20090026 Ver 1_401 Application_20090109

Quible
09-0026
Quible & Associates, P.C. P Drawer 870
Kitty Ho wk, NC 27949
AtH 949
ENGINEERING • ENVIRONMENTAL SCIENCES • PLANNING • SURVEYING PAID Phone: [phone]
SINCE 1959 Fax: [phone]
PRINCIPALS
Sean C. Boyle, P.E.
Joseph S. Lassiter, C.E.P.
NC Division of Water Quality Eduardo J. Valdivieso, P.E.
Attn: Ian McMillan ASSOCIATES
1650 Mail Service Center Joseph J. Anlouf, P.E.
Raleigh, NC 27699-1650 Katherine C. Marchello, P.L.S.
January 6, 2009
RE: Lots 68 Beachside Landing
Ocracoke, Hyde County, NC
Mr. McMillan:
Enclosed is a Nationwide 18 and 401 Water Quality Certification submission for Lot 68 Beachside
Landing, located in Beachside Extension Subdivision in Ocracoke, Hyde County, North Carolina.
The applicant has a contract to purchase this property and has signed the authorization letter
along with the current owner. Also enclosed is the offer to purchase (Rex D. Peters from Omerta,
LLC). We have prepared this application for a Nationwide #18 Permit for 0.078 acres of Section
404 wetland impacts. The wetland impact area proposed is on Lot 68 as depicted on the site
plan. Uplands on Lot 68 have been evaluated for on-site septic suitability, and have been issued
an Improvement Permit by Hyde County Health Department.
The coastal wetlands line has been established by DCM in August 2006. The coastal wetlands
line in this area lies to the north side of Lot 68, and there are no proposed impacts to coastal
wetlands or the Tar-Pamlico Buffer Zones that apply in this river basin. The Section 404 wetlands
line received the current jurisdictional determination on 3/30/07 (SAW-2006-41141-148).
Enclosed are five copies of the following:
• Site Plan
• Agent Authorization Letter
• PCN Application
• USGS Vicinity Map
• EEP In-Lieu Fee Request
• Hyde County Improvement Permit
• Contract to Purchase Lot 68
• Copy of the $240 Processing Fee Check to NCDENR
Please review and process this permit request. If you have any questions or require additional
information, please contact me at [phone].
Sincerely,
Quible & Associates, P.C. Q ?e
Brian RubinoJAN 2oo9
CC: Kyle Barnes, DWQ tYETI1+?iD? R-WATERQUALITY AND Tom Steffens, USACE
Quible
Quible & Associates, P.C.
ENGINEERING • ENVIRONMENTAL SCIENCES • PLANNING • SURVEYING
SINCE 1959
Thomas Steffens
US Army Corps of Engineers
P.O. Box 1000
Washington, NC 27889
January 6, 2009
RE: Lots 68 Beachside Landing
Ocracoke, Hyde County, NC
Mr. Steffens:
P.O. Drawer 870
Kitty Hawk, NC 27949
Phone: [phone]
Fax: [phone]
PRINCIPALS
Sean C. Boyle, P.E.
Joseph S. Lassiter, C.E.P.
Eduardo J. Valdivieso, P.E.
ASSOCIATES
Joseph J. Anlauf, P.E.
Katherine C. Marchello, P.L.S.
Enclosed is a Nationwide 18 and 401 Water Quality Certification submission for Lot 68 Beachside
Landing, located in Beachside Extension Subdivision in Ocracoke, Hyde County, North Carolina.
The applicant has a contract to purchase this property and has signed the authorization letter
along with the current owner. Also enclosed is the offer to purchase (Rex D. Peters from Omerta,
LLC). We have prepared this application for a Nationwide #18 Permit for 0.078 acres of Section
404 wetland impacts. The wetland impact area proposed is on Lot 68 as depicted on the site
plan. Uplands on Lot 68 have been evaluated for on-site septic suitability, and have been issued
an Improvement Permit by Hyde County Health Department.
The coastal wetlands line has been established by DCM in August 2006. The coastal wetlands
line in this area lies to the north side of Lot 68, and there are no proposed impacts to coastal
wetlands or the Tar-Pamlico Buffer Zones that apply in this river basin. The Section 404 wetlands
line received the current jurisdictional determination on 3/30/07 (SAW-2006-41141-148).
Enclosed is the following:
• Site Plan
• Agent Authorization Letter
• PCN Application
• USGS Vicinity Map
• EEP In-Lieu Fee Request
• Hyde County Improvement Permit
• Contract to Purchase Lot 68
• Copy of the $240 Processing Fee Check to NCDENR
Please review and process this permit request. If you have any questions or require additional
information, please contact me at [phone].
Sincerely,
Qui?ble & Associates, P.C.
Fk„v 1 r elf
Brian Rubino
CC: Kyle Barnes, DWQ
Ian McMillan, DWQ
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VICINITY MAP
NOTES:
1. APPLICANT. REX D. PETERS
P.O. BOX 28
KILL DEVIL HILLS, NC 27948
° 2. PROPERTY AREA: 6,750 SQ.FT. (0.155 AC.)
A. EX. UPLANDS: 1,559 SQ.FT.B. EX. WETLANDS:5,191 SQ.FT.
3. PROPOSED WORK:
USING A NATIONWIDE #18: FILL OF (3,403 SQ.FT./0.078 AC)
r? OF SECTION 404 FRESHWATER WETLANDS ON LOT 68
(REQUIRES 401 WATER QUALITY CERT.)

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PROJECT
COPYRIGHT © 2006
QUIBLE & ASSOCIATES, P.C.
DRAWN
BDR THIS DOCUMENT IS THE PROPERTY 01
QUIBLE do ASSOCIATES, PC. ALL

