WQ0035283_Owner (Name Change)_20210830

41A.
01.11;
East Coast frigineering, P.C.
EN GI NEERS•PLANNERS•CONSUL.TANTS
RECEIVED
August 25,2021 1 U G 3 0 2021
Ms. Kristin Litzenberger NCDEQ/DWRINPDES
Division of Water Resources
NC Department of Environment and Natural Resources
512 North Salisbury Street
Raleigh,North Carolina 27699
Subject: Ocean Breeze Family Camping& RV Resort(formerly Caison Campground)
Brunswick County,North Carolina
Wastewater Collection System Extension
Permit No. WQ0035283 Modification, dated May 12,2016
Permit Ownership/Name Change
Dear Ms. Litzenberger:
On behalf of our Client, Caison Family, LLC, please find enclosed the following information
required for the permit ownership/name change submittal for the subject project:
1. One original and one copy of the executed Sewer System Permit
Ownership/Name Change application;
2. Two (2) copies of Mr. Oneil Caison's death certificate;
3. Two (2) copies of the existing permit;
4. Two (2) copies of each of the Partial Engineer's Certifications for the project;
5. Two (2) copies of the Final Certification for the subject project;
6. Two (2) copies of the Deed for property;
7. Two (2) copies of the Sewer Extension Permit Status Update Form;
8. Two (2) copies of the Secretary of State LLC Annual Report;and
9. A copy of the August 23,2021 Final Certification letter to Mr. Dean Hunkele.
The original permittee, Mr. Oneil Caison passed away before the final certification had been
completed. Mrs. Shelba Caison, as administrator of his estate, has transferred the property into
Caison Family, LLC. The enclosed Final Permittee Certification has been executed by Mr. James
Kyle Caison as President of Caison Family, LLC. Once the ownership transfer has been processed,
we will submit the complete Final Engineer's Certification Package to Mr. Dean Hunkele in the
Wilmington Regional Office.
4918 Main Street * Post Office Box 2469 * Shallotte, North Carolina 28459 *Tel.: [phone] * Fax: [phone]
Firm License Number: C-4785

� h •
Ms. Litzenberger Page Two Permit WQ0035283 MOD
August 25,2021 Permit Ownership Name Change
We appreciate in advance your prompt attention in this matter. Should you have any questions or
comments,please do not hesitate contacting our office at your convenience.
Sincerely,
J. Christian Russell, P.E.
Project Manager
Attachments
pc: Mrs. Shelba Caison (Ocean Breeze Family Campground) w/Attachments via Email
Mr. William Pinnix, P.E.,Brunswick County Engineering w/Attachments via Email
Mr. Dean Hunkele, NCDENR Water Resources w/Attachments via Email
File: 0693 (Caison Campground)
4918 Main Street* Post Office Box 2469*Shallotte, North Carolina 28459*Tel.:[phone]* Fax: [phone]
Firm License Number: C-4785

State of North Carolina
DWR Department of Environmental Quality
Division of Water Resources
SEWER SYSTEM PERMIT OWNERSHIP/NAME CHANGE
Division of Water Resources INSTRUCTIONS FOR FORM: PNOCF 01-16
This form is for ownership changes or name changes of a sewer system permit. Please note that"Permittee"references the
existing permit holder,and that"Applicant"references the entity applying for the ownership/name change.
Sewer permits start with a WQ or WQCS and contain the terms sewer extension or collection system in the subject field. This
form should not be used for permits with NC,NCG,SW or other types of non-sewer permits beginning with WQ.
For more information, visit the Division's Water Quality Permitting's website:
A. Sewer System Permit Ownership/Name Change(FORM: PNOCF 01-16)Application(All Applications):
® Submit an original completed and appropriately executed application(PNOCF 01-16).
® The Existing Permittee's Certification shall be signed in accordance with 15A NCAC 02T .0106(b). Per 15A NCAC 02T
.0106(c), an alternate person may be designated as the signing official if a delegation letter is provided from a person who
meets the criteria in 15A NCAC 02T.0106(b).
® The Applicant's Certification shall be signed in accordance with 15A NCAC 02T.0106(b). Per 15A NCAC 02T.0106(c),an
alternate person may be designated as the signing official if a delegation letter is provided from a person who meets the criteria
in 15A NCAC 02T.0106(b).
B. Existing Permit(All Applications):
® Submit a copy of the most recently issued permit and certification.
C. Property Ownership Documentation(All Applications):
➢ The Applicant shall demonstrate they are the owner of all property containing the sewer system facilities:
El Legal documentation of ownership(i.e.,GIS,deed,article of incorporation,or contract),or
❑ Written notarized intent to purchase agreement signed by both parties with a plat or survey map,or
❑ Approved board minutes
D. Certificate of Public Convenience and Necessity(All Applications where the Applicant is a Privately-Owned Public Utility):
❑ Per 15A NCAC 02T .0115(a)(1), provide one copy of the Certificate of Public Convenience and Necessity from the North
Carolina Utilities Commission demonstrating the Applicant is authorized to hold the utility franchise for the area to be served
by the non-discharge system.
E. Operational Agreements(Applications where the Applicant is a Home/Property Owners'Association or Developer of lots to be
sold):
> Home/Property Owners' Associations
❑ Per 15A NCAC 02T.0115(c),submit an original properly executed Operational Agreement(FORM: HOA).
❑ Per 15A NCAC 02T .0115(c), submit an original proposed or approved Articles of Incorporation, Declarations and By-
laws that contain the language required by the Operational Agreement.
> Developers of lots to be sold
❑ Per 15A NCAC 02T.01 15(b),submit an original of the properly executed Operational Agreement(FORM:DEV).
F. Package Submitted in Duplicate
® Submit a copy of all required documents in Instructions A-E as required
THE COMPLETED APPLICATION AND SUPPORTING DOCUMENTATION SHALL BE SUBMITTED IN DUPLICATE
TO:
NCDEQ-DWR
Water Quality Permitting Section
PERCS Unit
By U.S. Postal Service: By Courier/Special Delivery:
1617 MAIL SERVICE CENTER 512 N.SALISBURY ST.
RALEIGH,NORTH CAROLINA 27699-1636 SUITE 925
RALEIGH,NORTH CAROLINA 27604
TELEPHONE NUMBER: [phone]
ORIGINAL
INSTRUCTIONS FOR APPLICATION PNOCF 01-16 Page 1 of 1

