and one (1) copy of the
petition must be filed with the Office of Administrative Hearings.
The petition may be faxed-provided the original and one copy of the document is received by the Office
of Administrative Hearings within five (5) business days following the faxed transmission.
The mailing address for the Office of Administrative Hearings is:
Office of Administrative Hearings
6714 Mail Service Center
Raleigh, NC 27699-6714
Telephone: [phone], Facsimile: (919)-733-3478
A copy of the petition must also be served on DENR as follows:
Ms. Mary Penny Thompson, General Counsel
Department of Environment and Natural Resources
1601 Mail Service Center
Raleigh, NC 27699-1601
This letter completes the review of the Division of Water Quality under the Neuse River Riparian Buffer
Protection Rules [ 15A NCAC 2B.0233(9)(b)]. Please call Chris Pull inger at 252-948-3920 if you have
any questions or require copies of our rules or procedural materials.
Sin erely,
Al Hodge, S?' ervisorr
Division of Water Quality
Surface Water Protection
Washington Regional Office
Enclosures: copy of approved plat
cc: DWQ 401 O/E
WaRO File Copy
DCM, Morehead City - Attn: Brad Connell
File Name: 2005-1894 v2
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fMPROVEMENT PERMIT
NORTH CAROLINA DEPARTMENT OF ENVIRONMENT, HEALTH h NATURAL RESOURCEa-
DIVISION OF ENVIRONKENTAL HEKLTH, ON-SITE W&STEW&TER 'SECTION
(1J'C1TY._-_? a. ??._.. PIt!: - 0-5-2
RECOR13 NUMBER- ----
OHNEI: ?tij!MBF?t: (9c?
i?.h. Ca roan _ PIGdt
Oi;NER'3
ADITRESS/i:OCAT'CrN?dE PROPERTY: _a,t gp 5&13 ttiea 'I o to D©avoot __.
Iand3na Rd go?rnx. 8O0' axd TR ?antR tAe rs* oo
tp tAs rlgsit t YO" CJX 3rj4? ra ivht 3h01d _._a. _.
SUBDIYISIO?1;ocnd ica PHRSE:..____ --LOT;,
TYPE OF ESTABLISHMENT
P.E. IDENCE; (%) YES ( ) NG NUMBER Of NUMBER OF OCCUPANTS: j ffij,__IIESICN FLOW
OTHER (DESCRIBE)
BASEMENT PLURBING: YES( ) NO(a)
TYPE OF WELL: (x)PUBLIC ( )WELL { )OTHER
`.'•'YPE'. OF WASTEWATER SYSTEM: (SEE ?ABt.F
INSTALLATION DESCRIPTION INITIAL REPAIR
_PESIGMTt ?
{G- T1IRFt P GG'??N $A. Z D 'C_? 0.4 4 A.
LN
SRENC" iilant {ET)
.?RBidCX SPA,CI<i?G {M??.-) (FT) _ *'OC
CF-Ti
UNBE$ ? ARE 3, _z 3(75') 22,x____
SEPTIC V E d
2 Cti ?NATI L C0.ROiS 9 Pen
CONDITIONS: This Per- is da?lanec# tn-#-Wise e?tuer c a?b red
pitrifiggt&QU _ 'w-l - em W-hiCh 3 25X reductlQ? in a atauat of n+trkfiestkon ?kue recio,irgd.
THIS PERMIT SHALL BE ACCOMPANIED BY A LAYOUT SHOWN 00 A PLAT,
INCLUDING A SYSTEMS SPECIFICATION SHEET WHICH SHALL BF AN INTEGRAL
PART OF THIS IMPROVEMENT PERMIT.
THIS IMPROVEMENT PERMIT MUST BE &TTACRED TO A CONSTRUCTION
AUTHORIZATION BEFORE OBTAINING A BUILDING PERMIT OR OTHER
CONSTRUCTION PERMITS AND BEFORE A WXSTEWATER SYSTEM IS INSTALLED.
THIS IMPROVEMENT PERMIT 15 SUBJECT TO REVOCATION IF THE SITE PLANS OP.
THE INTENDED USE CHANGE FROM THOSE SE014N ON THE IMPROVEMENT PERMIT
CHANGES FRhn THE ABOVE SHALL REQUIRE HEALTH DEPARTMENT APPROVAL.
GFHNR AU?ltORIZED AGENT: "-° x'S. DATE:
No. OF ATTACKXFNTS : _
? Q fI
EXHfBIT A
PAMLICO COUNTY HEALTH DEPARTMENT
DP.T SYSTEM LOCATIOK A DESICN
In-1-ga _
PIN 0 2- V - 10
RECORD 13ilB
SCALE _
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s ----- ° - -- --- ----------- --- -
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pair EXHIBIT B-L.