CAD REF RIGHTS ARE RESERVED. ANY RE-
PRODUCTION OF THIS OR POSSESSI01
. WITHOUT PRIOR PERMISSION OF
QUIBLE do ASSOCIATES, PC WILL
CONSTITUTE VIOLATION OF COPYRIGHT
LAWS. VIOLATION WILL BE SUBJECT
DATE TO LEGAL ACTION
1/2/09
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NOTE: HYDE COUNTY HEALTH DEPT. HAS ISSUED AN
ON-SITE SEPTIC TREATMENT SYSTEM IMPROVEMENT PERMIT
NATIONWIDE 18 AND 401 CERTMCATION
LOT 68 BEACHME LANDING
OCRACOKE HYDE COUNTY
NORTH CAROLINA
0 30 60
GRAPHIC SCALE IN FEET 1'=30
Quible SINCE 1959
& Associates, P.C.
ENGINEERING • CONSULTING • PLANNING
ENVIRONMENTAL SCIENCES * SURVEYING
Phone: [phone]
Fax: [phone]
E-Mall: quible0earthlink.net
'/SYESPTn C
EM
UPLANDS
January 5, 2009
RE: Lot 68, Beachside Landing
Ocracoke, Hyde County, North Carolina
I authorize Quible & Associates, P,C. to act as agent on behalf of the current owner, Omerta,
LLC and the contracted purchaser, Rex D. Peters, for environmental permitting, including
USAGE and DWQ permits if necessary.
Name: Mike Nolan. Omerta LLC Date /- G -0 /
Name: Rex D. Peters Date l G D 1
Office Use Only: Form Version March 08
USACE Action ID No. DWQ No. 0 9- 0 0 2 6
k.. any Faiut,uia1 ,Lo,,, ,b nut appttcauie to tnts project, please enter "Not Applicable" or "N/A".)
1. Processing P-A-1 D
1. Check all of the approval(s) requested for this project:
® Section 404 Permit ? Riparian or Watershed Buffer Rules
? Section 10 Permit ? Isolated Wetland Permit from DWQ
® 401 Water Quality Certification ? Express 401 Water Quality Certification
2. Nationwide, Regional or General Permit Number(s) Requested: Nationwide 18
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 impacts, 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 Coastal Management Area of
Environmental Concern (see the top of page 2 for further details), check here:
II. Applicant Information L j'!L?
t.? i !1 ? CI
1. Owner/Applicant Information v U
Name: Rex D. Peters JAN 8 20?g
Mailing Address: P.O. Box 28 aEss-WATERQOAL+Ty
Kill Devil Hills NC 27948 s??+
Telephone Number: [phone] Fax Number:
E-mail Address:
2. Agent/Consultant Information (A signed and dated copy of the Agent Authorization letter
must be attached if the Agent has signatory authority for the owner/applicant.)
Name: Brian Rubino
Company Affiliation: Quible & Associates P.C.
Mailing Address: P.O. Drawer 870
Kitty Hawk NC 27949
Telephone Number: [phone] Fax Number: [phone]
E-mail Address:[e-mail]
Page 5 of 13
III. Project Information
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 and 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
USACE 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 are provided.
1. Name of project: Lot 68, Beachside Landing
2. T.I.P. Project Number or State Project Number (NCDOT Only):
3. Property Identification Number (Tax PIN): M.B. B PG. 69-132
4. Location
County: Hyde Nearest Town: Ocracoke
Subdivision name (include phase/lot number): Beachside Extension
Directions to site (include road numbers, landmarks, etc.):
From Hatteras to Ocracoke ferry terminal take NC 12 to the village of Ocracoke; take first
right after Howard's Pub and another right onto Central Drive; take a left onto Lake Drive
5. Site coordinates (Lat/Long or decimal degrees): 35.10778 N, -75.96961 W
(Note - If project is linear, such as a road or utility line, attach a sheet that separately lists the
coordinates for each crossing of a distinct waterbody.)
6. Property size (acres): 0.15
7. Name of nearest receiving body of water: Pamlico Sound
8. River Basin: Tar-Pamlico
(Note - this must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at http://h2o.enr.state.nc.us/admin/maps/.)
9. Describe the existing conditions on the site and general land use in the vicinity of the project
at the time of this application: Undeveloped grassy with sparse trees and shrub-scrub type
veizetation: property contains upland areas and freshwater Section 404 wetlands The nearest
coastal wetlands line is 141 ft to the north of Lot 68. The coastal wetlands for this area of
Beachside Extension was established by DCM in August 2006 The Section 404 wetlands
Page 6 of 13
line has been confirmed by USACE on 3/20/07 (SAW-2006-41141-148) None of the
proposed work is within coastal wetland areas or within the Tar-Pamlico Buffer areas This
general vicinity of Ocracoke is comprised of residentially developed and undeveloped
residential lots, and commercially developed businesses along NC 12
10. Describe the overall project in detail, including the type of equipment to be used:
The proposed work involves placement of sand fill in the Section 404 freshwater (non
coastal) wetland area identified on the accom anyin proposed site plan for the purpose of
residential house construction on Lot 68 Prior to any fill on the subject lots silt fence will
be properly installed to around the boundary of the land disturbance areas Sand will be
transported to the site via dump truck and will be spread and compacted with a back hoe
This material will be seeded for stabilization prior to construction of the house and associated
septic system. The septic system has been permitted by Hyde County Health on existing
uplands.
"
11. Explain the purpose of the proposed work: The purpose of the proposed work is to provide
one buildable homesite on Lot 68 (platted in 1960) that has an existing natural upland area
This lot is suitable for an on-site septic system (see improvement permit enclosed)
IV. Prior Project History
If jurisdictional determinations and/or permits have been requested and/or obtained for this
project (including all prior phases of the same subdivision) in the past, please explain. Include
the USACE Action ID Number, DWQ Project Number, application date, and date permits and
certifications were issued or withdrawn. Provide photocopies of previously issued permits,
certifications or other useful 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.I.P. project, along with
construction schedules._ A USACE jurisdictional determination has been issued on 3/30/07
(SAW-2006-41141-148). A Nationwide #14 has been issued for minor road crossings in the
subdivision, but there is no history of permit requests for Lot 68
V. Future Project Plans
Are any future permit requests anticipated for this project? If so, describe the anticipated work,
and provide justification for the exclusion of this work from the current application.
No additional wetland impact permit requests will be necessary for this project There will be a
future building permit request to Hyde County. The development footprint depicted on the
proposed site plan adheres to Hyde Count requirements and a septic improvement permit has
been issued by Hyde County Health Department (enclosed)
VI. Proposed Impacts to Waters of the United States/Waters of the State
Page 7 of 13
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). Be 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.
L Provide a written description of the proposed impacts: Impacts include a jurisdictional
Section 404 wetland impact of 0.078 acres This includes an area that is proposed to be filled
for a single-family residential structure and a parking area Prior to any land disturbance silt
fencing will be installed around the perimeter of the work area The sand material will be
compacted and seeded for stabilization prior to construction
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,
senarately lict imnnrtc rlna to 1- fl, ctr....t,,,-o .,tea ?1 4:_-
Wetland Impact
Site Number
(indicate on map)
Type of Impact Type of Wetland
(e.g., forested, marsh,
herbaceous, bog, etc.) Located within
100-year
Floodplain
(yes/no) Distance to
Nearest
Stream
(linear feet) Area of
Impact
(acres)
Area 1 Fill/grading Sec. 404 (non-riparian) yes 2,4001f to
Pamlico Sound 078

Total Wetland Impact (acres) 0.078
3. List the total acreage (estimated) of all existing wetlands on the property: 0.120 acres
4. Individually list all intermittent and perennial stream impacts. Be sure to identify temporary
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
must be included- To c91r„1ntP nrrpna- ]---+t, v ..:a.L , , ,