Division State of North Carolina
Department of Environmental Quality
DWR of
SEWER SYSTEM PERMIT OWNERSHIP/NAME CHANGE
INSTRUCTIONS FOR FORM:PNOCF 01-16
Division of Water Resources
I. EXISTING PERMITTEE INFORMATION:
1. Permittee's name:Oneil Caison
2. Signature authority's name: Shelba Caison on Oneil Caison's behalf per 15A NCAC 02T.0106(b)
3. Signature authority's title:Administrator of Estate
4. Permittee's mailing address:2772 Sparta Loop Road SW
City: Supply State:NC Zip:28462-
5. Permittee's contact information: Phone number:[phone] Fax Number( ) -
Email Address:
II. APPLICANT INFORMATION:
1. Applicant's name:Caison Family,LLC
2. Signature authority's name:James Kyle Caison per 15A NCAC 02T.0106(b)
3. Signature authority's title:President
4. Applicant's mailing address:2772 Sparta Loop Road SW
City: Supply State:NC Zip:28462-
5. Applicant's contact information: Phone number:[phone] Fax Number( ) -
Email Address: _('c "I or
6. Representative's name:
7. Representative's title:
8. Representative's contact information Phone number:( ) - Fax Number( ) -
Email Address:
III. PERMIT INFORMATION:
1. Existing permit number: WQ0035283 and most recent issuance date:May 12,2016
2. Reason for the permit application: Select If other, attach detailed explanation
3. Has the facility been constructed? ® Yes or❑No
4. Has the facility been certified per 15A NCAC 02T.0116? ®Yes or❑No
FORM: PNOCF 01-16 Page 1 of 2

w
IV. CERTIFICATIONS:
Existing Permittee's Certification per 15A NCAC 02T.0106(b):
I, Shelba Caison on the bahalf of Oneil Caison attest that this application
(Signature Authority's name&title from Application Item I.2&3)
has been reviewed by me and is accurate and complete to the best of my knowledge. I understand that prior to reissuance of the permit
into the Applicant's name, I will continue to be responsible for compliance with the current permit and any discharge of wastewater
from this system to surface waters or the land may result in an enforcement action that may include civil penalties, injunctive relief,
and/or criminal prosecution. I will also make no claim against the Division of Water Resources should a condition of the existing permit
be violated. I also understand that if all required parts of this application are note completed and that if all required supporting
information and attachments are not included,this application will be returned to me as incomplete.
NOTE —In accordance with General Statutes 143-215.6A and 143-215.6B, any person who knowingly makes any false statement,
representation, or certification in any application package shall be guilty of a Class 2 misdemeanor, which may include a fine not to
exceed$10,000 as well as civil penalties up to$2 ,00q per
�vviola/t��n.� "
Signature: !/ `'G�� . /` IV d 1� U�U.�✓6 Date: �F
l C�/�LC, Cl
Applicant's Certification per 15A NCAC 02T.0106(b):
I,James Kyle Caison,President attest that this application
(Signature Authority's name&title from Application Item II.2&3.)
has been reviewed by me and is accurate and complete to the best of my knowledge. I understand that after issuance of the permit into
the Applicant's name, I will be responsible for compliance with the issued permit and any discharge of wastewater from this non-
discharge system to surface waters or the land may result in an enforcement action that may include civil penalties, injunctive relief,
and/or criminal prosecution. I will make no claim against the Division of Water Resources should a condition of this permit be violated.
I also understand that if all required parts of this application package are not completed and that if all required supporting information
and attachments are not included,this application package will be returned to me as incomplete.
NOTE — In accordance with General Statutes 143-215.6A and 143-215.6B, any person who knowingly makes any false statement,
representation, or certification in any application package shall be guilty of a Class 2 misdemeanor, which may include a fine not to
exceed$10,000 as well as civil penalti up to$25,000 per violation.
c
Signature: 4 CO - ` Date: oZ cc- 1
FORM: PNOCF 01-16 Page 2 of 2