O /'Non
PQLYSTYPENff AGCRECATE SYSTEM
12'.ORAWAGE BUNOLE WFH
;' DIAMEit,R CORRICAi , PERFOR•
APP90VO SARRIER POLYFHYl..BE DIS` RIELMON PIPE
SEPARATOR
2012 S-S 12' DIAMF-IE.
DRAINAGE BUNDLE
VATH OUT P1 PIC
12' '.r M
y MIN.
_ POLYSTYReq.c
us` ACCRKAi E
nui'llL-P 01: [,Ih(ES: 3
r.rcrrr.•rrr OF r..zxr:s: _ 3 ( 7-r = ?7`?
rat 1 ! 1 - n.1;' nw ?T IDi?
0/? PE?2N.? "
CHAM.B.EPED SYSTEM DESIGN
? ptlo? tank
D
1HUtiR OF LINES:
;11GIT of 1.111ES:
of !:tonce. bet,Jcen
Al _rlrirat!on lines:
?,ticra•Leachw+q
s4ewau has
1/4" 31613 lot
-,rater disoarsat

Ealwe oomm of u
is Coen for dduem
Inhual-on into io.1
12 Inches of soil
covar ovor tronch
SL 2009-406
Effkd ve An 5, 2009
On-Site Wastewater Permits Issued
Prior to Jan. 1, 2003
Expired
I After Jan. 1, 2003 but I
before Jan. 1, 2008
Permit extended for 3
years
I On or after Jan. 1, 2008 and I
through Dec. 31, 2010
On or after Jan. 1, 2011
Prior to Jan. 1, 2008
Permit valid though
Dec. 31, 2015,
regardless of issuance
date
On-Site Wastewater Permits EzpiredlEapires
I On or after Jan. 1, 2008 and
thr I
ough Dec. 31, 2010
Permit valid for five
years fim issuance
date
After Jan. 1, 2011
Permit valid through Jan 1, Permit valid for five years from
Expired 2011 plus time remaining (in issuance date, plus the # of
days) as of Jan. 1, 2008. days between Jan 1, 2008 and
Dec. 31, 2010 permit was valid
LEGEND
EIP 00SW SM PIPE
OR EXSnNC AWN ROD
EPK EXISTING PK NAIL
SAP SET IRON PIPE
SW SET PK NAIL /
NPs NO Paw SET
R/WY RIGHT OF WAY
- EDGE OF PAVEl"T

t I ?`
60.06
248. 1' ? \
S86044' 16"W 06%
' THOMAS E. OSBORNE ET UX S85°42'26-E GEORGE WEEKS ET UX
PATRICIA M. OSBORNE LORRAINE WEEKS 611 d 3.!f?.53' 08 258 PG 464
DB 309 PG
TAX D: K052-2255-9 TAX ID; K052-38-L
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t 006MM AANOM AD
REFERENCES
PC A. SL 22-1
DS 248 PG 540
I, Kendall E. Gaskins, hereby certify that
this map was drawn under my direction
and supervision from an actual survey
made under my direction and supervision,
that the error of closure as calculated
by latitudes and departures is 1:10,000+.
Witness my hand and seal this
12th day-of _SEP_TEMBER, 2005.
Kendall E. Gaskins, PLS L-382
AREA OF RAPACT
ZONE 2 ... 1764.05 SF
ZONE 1 ..... 0.00 SF
THIS PROPERTY IS LOCATED WITHIN
A SPECIAL FLOOD HAZARD AREA
FLOOD ZONE ------------- AE
BASE FLOOD ELEV .......... 7.0
FIRM MAP ......... 3720750000)
COMMUNITY PANEL ...... . 370181
COMMUNITY NAME ... PAMLICO COUNTY
EFFECTIVE . . . , . .. .. JULY 2, 2004
- SURVEY FOR -
MERRON N. CAROON and
wife LINDA L. CAROON
LOT 10 - DOGWOOD LANDING, SECTION 1
TAX ID: K052-25-10
NUMBER 3 TOWNSHIP
PAMLICO COUNTY
NORTH CAROLINA
SURVEYED: AUGUST 25, 2005
SCALE 1" = 100'
Kendall E. Gaskins, PLS
PROFESSIONAL LAND SURVEYING
PO Box 354
8162 Main Street
Vanceboro, NC 28586
Phone: [phone]
Fax: [phone]
VICINITY SKETCH
NOT TO SCALE
GEORGE WEEKS ET UX
LORRAINE WEEKS
08 256 PG 464
TAX ID: K052-38-L
..irk 05-0128