Stream im
t v - --- -- -? ----D.... < ? .. .....?., 1-- u viu?. vy 'f J,J VV.
pac
Number
(indicate on ma
)
Stream Name
Type of Impact
Perennial or
Intermittent? Average
Stream Width

Before Impact Impact
Length

(linear feet) Area of
Impact

(acres)

Page 8 of 13
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. dredging- flnndinu dminnoP hnllrhandc Pto
Open Water Impact
Site Number

(indicate on ma)
Name of Waterbody
(if applicable)
of Impact
Type Pact Type of Waterbody

(lake, pond, estuary, sound, bay,
ocean, etc.) Area of

Impact

(acres)

Total Open Water Impact (acres)
6. List the cumulative impact to all Wnterc of the IT c n-cnltincr from thA .,r.,-+-
Stream Impact (acres): None
Wetland Impact (acres): 0.078
Open Water Impact (acres): None
Total Impact to Waters of the U.S. (acres) 0.078
Total Stream Impact (linear feet): None
7. Isolated Waters
Do any isolated waters exist on the property? ? Yes ® 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.
8. Pond Creation NA
If construction of 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 on 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/embankment, excavation, installation of
draw-down valve or 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. Impact Justification (Avoidance and Minimization)
Page 9 of 13
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, discuss construction
techniques to be followed during construction to reduce impacts. The wetland impact area has
been minimized to allow single family home construction There is no proposed fill within an
Area of Environmental Concern (AEC) including estuarine AEC and coastal wetlands
Additionally, Lot 68 does not lie within the Tar-Pamlico Buffer Zones
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 150 linear feet of total impacts to perennial
streams.
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 the 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 values, 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.enr.state.nc.us/ncwetlands/strmgide.html.
1. 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 separate sheet if more space is needed.
Proposed mitigation includes payment into the NCEEP at a 2.1 mitigation to fill ratio (See
enclosed In-Lieu Fee Request Form)
Page 10 of 13
2. Mitigation may also be made by payment into the North Carolina Ecosystem Enhancement
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 http://h2o.enr.state.nc.us/wrp/index.htm. If use of the NCEEP is proposed, please
check the appropriate box on page three and provide the following information:
Amount of stream mitigation requested (linear feet): N/A
Amount of buffer mitigation requested (square feet): N/A
Amount of Riparian wetland mitigation requested (acres): N/A
Amount of Non-riparian wetland mitigation requested (acres): 0.25 acres (2:1 mitigation
to fill ratio)
Amount of Coastal wetland mitigation requested (acres): N/A
IX. Environmental Documentation (required by DWQ)
1. Does the project involve an expenditure of public (federal/state/local) funds or the use of
public (federal/state) land? Yes ? No
2. 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 a NEPA/SEPA document is required, call the SEPA
coordinator at [phone] to review current thresholds for environmental documentation.
Yes ? No ?
3. If yes, has the document review been finalized by the State Clearinghouse? If so, please
attach a copy of the NEPA or SEPA final approval letter. Yes ? No ?
X. Proposed Impacts on Riparian and Watershed Buffers (required by DWQ)
It 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 Office may be included as appropriate. Photographs may also be included at the
applicant's discretion.
1. 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
Page 11 of 13
2. 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 multipliers.
Zone* Impact
(s are feet
Multiplier
Required
Mitigation
1 1,484 3 (2 for Catawba) 4,452
2 5,134 1.5 7,701
Total I 6,618 I 12,153
* Zone 1 extends out 30 feet perpendicular from the top of the near bank of channel; Zone 2 extends an
additional 20 feet from the edge of Zone 1.
3. 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 Restoration Fund). Please attach all appropriate information as identified
within 15A NCAC 2B .0242 or .0244, or .0260.
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. If percent impervious surface exceeds 20%, please provide calculations
demonstrating total proposed impervious level. No existing impervious coverage
Proposed new impervious coverage associated with the proposed house footprint is 1,463 sq ft
The driveway will be pervious gravel
XII. Sewage Disposal (required by DWQ)
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.
An on-site septic treatment system will be installed Upland soils have been evaluated by the
Hyde County Health Department (see enclosed improvement permit for Lot 68)
XIII. Violations (required by DWQ)
Is this site in violation of DWQ 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 DWQ)
Will this project (based on past and reasonably anticipated future impacts) result in additional
development which could impact nearby downstream water quality? Yes ? No
Page 12 of 13
If yes, please submit a qualitative or quantitative cumulative impact analysis in accordance with
the most recent North Carolina Division of Water Quality policy posted on our website at
http://h2o.enr.state.nc.us/ncwetlands. If no, please provide a short narrative description:
There would be no additional development on the subject lot that would impact wetlands or
downstream waters.
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 may
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
Threatened Species, accessibility problems, or other issues outside of the applicant's control).
11401
Applicant/Agent's Signature Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
Page 13 of 13

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Copyright (C) 1998, Maptech, Inc
NORTH CAROLINA ECOSYSTEM ENHANCEMENT PROGRAM, NCEEP
IN-LIEU FEE REQUEST FORM
Revised 9/11/2008
Print this form, fill in requested information, sign and date, and either mail to NCEEP, 1652 Mail Service Center, Raleigh, INC
27699-1652, fax to 919-715-2219, or email to [e-mail]. Attachments are acceptable for clarification
purposes (location map is required).
CONTACT INFORMATION APPLICANT'S AGENT (optional) _ APPLICANT
i
1. Business or Individual Name - v-
-- --- -_. ._. -- - ------ --
2_Street Address or P O Box P. b p rq w ?? $ U P. O. (3p ?c 2S
3. City, State, Zip ............ ?lbw K,
4. Contact Person
5. Telephone Number ?2SZ) 2 Co 1- 33 G ZJ`Z '?
----------- ------ ------ - -------- --- ----- - -----
6. Fax Number
7 E-Mail Address (optional) (p,ru bi?i a (P q L", 6I R .(0 -I
PROJECT INFORMATION -y - - -_----
8 Project Name
..__ ,. ea c h, et e_ _ 6:,,,k04,
---- ------ ----
- - -- - _ ' LOT'
_
9. Project Location (nearest town, city) jj??
**ATTACH MAP SHOWING IMPACT LOCATION* V L (a c o ?ce
10 Lat-Long Coordinates (optional) ---
11. Project County
12. River Basin -------
Tar -rniI. C 0 -------------------------------------------
13. Cataloging Unit (8-digit) (See Note 1)
b3 ozb i 0 S
14. Riparian Wetland Impact (ac.) (e.g., 0.13)
- -- -- --- ---- -------- ------ - -- - -- N 0 Al C_
-
15. Non-Riparian Wetland Impact (ac.) -