PAT MCCRORY
DONALD R. VAN DER VAART
Marl
Water Resources
ENVIRONMENTAL OUALIT Y S. JAY 7,I M M E R M A N
May 12, 2016
Oneil Caison, Owner
Ocean Breeze Family Camping& RV Resort
2772 Sparta Loop Road Southwest
Supply, NC 28462
Subject: Permit No. WQ0035283 MODIFICATION
Oneil Caison
Ocean Breeze Family Camping& RV Resort Private Sewer
Wastewater Collection System Extension
Brunswick County
Dear Mr. Caison:
In accordance with your application received April 7, 2016, we are forwarding herewith Permit No.
WQ0035283 dated May 12, 2016 to Oneil Caison (Permittee) for the construction and operation upon
certification of the subject wastewater collection system extension. This permit shall be effective from
the date of issuance until rescinded, shall void Permit No. WQ0035283 issued November 21, 2013, and
shall be subject to the conditions and limitations as specified therein.This cover letter shall be considered
a part of this permit and is therefore incorporated therein by reference.
This modification adds 1,360 feet of 8-inch gravity sewer with 5,700 gpd to serve 37 campsites and a 4-
washer laundry in Phase 3.
Please pay particular attention to the following conditions contained within this permit:
Special Conditions:
Condition 1.1: This permit shall become voidable unless the agreement between Oneil Caison and
Brunswick County for the collection and final treatment of wastewater is in full force and
effect.
Standard Conditions:
Condition 11.1: This permit shall not be automatically transferable; a request must be made and
approved.
Condition 11.4: Requires that the wastewater collection facilities be properly operated and maintained
in accordance with 15A NCAC 2T .0403 or any individual system-wide collection system
permit issued to the Permittee.
127 Cardinal Drive Extension,Wilmington,North Carolina 28405 '- r'i'"1
Phone:[phone]\Internet:www.deq.nc.gov /
An Equal Opportunity\Affirmative Action Employer—Made in part by recycled paper

Environmental
Quality
In accordance with the provisions of Article 21 of Chapter 143, General Statutes of North Carolina as
amended, and other applicable Laws, Rules, and Regulations, permission is hereby granted to the
ONEIL CAISON
BRUNSWICK COUNTY
for the construction and operation upon certification of approximately 1,360 linear feet of 8-inch gravity sewer to
serve 37 campsites, and a 4-washer laundry as part of the Ocean Breeze Family Camping & RV Resort Phase 3
Private Sewer project, and the discharge of 5,700 gallons per day of collected domestic wastewater into Brunswick
County's existing sewerage system, pursuant to the application received April 7, 2016 and in conformity with 15A
NCAC 2T; the Division's Gravity Sewer Minimum Design Criteria adopted February 12, 1996 as applicable; the
Division's Minimum Design Criteria for the Fast-Track Permitting of Pump Stations and Force Mains adopted June 1,
2000 as applicable;and other supporting data subsequently filed and approved by the Department of Environmental
Quality and considered a part of this permit.
November 21,2013 MODIFICATION VERSION 1.1
Continued operation of approximately 527 linear feet of 8-inch gravity sewer to serve 28 sites as part of the Ocean
Breeze Family Camping& RV Resort Phase 2 Private Sewer project, and the discharge of 2,800 gallons per day of
collected domestic wastewater into the Brunswick County's existing sewerage system, pursuant to the original
application received October 17,2013 and revised application&information received on November 5,2013. System
certified complete on July 3,2014.
March 25, 2011 (Original Issuance) Version 1.0
Continued construction and operation upon certification of approximately 2,991 linear feet of 8-inch gravity sewer
to serve 87 Individual camp sites @ 100 gpd/site (8,700 gpd), a laundry facility with (4) four washers @ 500
gpd/washer (2,000 gpd), and an office building with(2)two employees @ 25 gpd/employee(50 gpd) as part of the
Ocean Breeze Family Camping&RV Resort Phase 1 Private Sewer project,and the discharge of 10,750 gallons per
day of collected domestic wastewater into Brunswick County's existing sewerage system,pursuant to the application
received March 9,2011. System certified complete on July 22,2014.
This permit shall be effective from the date of issuance until rescinded and shall be subject to the specified
conditions and limitations contained therein.
Permit Number: WQ0035283 Issued Today: May 12,2016
James Hi' r son, Regional Supery sor
Wilmingthr0 gional Office
Water Quality Regional Operations Section
Division of Water Resources, NCDEQ
By Authority of the Director and The Environmental Management Commission
Permit No. WQ0035283 Page 3 of 8