16. Coastal Marsh Impact (ac.) - -
_.-- -- NONE
17. Stream Impact (ft.) (e.g. 1,234) Warm Cool Cold
(See Note 2) ........ .........
- -:
AA>n/
18. Buffer Impact-Zone (sq. ft.) (e.g. 12,345)
(See Note 3) Nt3N E . `Zone 1: ;Zone 2:
19. Regulatory Agency Staff Contacts
(Indicate names, if known) USACE: . Stz{fe.n.S DWQ: K i3c.fv??S
20. Other Regulatory ID Information
USACE
)
(e.g.,
Action ID, if known
IMPORTANT
Check (?) below if this request is a: Si nature
or Agent:
_ revision to a current acceptance, or =
_ re-submission of an expired acceptance
_ extension of unexpired acceptance

Date: /
i - tci°6 9
Note 1: For help in determining the Cataloging Unit, go to EPA's "Surf Your Watershed" web page:
http://cfpub.epa.aov/surf/locate/index cfm Note (9) above: requirement to attach location map.
Note 2: For guidance on stream temperatures, go to:
http://www.saw.usace.armv.mii/WETLANDS/Mitigation/Documents/Stream/Appendices/Appendix) pdf
Note 3: Buffer mitigation applicable only in the Neuse, Tar-Pamlico and Catawba river basins, and the Randleman Lake
Water Supply Watershed. Direct all questions to Valerie Mitchener at 919-715-1973 or [e-mail]
f HYDE COUNTY HEALTH DEPARTMENT
P.O. Box 100 Swan Quarter, NC 27885
Phone # [phone]
IMPROVEMENT PERMIT
INITIAL INSTALLATION: XXX EXPANSION: REPAIR:
Permit No: 102006-7 Date: November 20, 2006
Permittee: Elizabeth Ann Warner
Address: C/O E.3. Valdivieso, P.O. Drawer 870, Kitty Hawk, NC 27948
Phone No.: [phone]
Property Location: Lot #68 Beachside Extension S/D, Ocracoke
Facilities to be served: 4 bedroom house
Water Supply: private well
Wastewater Flow GPD: 480
Wastewater System Type: Va., TS-I, Pretreatment
Wastewater System Repair: NA
Long Term Acceptance Rate: 1.0 gpd/sq,ft,
Absorption Area: 360 sq.ft.
Septic Tank Capacity: 1000 gallons with filter
Pump Tank Capacity: 1000
Total Bed/Trench Length: To be determined by engineer Width: To be determined by
engineer
Bed/Trench Spacing: NA
Maximum Bed/Trench Bottom Depth: 6" above the naturally occurring soil surface
IMPROVEMENT PERMT
ELIZABETH ANN WARNER
RAGE 2
CONDITIONS:
1. Plans and specifications shall be submitted to the Hyde County Health Department
for a TS-1 pretreatment system. The plans and specifications shall be prepared by
a registered professional engineer and his/her seal affixed to the submittal.
2. The plans and specifications shall contain information necessary for construction
of the system in accordance with the applicable rules and laws, the system
approval, and section .1938 (i)(1-7) of the Laws and Rules For Sewage Treatment
and Disposal Systems.
3. Prior to the issuance of the Operation Permit, the owner shall submit to the Hyde
County Health Department a statement signed by the design engineer stating that
construction is complete and in accordance with the approved plans and
specifications and approved modifications. Periodic observations of construction
and a final inspection for design compliance by the design engineer or his/her
representative shall be required for this statement. The statement shall be affixed
with the design engineer's seal.
4. This permit does not circumvent any other permits required by other agencies for
filling activities.
5. Use water conserving fixtures Le. 1.6 gallon flush toilets, 2 gpm shower heads, 1
gpm all lavatories.
6. An Authorization to Construct will be issued upon final approval of the submitted
plans and specifications and the initial site modifications.
7. The well shall be located a minimum of 50' from all parts of the wastewater
system and 25' from any building foundation.
8. All setbacks from the drainfield shall be measured from a point 5' from the nearest
edge of the rock bed.
9. The system will require operation and maintenance by a licensed subsurface
operator certified by the Water Pollution Control System Operator Certification
Commission. A copy of the contract with the ORC shall be submitted to the Hyde
County Health Department prior to the issuance of an Operation Permit.
IMPROVEMENT PERMIT
ELIZABETH ANN WARNER
PAGE 3

This Improvement Permit shall be valid:
Without expiration
upon a showing satisfactory to the Hyde County Health Department that the site and soil
conditions are unaltered, that the facility, design wastewater flow, and wastewater
characteristics are not increased, and that a wastewater system can be installed that
meets the permitting requirements in effect on the date this permit was issued., This
permit is subject to revocation if site plans or the intended use changes.
Authorized Accent: ? -.,- /--- .O 0
cnvcroamental Health Specialist
Hyde County Health Department
OFFER TO PURCHASE AND CONTRACT - VACANT LOT/LAND
[Consult "Guidelines" (form 12G) for guidance in completing this form]
NOTE: This contract is intended for unimproved real property that Buyer will purchase only for personal use and does not have
immediate plans to subdivide. It should not be used to sell property that is being subdivided unless the property has been platted,
properly approved and recorded with the register of deeds as of the date of the contract. If Seller is Buyer's builder and the sale involves
the construction of a new single family dwelling prior to closing, use the standard Offer to Purchase and Contract (Form 2-T) with the
New Construction Addendum (Form 2A3-T).
Rex D Peters , as Buyer,
hereby offers to purchase and Omerta, LLC , as Seller,
upon acceptance of said offer, agrees to sell and convey, all of that plot, piece or parcel of land described below (hereafter referred to as
the "Property"), upon the terms and conditions set forth herein. This offer shall become a binding contract on the date that: (i) the last
one of the Buyer and Seller has signed or initialed this offer or the final counteroffer, if any, and (ii) such signing or initialing is
communicated to the party making the offer or counteroffer, as the case may be. Such date shall be referred to herein as the "Effective
Date."
1. REAL PROPERTY: Located in Hyde County, State of North Carolina,
being known as and more particularly described as:
Address: Street Lot # 68 Lake Drive Beachside S
City: Ocracoke zip 27960
NOTE: Governmental authority over taxes, zoning, school districts, utilities and mail delivery may differ from address shown.
Legal Description:
Subdivision Name: Beachside
Plat Reference: Lot 68 Block or Section as shown on
Plat Book or Slide at Page(s) (Property acquired by Seller in Deed Book at Page ).
NOTE: Prior to signing this Offer to Purchase and Contract - Vacant Lot/Land, Buyer is advised to review Restrictive Covenants, if
any, which may limit the use of the Property, and to read the Declaration of Restrictive Covenants, By-Laws, Articles of Incorporation,
Rules and Regulations, and other governing documents of the owners' association and/or the subdivision, if applicable. If the Property
is subject to regulation by an owners' association, it is recommended that Buyer obtain a copy of a completed Owners' Association
Disclosure And Addendum (standard form 2A12-T) prior to signing this Offer to Purchase and Contract, and include it as an addendum
hereto.
2. PURCHASE PRICE: The purchase price is $ 300, 000.00 and shall be paid in U.S.
Dollars. Should any check or other funds paid by Buyer be dishonored, for any reason, by the institution upon which the payment is
drawn, Buyer shall have one (1) banking day after written notice to deliver good funds to the payee. In the event Buyer does not timely
deliver good funds, the Seller shall have the right to terminate this contract upon written notice to the Buyer. The purchase price shall
be paid as follows:
(a) $100.00 , EARNEST MONEY DEPOSIT with this offer by ? cash ? personal check ? bank check
? certified check ? other: to be deposited and held in escrow by
Michael Casey, Trustee ("Escrow Agent") until the sale is closed, at which time it will be credited to
Buyer, or until this contract is otherwise terminated. In the event: (1) this offer is not accepted; or (2) any of the conditions hereto are
not satisfied, then all earnest monies shall be refunded to Buyer. In the event of breach of this contract by Seller, all earnest monies
shall be refunded to Buyer upon Buyer's request, but such return shall not affect any other remedies available to Buyer for such breach.
In the event of breach of this contract by Buyer, then all earnest monies shall be forfeited to Seller upon Seller's request, but such
forfeiture shall not affect any other remedies available to Seller for such breach.
NOTE: In the event of a dispute between Seller and Buyer over the return or forfeiture of earnest money held in escrow, a licensed real
estate broker ("Broker") is required by state law (and Escrow Agent, if not a Broker, hereby agrees) to retain said earnest money in the
Escrow Agent's trust or escrow account until Escrow Agent has obtained a written release from the parties consenting to its disposition
or until disbursement is ordered by a court of competent jurisdiction. Alternatively, if a Broker is holding the Earnest Money, the
Broker may deposit the disputed monies with the appropriate clerk of court in accordance with the provisions of N.C.G.S. §93A-12.
Page 1 of 7
This form jointly approved by: STANDARD FORM 12-T
North Carolina Bar Association Revised 7/2008
REALTOR® North Carolina iation of REALTORS®, Inc. OPPORTUNITY ©7/2008
Buyer initial Seller initials ---1?--
Ocean Trail Realty P.O. Box 2059, Kitty Hawk C 27949 Phone: [phone] Fax: [phone] Beachside.zfx
O°CPIX Produced with ZipFormw by RE FormsNet, LLC 18070 Fifteen Mile Road, Fraser, Michigan 48026 www.7imrm.com
THE PARTIES AGREE THAT A REAL ESTATE BROKERAGE FIRM ACTING AS ESCROW AGENT MAY PLACE ANY
EARNEST MONIES DEPOSITED BY BUYER IN AN INTEREST BEARING TRUST ACCOUNT AND THAT ANY
INTEREST EARNED THEREON SHALL BE DISBURSED TO THE ESCROW AGENT MONTHLY IN CONSIDERATION
OF THE EXPENSES INCURRED BY MAINTAINING SUCH ACCOUNT AND RECORDS ASSOCIATED THEREWITH.
(b) $ (ADDITIONAL) EARNEST MONEY DEPOSIT to be paid to Escrow Agent no later than
TIME BEING OF THE ESSENCE WITH REGARD TO SAID DATE.
(c) $ OPTION FEE in accordance with paragraph 13, Alternative 2, to be paid to Seller on the
Effective Date. (NOTE: If Alternative 2 applies, then do not insert $0, N/A, or leave blank).
(d) $ , BY ASSUMPTION of the unpaid principal balance and all obligations of Seller on the existing
loan(s) secured by a deed of trust on the Property in accordance with the attached Loan Assumption Addendum.
(e) $ , BY SELLER FINANCING in accordance with the attached Seller Financing Addendum.
(1) $ 299, 900.00 , BALANCE of the purchase price in cash at Closing.
3. LOAN CONDITION:
(a) Loan. Buyer's performance is contingent upon Buyer's ability to obtain a a Conventional ? Other:
loan at a a Fixed Rate ? Adjustable Rate in the principal amount of $295, 000.00 for a term of 15 year(s),
at an initial interest rate not to exceed 6.000 % per annum, with mortgage loan discount points not to exceed 1.000 %
and with loan origination fee not to exceed 1.000 % of the loan amount ("Loan").
(b) Loan Obligations: The Buyer agrees to:
(i) Make written application for the Loan, authorize any required appraisal and pay any necessary fees within 30
days after the Effective Date;
(ii) Promptly furnish Seller written confirmation from the lender of having applied for the Loan.
If Buyer fails to furnish Seller written confirmation from the lender of having applied for the Loan, Seller may make written demand
for compliance. If Buyer does not furnish Seller written confirmation from the lender of application within five (5) days after such
demand, then Seller may terminate this contract by written notice to Buyer at any time thereafter, provided Seller has not received
either written evidence of the application or a waiver of the Loan Condition, and all Earnest Money shall be forfeited to Seller as