a. The sewer system shall be effectively maintained and operated at all times to prevent discharge
to land or surface waters, and to prevent any contravention of groundwater standards or surface
water standards.
b. A map of the sewer system shall be developed and shall be actively maintained.
c. An operation and maintenance plan including pump station inspection frequency, preventative
maintenance schedule, spare parts inventory and overflow response has been developed and
implemented.
d. Pump stations that are not connected to a telemetry system shall be inspected every day(i.e. 365
days per year). Pump stations that are connected to a telemetry system shall be inspected at
least once per week.
e. High-priority sewer lines shall be inspected at least once per every six-months and inspections are
documented.
f. A general observation of the entire sewer system shall be conducted at least once per year.
g. Overflows and bypasses shall be reported to the appropriate Division regional office in accordance
with 15A NCAC 2B .0506(a), and public notice shall be provided as required by North Carolina
General Statute §143-215.1C.
h. A Grease Control Program is in place as follows:
1. For public owned collection systems, the Grease Control Program shall include at least
biannual distribution of educational materials for both commercial and residential users and
the legal means to require grease interceptors at existing establishments. The plan shall also
include legal means for inspections of the grease interceptors,enforcement for violators and
the legal means to control grease entering the system from other public and private satellite
sewer systems.
2. For privately owned collection systems, the Grease Control Program shall include at least bi-
annual distribution of grease education materials to users of the collection system by the
permittee or its representative.
3. Grease education materials shall be distributed more often than required in Parts (1) and (2)
of this Subparagraph if necessary to prevent grease-related sanitary sewer overflows.
i. Right-of-ways and easements shall be maintained in the full easement width for personnel and
equipment accessibility.
j. Documentation shall be kept for Subparagraphs(a)through(i)of this Rule for a minimum of three
years with exception of the map,which shall be maintained for the life of the system.
5. Noncompliance Notification:
The Permittee shall report by telephone to a water resources staff member at the Wilmington
Regional Office, telephone number [phone], as soon as possible, but in no case more than 24
hours or on the next working day, following the occurrence or first knowledge of the occurrence of
either of the following:
a. Any process unit failure,due to known or unknown reasons,that renders the facility incapable
of adequate wastewater transport, such as mechanical or electrical failures of pumps, line
blockage or breakage, etc.; or
b. Any SSO and/or spill over 1,000 gallons; or
Permit No.WQ0035283 Page 5 of 8

After-construction requests are discouraged by the Division and may not be approved,thus requiring
replacement or repair prior to certification &activation. [15A NCAC 02T.0116]
8. Gravity sewers installed greater than ten percent below the minimum required slope per the Division's
Gravity Sewer Minimum Design Criteria shall not be acceptable and shall not be certified until
corrected. If there is an unforeseen obstacle in the field where all viable solutions have been
examined, a slope variance can be requested from the Division with firm supporting documentation.
This shall be done through a permit modification with fee. Such variance requests will be evaluated
on a case-by-case basis.Resolution of such request shall be evident prior to completing and submitting
the construction certification. [ 15A NCAC 02T.0105(n)]
9. A copy of the construction record drawings shall be maintained on file by the Permittee for the life of
the wastewater collection facilities. [15A NCAC 02T.0116]
10. Failure to abide by the conditions and limitations contained in this permit; 15A NCAC 2T;the Division's
Gravity Sewer Design Criteria adopted February 12, 1996 as applicable;the Division's Minimum Design
Criteria for the Fast-Track Permitting of Pump Station and Force Mains adopted June 1, 2000 as
applicable; and other supporting materials may subject the Permittee to an enforcement action by
the Division, in accordance with North Carolina General Statutes §143-215.6A through §143-215.6C,
construction of additional or replacement wastewater collection facilities,and/or referral of the North
Carolina-licensed Professional Engineer to the licensing board. [15A NCAC 02T .0104; 15A NCAC 02T
.0108(b-c)]
11. In the event that the wastewater collection facilities fail to perform satisfactorily, including the
creation of nuisance conditions,the Permittee shall take immediate corrective action, including those
as may be required by this Division, such as the construction of additional or replacement facilities.
[15A NCAC 02T.0110; 15A NCAC 02T.0108(b)]
12. The issuance of this permit shall not exempt the Permittee from complying with any and all statutes,
rules, regulations,or ordinances that may be imposed by the Division any other Federal,State,or Local
government agencies which have jurisdiction or obtaining other permits which may be required by
the Division or any other Federal, State, of Local government agencies. [G.S. 143-215.1(b)]
Permit No.W00035283 Page 7 of 8

FAST TRACK SEWER ENGINEERING CERTIFICATION
PERMITTEE: 43ncii Ceri�on Ca-'5-6 - Imo, / // -L-•C
PERMIT#: WQ0035283
PROJECT: Colson Campground Private Sewer
ISSUE DATE: March 25, 201 1
COUNTY: Brunswick
This project shall not be considered complete nor allowed to operate in accordance with Condition 6
of this permit until the Division has received this Certification and all required supporting documentation.
Consequently, it should be submitted in a manner that documents the Division's receipt, Send the
required documentation to the Regional Supervisor,Surface Water Protection Section at the address at
the bottom.
Any wastewater flow made tributary to the wastewater collection system extension prior to completion.
of this Certification shall be considered a violation of the permit and shall subject the Permittee to
appropriate enforcement actions. The Permittee is responsible for tracking all partial certifications up
until a final certification is received. A Final Certification shall be a complete set of record drawings and
design calculations regardless of whether partials have been submitted.
PERMITTEE'S CERTIFICATION
I. the undersigned agent for the Permittee, hereby state that this project has been constructed pursuant
to the applicable standards & requirements, the Professional Engineer below has provided applicable
design/construction information to the Permittee, and the Permittee is prepared to operate & maintain
the wastewater collection system permitted herein or portions thereof. .
Printed Name, Title gnature Date
ENGINEER'S CERTIFICATION
1, J. Christian Russell, P.E. , as a duly r istered Professional Engineer in the State of North Carolina,
having been authorized to observe (periodically, 0 weekly, ❑ full time) the construction of the
project name and location as referenced above for the above Permittee hereby state that, to the best
of my abilities, due care and diligence was used in the observation of the construction such that the
construction was observed to be built within substantial compliance of this permit; 15A NCAC 2T; the
Division of Water Quality's (Division) Gravity Sewer Minimum Design Criteria adopted February 12, 1996
as applicable; the Division's Minimum Design Criteria for the Fast-Track Permitting of Pump Stations and
Force Mains adopted June 1, 2000 as applicable;and other supporting materials.
North Carolina Professional Engineer's Seal w/signature &date .�` �H CAROB''%,
F�ssi'�•
35054
8-20-2021 :•
6NGINE ¢ �4)
"."'/1 1ST,AN R�c�
CERTIFICATION( COMMENTS OR DETAILS '''
LrJ Final ❑ Partial
Comments: Covering Phases 1, 2&3. Pump station and forcemain#WQ0035282, Final certification submitted on 9-11-2012
NC Division of Water Quality 127 Cardinal Drive Extension Wilmington, 1—,IC 28405
wiiminnfnn Aaninnnl riff „

FAST TRACK SEWER ENGINEERING Ci RZIFiCATION
PERMITTEE: Orloll Colson
PERMIT it: WQ0035283
PROJECT: Colson Campground Private Sewer
ISSUE DATE: March 25, 2011
COUNTY: Brunswick
This project shall not be considered complete nor allowed to eporate In accordance with Condition 6
of this permit until the Division has received this Certification one all required supporting documentation,
Consequently, it sold be submitted in a manner that ctocurnonls the Division's receipt, Send the
required documenlcilion to the Regional Supervisor,Surface Water Protection Section al the address at
the bottom.
Any wastewater flow made tributary to the wastewater collection system extension prior to completion
of this Certification shall be considered a violation of the permit and shall subject the Permliteo to
appropriate enforcement actions. Inc Permit tee is responsible for tracking all partial certifications up
until a flea; certification is received. A Final Certification slog be cr complete set of record drawings and
design calculations regardless of whether partials have been submitted,
PERMITTEE'S CERTIFICATION
I, the undersigned agent for the Permittee,hereby stale that this project has bean constructed pursuant
to the applicable standards & requirements, the Professional Engineer below has provided applicable
design/construction Information to the Permillee, arid the Permittoe is prepared to operate &maintain
the wastewater collection system permitted heroin or portions thereof.
Oneil Caison,Owner
Printed Name,Titie Signature Date
ENGINEER'S CERTIFICATION
t, Gerald DeVito as a duly re. istered Professional Engineer in the Slate of North Carolina,
having been authorized to observe IX periodically, ❑ weekly, 0 full lime) the construction of the
project name and location as referenced above for the above Permiltee hereby stale that, la the best
of my abilities, due care and diligence was used in the observalion of the construction such that the
construction was observed to be built within substantial Compliance of this permil: 15A NCAC 2T; the
Division of Water Quality's (Division) Gravity Sewer Minimum Design Criteria adapted February 12, t996
as applicable; the Division's Minimum Design Criteria for the Fast-Track Permitting of Pump Stollens and
Force Mains adopted June I, 2000 as applicable;cinct other supporting materials.
North Carolina Professional Engineer's Seal w/signolure K dote
• r))t,tF►a,
CERTIFICATION COMMENTS OR DETAILS
(. flnul t;,.
❑Partial '- � •'
Cornrnents: /3,4L C
For completion of Phase I See previous partial certification dated 7/31/12
NC Division of Water Quality 127 Catdinot Drive Extension Wilmington,HC 288405
Wilmin(1len Roc )(Cr