liquidated damages and as Seller's sole and exclusive remedy for Buyer's failure to close, but without limiting Seller's rights under
paragraph 14 for damage to the Property. Buyer further agrees to:
(iii) Pursue qualification for and approval of the Loan diligently and in good faith;
(iv) Continually and promptly provide requested documentation to lender.
(c) Buyer's Right to Terminate: If Buyer has complied with Buyer's Loan Obligations in subsection (b) above, then within 30
days after the Effective Date (or any agreed-upon written extension of this deadline) TIME BEING OF THE ESSENCE, Buyer shall
have the right to terminate this contract by delivering to Seller written notice of termination if Buyer, in Buyer's sole discretion, is not
satisfied that the Loan will be approved and funded. If Buyer has timely delivered such notice, this contract shall be terminated and all
Earnest Money shall be refunded to Buyer. If Buyer fails to deliver such notice, then Buyer will be deemed to have waived this
condition. Thereafter, if Buyer fails to close based upon inability to obtain the Loan, then all Earnest Money shall be forfeited to Seller.
If Buyer provides Seller reasonable third-party documentation confirming Buyer's inability to obtain the Loan, then the Earnest Money
shall serve as liquidated damages and as Seller's sole and exclusive remedy for Buyer's failure to close, but without limiting Seller's
rights under paragraph 14 for damage to the Property. (WARNING: Buyer is advised to consult with Buyer's lender to assure that the
number of days allowed for Buyer to obtain the Loan is sufficient to allow Buyer's lender time to take all reasonable steps necessary to
provide reliable loan approval.)
4. FLOOD HAZARD DISCLOSURE/CONDITION (Choose ONE of the following alternatives):
To the best of Seller's knowledge, the Property IS located partly or entirely within a designated Special Flood Hazard Area. Buyer
understands that it may be necessary to purchase flood insurance in order to obtain any loan secured by the Property from any
federally regulated institution or a loan insured or guaranteed by an agency of the U. S. Government.
? To the best of Seller's knowledge, the Property IS NOT located partly or entirely within a designated Special Flood Hazard Area. If,
following the Effective Date of this contract, it is determined that the Property is located partly or entirely within a designated
Special Flood Hazard Area according to the current FEMA flood map, or if this contract is subject to a Loan Condition and Buyer's
lender requires Buyer to obtain flood insurance as a condition of making the Loan, then in either event Buyer shall have the right to
terminate this contract upon written notice to Seller, and all earnest monies shall be refunded to Buyer.
5. OTHER CONDITIONS: (State N/A in each blank that is not a condition to this contract.)
(a) There must be no restriction, easement, zoning or other governmental regulation that would prevent the reasonable use of the
Property for residential
b purposes.
O The Property must be in substantially the same or better condition at Closing as on the date of this offer, reasonable wear and tear
excepted.
Page 2 of 7 STANDARD FORM 12-T
Revised 7/2008
Buyer initials Seller initials 07/2008
Produced with ZipForrn- by RE FormsNet, LLC 18070 Fifteen Mile Road, Fraser, Michigan 48026 www.zipform.com Beachside.zfx
(c) The Property must appraise at a value equal to or exceeding the purchase price or, at the option of Buyer, this contract may be
terminated and all earnest monies shall be refunded to Buyer, even if the Loan Condition has been waived as provided in
paragraph 3.
If this contract is NOT subject to a financing contingency requiring an appraisal, Buyer shall arrange to have the appraisal
completed on or before
(d) All deeds of trust, liens and other charges against the Property, not assumed by Buyer, must be paid and satisfied by Seller prior to
or at Closing such that cancellation may be promptly obtained following Closing. Seller shall remain obligated to obtain any such
cancellations following Closing.
(e) Title must be delivered at Closing by GENERAL WARRANTY DEED unless otherwise stated herein, and must be fee simple
marketable and insurable title, free of all encumbrances except: ad valorem taxes for the current year (prorated through the date of
Closing); utility easements and unviolated restrictive covenants that do not materially affect the value of the Property; and such
other encumbrances as may be assumed or specifically approved by Buyer. The Property must have legal access to a public right of
way.
6. SPECIAL ASSESSMENTS: NOTE: For purposes of this agreement, a "confirmed" special assessment is defined as an
assessment that has been approved by a governmental agency or an owners' association for the purpose(s) stated, whether or not it is
fully payable at time of closing. A "pending" special assessment is defined as an assessment that is under formal consideration by a
governing body. Seller warrants that there are no pending or confirmed governmental special assessments for sidewalk, paving, water,
sewer, or other improvements on or adjoining the Property, and no pending or confirmed owners' association special assessments,
except as follows (Insert "None" or the identification of such assessments, if any):
Unless otherwise agreed, Seller shall pay all owners' association assessments and all governmental assessments confirmed through the
time of Closing, if any, and Buyer shall take title subject to all pending assessments disclosed by Seller herein, if any.
7. PRORATIONS AND ADJUSTMENTS: Unless otherwise provided, the following items shall be prorated and either adjusted
between the parties or paid at Closing: (a) Ad valorem taxes on real property shall be prorated on a calendar year basis through the date
of Closing; (b) All late listing penalties, if any, shall be paid bly Seller; (c) Rents, if any, for the Property shall be prorated through the
date of Closing; (d) Owners' association dues and other like ?es shall be prorated through the date of Closing. Seller represents
that the regular owners' association dues, if any, are $ per . Unless otherwise agreed,
Buyer shall pay any fees required for obtaining account pay?h a information on owners' association dues or assessments for payment
or proration and any charge made by the owners' association in connection with the disposition of the Property to Buyer, including any
transfer and/or document fee imposed by the owners' association.
8. EXPENSES: Unless otherwise agreed, Buyer shall be responsible for all costs with respect to any loan obtained by Buyer,
appraisal, title search, title insurance, recording the deed and for preparation and recording of all instruments required to secure the
balance of th purchase price unpaid at Closing. Seller shall pay for preparation of a deed and all other documents necessary to perform
Seller's oPins 7ection under this agreement, and for excise tax (revenue stamps) required by law. Seller shall pay at Closing
$ toward any of Buyer's expenses associated with the purchase of the Property, including any FHA/VA
lender and costs that Buyer is not permitted to pay, but excluding any portion disapproved by Buyer's lender.
9. EVIDENCE OF TITLE: Seller agrees to use his best efforts to deliver to Buyer as soon as reasonably possible after the Effective
Date of this contract, copies of all title information in possession of or available to Seller, including but not limited to: title insurance
policies, attorney's opinions on title, surveys, covenants, deeds, notes and deeds of trust and easements relating to the Property. Seller
authorizes (1) any attorney presently or previously representing Seller to release and disclose any title insurance policy in such
attorney's file to Buyer and both Buyer's and Seller's agents and attorneys; and (2) the Property's title insurer or its agent to release and