Request for Engineering Certification Date of Letter: June 15,2021
Sewer Extension Permit Status Update
Please complete the applicable portion of this form for each permit and return this form and supporting documents by July 14,2021
to the attention of Collin Geersen at the Division's Municipal Permitting Unit by the delivery method below:
NCDEQ/DWR
WQPS-Municipal Permitting Unit
By U.S. Postal Service: By Courier/Special Delivery: By Email:
1617 Mail Service Center 512 N. Salisbury St. Suite 925 Collin Geersen
Raleigh, NC 27699-1617 Raleigh, NC 27604 [e-mail]
Permit No.:WQ0035283 Permittee: a,;60rl '411N'(� I �C,
Project Name: Ocean Breeze Family Camping & RV Resort Private Sewer
Project Status (Complete Signature&Date section below. Check appropriate box[ 'to indicate Permittee's response.)
Name&Title(print): hey _ 15 r"-Pre ,(412/1
Signature: iyrc�- `��"� ritti`_ Date: OC-oC j
-oe - 1.- I_^ Pi n�
Comments: f'J^ (� `(�r �S ��QC�„rn�" �(J Y�,�;h+, l-b.`� 0 ,___(.i �S
SEWER NOT YET CONSTRUCTED
❑ The Permittee certifies that the permitted project has not been constructed but shall be constructed in the future in conformity
with the approved Permit, project plans,specifications, and supporting documents.The Permittee understands that the
appropriate certification documents will need to be forwarded to the Division prior to operation. Subject permit shall be
maintained in Active status. NOTE: If sewer will never be built,please complete Permit Rescission Request section below.
SEWER HAS BEEN CONSTRUCTED
D'Engineer's Certification: The Permitted project has been constructed and the required Certification page and supporting
documents are being submitted to the Division with this form.
OWNERSHIP/NAME CHANGE
CV-The Permittee requests information to apply for ownership or name change. Please provide email and phone number below for
follow-up.
, ..
Permit Rescission Request
The Permittee requests that the subject permit be rescinded and certifies that the permitted sewer system has not been and shall
not be constructed nor made operational. By signing below, we acknowledge that should we wish to operate a non-discharge sewer
system in the future,we shall apply for and receive a new Wastewater Collection System Permit.
Name&Title(Print):
Signature: Date:
Comments:
Contact Information Updates for Permittee
Updated Contact Person&Title(Print):�_ ' \ 4-d
Updated Mailing Address: f a _l ._2 .c-L. ffiy i NIK—,___ (per
Updated Email: C�(`O ISQn O_, ;.le Updated Phone: 9(O— ' Coo

Request for Engineering Certification Date of Letter: June 15,2021
Sewer Extension Permit Status Update
Please complete the applicable portion of this form for each permit and return this form and supporting documents by July 14,2021
to the attention of Collin Geersen at the Division's Municipal Permitting Unit by the delivery method below:
NCDEQ/DWR
WQPS-Municipal Permitting Unit
By U.S. Postal Service: By Courier/Special Delivery: By Email:
1617 Mail Service Center 512 N.Salisbury St.Suite 925 Collin Geersen
Raleigh, NC 27699-1617 Raleigh, NC 27604 [e-mail]
Permit No.:WQ0035283 Permittee: C ,;60,--) y I �
Project Name:Ocean Breeze Family Camping& RV Resort Private Sewer
Project Status(Complete Signature&Date section below. Check appropriate box'to indicate Permittee's response.)
Name&Title(print): e k ' re6 (-Lin
Signature: Date: Cj c:>%
Comments: grO-et.A t j�J\¢r J-'c � nagiAcJP ri-,` i (o>' i Cf - U ka
1�•r;S-�-cl _ cs
SEWER NOT YET CONSTRUCTED
0 The Permittee certifies that the permitted project has not been constructed but shall be constructed in the future in conformity
with the approved Permit,project plans,specifications,and supporting documents.The Permittee understands that the
appropriate certification documents will need to be forwarded to the Division prior to operation. Subject permit shall be
maintained in Active status.NOTE:If sewer will never be built,please complete Permit Rescission Request section below.
SEWER- HAS BEEN CONSTRUCTED
IV Engineer's Certification: The Permitted project has been constructed and the required Certification page and supporting
documents are being submitted to the Division with this form.
OWNERSHIP/NAME CHANGE
iThe Permittee requests information to apply for ownership or name change. Please provide email and phone number below for
follow-up.
Permit Rescission Request
The Permittee requests that the subject permit be rescinded and certifies that the permitted sewer system has not been and shall
__not be constructed nor made operational.ay signing below,we acknowledge that should we wish to operate anon-discharge sewer
system in the future,we shall apply for and receive a new Wastewater Collection System Permit.
Name&Title(Print):
Signature: Date:
Comments:
Contact Information Updates for Permittee
Updated Contact Person&Title(Print):
Updated Mailing Address: 1 6 r- �-. -,� 3Cic-�' - (a
Updated Email: C7 C Cl i S®i"\ . CC 'ly'C'., fee ' Updated Phone: Q((� 4i - Z 6(04

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LIMITED LIABILITY COMPANY ANNUAL REPORT ■
fo,2017
NAME OF LIMITED LIABILITY COMPANY: Caison Family, LLC
Filing Office Use Only
SECRETARY OF STATE ID NUMBER: 1344368 STATE OF FORMATION: NC E-Filed Annual Report
1344368
REPORT FOR THE CALENDAR YEAR: 2021 3/25//02618414812 46 8
SECTION A: REGISTERED AGENT'S INFORMATION nChanges
1. NAME OF REGISTERED AGENT: Caison, Shelba H.
2.SIGNATURE OF THE NEW REGISTERED AGENT:
SIGNATURE CONSTITUTES CONSENT TO THE APPOINTMENT
3. REGISTERED AGENT OFFICE STREET ADDRESS&COUNTY 4.REGISTERED AGENT OFFICE MAILING ADDRESS
2772 Sparta Loop Road SW 2772 Sparta Loop Road SW
Supply, NC 28462 Brunswick County Supply, NC 28462
SECTION B: PRINCIPAL OFFICE INFORMATION
1. DESCRIPTION OF NATURE OF BUSINESS: Land Lease
2. PRINCIPAL OFFICE PHONE NUMBER: [phone] 3.PRINCIPAL OFFICE EMAIL: Privacy Redaction
4. PRINCIPAL OFFICE STREET ADDRESS 5.PRINCIPAL OFFICE MAILING ADDRESS
2772 Sparta Loop Road SW 2772 Sparta Loop Road SW
Supply,NC 28462-5352 Supply, NC 28462-5352
6. Select one of the following if applicable. (Optional see instructions)
The company is a veteran-owned small business
The company is a service-disabled veteran-owned small business
SECTION C: COMPANY OFFICIALS(Enter additional company officials in Section E.)
NAME: Shelba H Caison NAME: Jeffrey Lynn Caison NAME: James Kyle Caison
TITLE: Secretary TITLE: Vice President TITLE: President
ADDRESS: ADDRESS: ADDRESS:
2772 Sparta Loop Road SW 2747 Destiny Catilyn Ave. 2749 Destiny Catilyn Ave.
Supply, NC 28462 Supply, NC 28462 Supply, NC 28462
SECTION D: CERTIFICATION OF ANNUAL REPORT. Section D must be completed in its entirety by a person/business entity.
Shelba H Caison 3/25/2021
SIGNATURE DATE
Form must be signed by a Company Official listed under Section C of This form.
Shelba H Caison Secretary
Print or Type Name of Company Official Print or Type Title of Company Official
This Annual Report has been filed electronically.
MAIL TO:Secretary of State, Business Registration Division,Post Office Box 29525,Raleigh,NC 27626-0525

t6
' LIMITED LIABILITY COMPANY ANNUAL REPORT ■
10/2017
NAME OF LIMITED LIABILITY COMPANY: Caison Family, LLC
Filing Office Use Only
SECRETARY OF STATE ID NUMBER: 1344368 STATE OF FORMATION: NC E-Filed Annual Report
1344368
REPORT FOR THE CALENDAR YEAR: 2021 3/25/0281812 4508
SECTION A: REGISTERED AGENTS INFORMATION (Changes
1. NAME OF REGISTERED AGENT: Caison, Shelba H.
2. SIGNATURE OF THE NEW REGISTERED AGENT:
SIGNATURE CONSTITUTES CONSENT TO THE APPOINTMENT
3. REGISTERED AGENT OFFICE STREET ADDRESS&COUNTY 4.REGISTERED AGENT OFFICE MAILING ADDRESS
2772 Sparta Loop Road SW 2772 Sparta Loop Road SW
Supply, NC 28462 Brunswick County Supply, NC 28462
SECTION B: PRINCIPAL OFFICE INFORMATION
1. DESCRIPTION OF NATURE OF BUSINESS: Land Lease
2. PRINCIPAL OFFICE PHONE NUMBER: [phone] 3.PRINCIPAL OFFICE EMAIL: Privacy Redaction
4. PRINCIPAL OFFICE STREET ADDRESS 5.PRINCIPAL OFFICE MAILING ADDRESS
2772 Sparta Loop Road SW 2772 Sparta Loop Road SW
Supply,NC 28462-5352 Supply, NC 28462-5352
6.Select one of the following if applicable. (Optional see instructions)
The company is a veteran-owned small business
The company is a service-disabled veteran-owned small business
SECTION C: COMPANY OFFICIALS(Enter additional company officials in Section E.)
NAME: Shelba H Caison NAME: Jeffrey Lynn Caison NAME: James Kyle Caison
TITLE: Secretary TITLE: Vice President TITLE: President
ADDRESS: ADDRESS: ADDRESS:
2772 Sparta Loop Road SW 2747 Destiny Catilyn Ave. 2749 Destiny Catilyn Ave.
Supply, NC 28462 Supply,NC 28462 Supply,NC 28462
SECTION D:CERTIFICATION OF ANNUAL REPORT. Section D must be completed in its entirety by a person/business entity.
Shelba H Caison 3/25/2021
SIGNATURE DATE
Form must be signed by a Company Official listed under Section C of This form.
Shelba H Caison Secretary
Print or Type Name of Company Official Print or Type Title of Company Official
This Annual Report has been filed electronically.
MAIL TO:Secretary of State, Business Registration Division,Post Office Box 29525,Raleigh,NC 27626-0525