disclose all materials in the Property's title insurer's (or title insurer's agent's) file to Buyer and both Buyer's and Seller's agents and
attorneys.
10. LABOR AND MATERIAL: Seller shall furnish at Closing an affidavit and indemnification agreement in form satisfactory to
Buyer showing that all labor and materials, if any, furnished to the Property within 120 days prior to the date of Closing have been paid
for and agreeing to indemnify Buyer against all loss from any cause or claim arising therefrom.
Page 3 of 7
STANDARD FORM 12-T
Revised 7/2008
Buyer initials Seller initials © 7/2008 -0- Produced with ZipFormI by RE ForrnsNet, LLC 18070 Fifteen Mile Road, Fraser, Michigan 48026 www.ziofo"n.com Beachside.zfx
11. CLOSING: Closing shall be defined as the date and time of recording of the deed and shall be on or before
October 30, 2009 (the "Closing Date"). All parties agree to execute any and all documents and papers necessary
Ln connection with Closing and transfer of title on or before the Closing Date at a place and time designated by Buyer. The deed is
to be made to TBD
Absent agreement to the contrary in this contract or any subsequent modification thereto, the following terms shall apply: If either party
is unable to close by the Closing Date, then provided that the party is acting in good faith and with reasonable diligence to proceed to
closing, such party shall be entitled to reasonable delay of the Closing Date and shall give as much notice as possible to the
non-delaying party and closing agent. In such event, however, either party for whom the Closing Date is delayed shall have a
maximum of ten (10) days from the Closing Date, or any extension of the Closing Date agreed-upon in writing, in which to close
without payment of interest. Following expiration of the ten-day period, the party not ready to close shall be responsible for paying to
the other party (if ready, willing and able to close) interest on the purchase price at the rate of eight percent (8%) per annum accruing
from the end of the ten-day period until closing occurs or the contract is terminated. Should the delay in closing continue for more than
thirty (30) days from the Closing Date or the last agreed-upon extension of the Closing Date, then the non-delaying party shall have the
unilateral right to terminate the contract and receive the earnest money, but the right to such receipt shall not affect any other remedies
available to the non-delaying party for such breach.
CLOSING SHALL CONSTITUTE ACCEPTANCE OF THE PROPERTY IN ITS THEN EXISTING CONDITION UNLESS
PROVISION IS OTHERWISE MADE IN WRITING.
12. POSSESSION: Unless otherwise provided herein, possession shall be delivered at Closing. No alterations, excavations, tree
removal or other such activities may be done before possession is delivered. Seller shall remove, by the date possession is made
available to the Buyer, all personal property which is not a part of the purchase and all garbage and debris from the Property.
13. PROPERTY INSPECTION/INVESTIGATION (Choose ONLY ONE of the following Alternatives):
? ALTERNATIVE 1:
(a) Soil, Utilities And Environmental Contingency: This contract is contingent upon Buyer obtaining report(s) that (i) the soil
is suitable for Buyer's Intended Use, (ii) utilities are available to the Property, (iii) there is no environmental contamination, law, rule or
regulation that prohibits, restricts or limits Buyer's Intended Use, and (iv) there is no flood hazard that prohibits, restricts or limits
Buyer's Intended Use (collectively the "Reports"). All costs and expenses of obtaining the Reports shall be borne by Buyer. Buyer shall
use Buyer's best efforts to obtain such Reports. If the Reports cannot be obtained, Buyer may terminate this contract and the Earnest
Money Deposit shall be refunded to Buyer. Buyer waives this condition unless Buyer provides written notice to Seller by
that this condition cannot be satisfied, TIME BEING OF THE ESSENCE.
(b) Septic/Sewer System (check only ONE):
? Buyer has investigated the costs and expenses to install the sewer system approved by the Improvement Permit attached hereto as
Exhibit A and hereby approves and accepts said Improvement Permit.
? Seller represents that the system has been installed, which representation survives Closing, but makes no further representations as
to the system. Buyer acknowledges receipt of the Improvement Permit attached hereto as Exhibit A. Buyer shall have the option of
inspecting or obtaining, at Buyer's expense, inspection(s) to determine the condition of the system. If the system is not performing the
function for which intended and is in need of immediate repair, Buyer may terminate this Contract and the Earnest Money Deposit shall
be refunded to Buyer. Buyer waives this condition unless Buyer provides written notice to Seller by
that this condition cannot be satisfied, TIME BEING OF THE ESSENCE.
M This Contract is contingent upon ? Buyer Q Seller ("Responsible Party") obtaining an Improvement Permit or written evaluation
from the County Health Department ("County") for a (check only ONE) ? conventional or ;2 other
ground absorption sewage system for a 4 bedroom home. All costs and expenses of obtaining such Permit or written evaluation
shall be borne by Responsible Party unless otherwise agreed. In any event Seller, by no later than January 6, 2009
shall be responsible for clearing that portion of the Property required by the County to perform its tests and/or inspections. Responsible
Party shall use best efforts to obtain such Permit or written evaluation. If the Improvement Permit or written evaluation from the
County cannot be obtained by February 6, 2009 (date), either party may terminate this Contract and the Earnest Money
Deposit shall be refunded to Buyer.
? Buyer has investigated and approved the availability, costs and expenses to connect to a ? public or ? community sewer system.
(c) Water (check only ONE):
? Buyer has investigated and approved the availability, costs and expenses to connect to a ? public or ? community water system
or ? shared private well.
? Buyer has investigated the costs and expenses to install the private drinking water well approved by the Construction Permit
attached hereto as Exhibit A and hereby approves and accepts said Construction Permit.
Page 4 of 7
STANDARD FORM 12-T
Revised 7/2008
Buyer initials Seller initials _4 ©7/2008
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? Seller represents that a private drinking water well has been installed, which representation survives Closing, but makes no further
representations as to the well. With respect to wells installed after July 1, 2008, Buyer acknowledges receipt of the County Health
Department's Certificate of Completion attached hereto as Exhibit A. Buyer shall have the option of inspecting or obtaining, at Buyer's
expense, inspection(s) to determine the condition of the well. If the well is not performing the function for which intended and is in
need of immediate repair, Buyer may terminate this Contract and the Earnest Money Deposit shall be refunded to Buyer. Buyer waives
this condition unless Buyer provides written notice to Seller by that this condition cannot
be satisfied, TIME BEING OF THE ESSENCE.
? This Contract is contingent upon ? Buyer ? Seller ("Responsible Party") obtaining a Construction Permit from the County Health
Department ("County") for a private drinking water well. All costs and expenses of obtaining such Permit, including but not limited to
any required survey, shall be borne by Responsible Party unless otherwise agreed. In any event Seller, by no later than
, shall be responsible for clearing that portion of the Property required by the County to conduct a field
investigation to evaluate the site. Responsible Party shall use best efforts to obtain such Permit. If the Construction Permit from the