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/..uIIGA U IdI Muni:L^cot.
valorem taxes,fees,assessments or other
liens which the Brunswick County Tax
Collector is charged with collecting,that are a
lien on:Parcel Number Zil POD 1111111111111111111111111111101111 64342 Pa60s ions 48 00i
as notated by the Brunswick County Brunswick County, NC Register of Deeds page 1 of 2
Essessor's Office, This is not a certification
t+tat the parcel number matches the deed
cascripton.
APEpz Return to
F?a: 11./ Int._ I_
Ck$ Ck. 1.IV Cash$
'efund :aist _Tfinance
^a Portions of docurnen legible due to cond lion
of original.
IDocumentcnn,,'r:G ornin�,i
instrument r ,
.. 'n��?�I�;ced cr copied.
NORTH CAROLINA GENERAL WARRANTY DEED
STATE OF NORTH CAROLINA
COUNTY OF BRUNSWICK
THIS DEED, made this the ` 4.1- day of n0 , 2020, by and between
SHELBA H. CAISON (widow),of 2772 Sparta Loo_plRoad SW, Supply, North Carolina 28462,
party of the first part, hereinafter referred to as Grantor, and CAISON FAMILY, LLC, of 2772
Sparta Loop Road SW, Supply, North Carolina 28462, party of the second part, hereinafter
referred to as Grantee;
WITNESSETH :
THAT Grantor, for a valuable consideration paid by Grantee, the receipt of which is
hereby acknowledged, have and by these presents do grant, bargain, sell and convey unto.
Grantee, her successors and assigns, in fee simple, all those certain tracts or parcels of land
situated in Lockwood Folly Township, Brunswick County, North Carolina, and being more
particularly described as follows:
BEING all of that tract or parcel shown as Tract 2 containing 22.56 acres as
more fully described in a survey plat dated October 3,2018,entitled"Minor
Subdivision for Shelba H. Caison", prepared by Christopher D. Stanley,
P.L.S., Easy Coast Engineering and Surveying, PC, and recorded in Map
Cabinet o(O , at Page .�"ol , in the Office of the Register of Deeds,
Brunswick County, North Carolina to which plat reference is made and
which is incorporated herein for greater certainty of description of said
property.
This Deed was prepared by BaxleySmithwick,PLLC
Without opinion of title

IIIIIIII IIIIIIIIIIIII IIIIIIIIIIIIIIII B434 ds 2 P0607 4a? I
Brunswick County, NC Register of Dee page 2 of 2
Together with a non-exclusive right-of-way and easement for purposes
of ingress, egress, regress and the operation, maintenance and extension
of public and private utility services over, within, along, and upon that
certain area shown as "Destiny Caitlyn Avenue", a 50 foot private
right-of-way, as shown on said plat which right-of-way and said easement
shall be appurtenant to and shall run with the title of the tract herein
conveyed.
In accordance with NCGS Section 105-317.2,the mailing addresses of Grantor
and Grantee are as stated above. The property herein conveyed does not include
the primary residence of Grantor.
TO HAVE AND TO HOLD the aforesaid lot or parcel of land and all privileges and
appurtenances thereunto belonging to Grantees in fee simple.
AND Grantor does hereby covenant with Grantee that Grantor is seized of the premises in
fee simple, that she has the right to convey the same in fee simple,that title is marketable and
free and clear of all encumbrances,and that Grantor will warrant and defend the title against the
lawful claims of all persons whomsoever, subject to the following exceptions: utility easements
and restrictive covenants of record, street rights-of-way, and ad valorem property taxes for the
year 2020 and subsequent years.
IN WITNESS WHEREOF, Grantor has caused this instrument to be duly executed, the
day and year first above written.
SHELBA H.CAISON
STATE OF NORTH CAROLINA
COUNTY OF BRUNSWICK
I certify that the following person appeared before me this day,acknowledging to me that
she voluntarily signed the foregoing document for the purposes therein stated and in the
capacity therein indicated: SHELBM/.
'a N(widow).
Date: y 7; 6d 6
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