County cannot be obtained by (date), either party may terminate this Contract and the Earnest Money
Deposit shall be refunded to Buyer.
(d) CLOSING SHALL CONSTITUTE ACCEPTANCE OF THE PROPERTY IN ITS THEN EXISTING CONDITION
UNLESS PROVISION IS OTHERWISE MADE IN WRITING.
? ALTERNATIVE 2: (This Alternative applies ONLY if Alternative 2 is checked AND Buyer has paid the Option Fee)
(a) Property Investigation with Option to Terminate: In consideration of the sum set forth in paragraph 2(c) paid by Buyer to
Seller (not Escrow Agent) and other valuable consideration, the sufficiency of which is hereby acknowledged (the "Option Fee"),
Buyer shall have the right to terminate this contract for any reason or no reason, whether related to the physical condition of the
Property or otherwise, by delivering to Seller written notice of termination (the "Termination Notice") by 5:00 p.m. on
, TIME BEING OF THE ESSENCE (the "Option Termination Date"). At any time
prior to Closing, Buyer shall have the right to inspect the Property at Buyer's expense (Buyer is advised to have all inspections of the
Property, including but not limited to those matters set forth in Alternative 1, performed prior to the Option Termination Date).
(b) Exercise of Option: If Buyer delivers the Termination Notice prior to the Option Termination Date, TIME BEING OF THE
ESSENCE, this contract shall become null and void and all earnest monies received in connection herewith shall be refunded to Buyer;
however, the Option Fee will not be refunded and shall be retained by Seller. If Buyer fails to deliver the Termination Notice to Seller
prior to the Option Termination Date, then Buyer will be deemed to have accepted the Property in its physical condition existing as of
the Option Termination Date; provided such acceptance shall not constitute a waiver of any rights Buyer has under paragraphs 3, 4 or 5
above. The Option Fee is not refundable, is not a part of any earnest monies, and will be credited to the purchase price at Closing.
(c) CLOSING SHALL CONSTITUTE ACCEPTANCE OF THE PROPERTY IN ITS THEN EXISTING CONDITION
UNLESS PROVISION IS OTHERWISE MADE IN WRITING.
14. RIGHT OF ENTRY, RESTORATION AND INDEMNITY: Buyer and Buyer's agents and contractors shall have the right to
enter upon the Property for the purpose of appraising and evaluating the Property, and performing the tests and inspections permitted in
this contract. Buyer shall, at Buyer's expense, promptly repair any damage to the Property resulting from any activities of Buyer and
Buyer's agents and contractors. Buyer will indemnify and hold Seller harmless from all loss, damage, claims, suits or costs, which shall
arise out of any contract, agreement, or injury to any person or property as a result of any activities of Buyer and Buyer's agents and
contractors relating to the Property. This indemnity shall survive this contract and any termination hereof, but Buyer shall not be
responsible for any loss, damage, claim, suit or cost arising out of pre-existing conditions of the Property and/or out of Seller's
negligence or willful acts or omissions.
15. OTHER PROVISIONS AND CONDITIONS: CHECK ALL STANDARD ADDENDA THAT MAY BE A PART OF THIS
CONTRACT, IF ANY, AND ATTACH HERETO. ITEMIZE ALL OTHER ADDENDA TO THIS CONTRACT, IF ANY, AND
ATTACH HERETO. (NOTE: UNDER NORTH CAROLINA LAW, REAL ESTATE AGENTS ARE NOT PERMITTED TO DRAFT
CONDITIONS OR CONTINGENCIES TO THIS CONTRACT.)
? Additional Provisions Addendum (Form 2AI I-T) ? Loan Assumption Addendum (Form 2A6-T)
? Back-Up Contract Addendum (Form 2AI-T) ? Owners' Association Disclosure And Addendum (Form 2A 12-T)
? Contingent Sale Addendum (Form 2A2-T) ? Seller Financing Addendum (Form 2A5-T)
? FHA/VA Financing Addendum (Form 2A4-T)
? OTHER:
Page 5 of 7
Buyer initials ' Seller initials Q 0
uced with LpFormT'- by RE FormsNet, LLC 18070 Frfteen Mile Road, Fraser, Michigan 48028 www.ziuforrn.com
STANDARD FORM 12-T
Revised 7/2008
07/2008
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16. RISK OF LOSS: The risk of loss or damage by fire or other casualty prior to Closing shall be upon Seller.
17. ASSIGNMENTS: This contract may not be assigned without the written consent of all parties, but if assigned by agreement, then
this contract shall be binding on the assignee and his hens and successors.
18. TAX-DEFERRED EXCHANGE: In the event Buyer or Seller desires to effect a tax-deferred exchange in connection with the
conveyance of the Property, Buyer and Seller agree to cooperate in effecting such exchange; provided, however, that the exchanging
party shall be responsible for all additional costs associated with such exchange, and provided further, that a non-exchanging party
shall not assume any additional liability with respect to such tax-deferred exchange. Seller and Buyer shall execute such additional
documents, at no cost to the non-exchanging party, as shall be required to give effect to this provision. (NOTE: If Alternative 2 under
paragraph 13 of this contract will apply, Seller should seek advice concerning the taxation of the Option Fee.)
19. PARTIES: This contract shall be binding upon and shall inure to the benefit of the parties, i.e., Buyer and Seller and their heirs,
successors and assigns. As used herein, words in the singular include the plural and the masculine includes the feminine and neuter
genders, as appropriate.
20. SURVIVAL: If any provision herein contained which by its nature and effect is required to be observed, kept or performed after
the Closing, it shall survive the Closing and remain binding upon and for the benefit of the parties hereto until fully observed, kept or
performed.
21. ENTIRE AGREEMENT: This contract contains the entire agreement of the parties and there are no representations, inducements
or other provisions other than those expressed herein. All changes, additions or deletions hereto must be in writing and signed by all
parties. Nothing contained herein shall alter any agreement between a REALTOR® or broker and Seller or Buyer as contained in any
listing agreement, buyer agency agreement, or any other agency agreement between them.
22. NOTICE AND EXECUTION: Any notice or communication to be given to a party herein may be given to the party or to such
party's agent. Any written notice or communication in connection with the transaction contemplated by this contract may be given to a
party or a party's agent by sending or transmitting it to any mailing address, e-mail address or fax number set forth in the "Notice
Address" section below. Seller and Buyer agree that the "Notice Information" and "Escrow Acknowledgment" sections below shall not
constitute a material part of this Offer to Purchase and Contract, and that the addition or modification of any information therein shall
not constitute a rejection of an offer or the creation of a counteroffer. This contract may be signed in multiple originals, all of which
together constitute one and the same instrument, and the parties adopt the word "SEAL" beside their signatures below.
Buyer ? has Q has not made an on-site personal examination of the Property prior to the making of this offer.
THE NORTH CAROLINA ASSOCIATION OF REALTORSO, INC. AND THE NORTH CAROLINA BAR ASSOCIATION MAKE
NO REPRESENTATION AS TO THE LEGAL VALIDITY OR ADEQUACY OF ANY PROVISION OF THIS FORM IN ANY
SPECIFIC TRANSACTION. IF YOU DO NOT UNDERSTAND THIS FORM OR FEEL THAT IT DOES NOT PROVIDE FOR
YOUR LEGAL NEEDS, YOU SHOULD CONSULT A NORTH CAROLINA REAL ESTATE ATTORNEY BEFORE YOU SIGN
IT.
Date:
Buy r ..b `
(SEAL)
Re D Pe ers
Date:
Buyer
Date: ' D
Seller j?C )
erta, LLC
Date:
(SEAL) Seller
Page 6 of 7
(SEAL)
STANDARD FORM 12-T
Revised 7/2008
07/2008
Produced with ZipForrn ° by RE Fo"nshlet, LLC 18070 Fifteen Mile Road, Fraser, Michigan 48026 www.zipform corn
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