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Home My WebLink About57101_FORGIONE, BILL_20110312❑CAMA / ❑ DREDGE & FILL GENERAL PERMIT Previous permit# ❑New ❑Modification ❑Complete Reissue ❑Partial Reissue -' Date previous permit issued As authorized by the State of North Carolina, Department of Environment and Natural Resources and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC ❑ Rules attached. Applicant Name_ Project Location: County Address City Phone # ( )_ Authorized Agent Affected ❑ CW AEC(s): ❑ OEA ❑ PWS: ORW: yes / no State Fax #( ) ❑ EW ❑ PTA ❑ HHF ❑ IH ❑ FC: PNA yes / no ZIP ❑ ES ❑ PTS ❑ UBA ❑ N/A Crit.Hab. yes / no Street Address/ State Road/ Lot #(s) Subdivision Y City ZIP Phone # ( ) River Basin Adj. Wtr. Body (nat /man /unkn) Closest Maj. Wtr. Body Type of Project/ Activity (Scale: ) Pier (dock) length — Platform(s) �•, A. I Finger pier(s) Groin length number Bulkhead/ Riprap length avg distance offshore max distance offshore Basin, channel cubic yards Boat ramp Boathouse/ Boatlift Beach Bulldozing Other y - -- i I y Shoreline Length SAV: not sure yes no — Sandbags: not sure yes no Moratorium: n/a yes no (n 1 Photos: yes no- Waiver Attached: yes no i A building permit may be required by: ^� r 0 See note on back regarding River Basin rules. Notes/ Special Conditions Agent or Applicant Printed Name Signature ** Please read compliance statement on back of permit Application Fee(s) Check # Permit Officer's Signature Issuing Date Expiration Date Local Planning Jurisdiction Rover File Name t Statement of Compliance and Consistency This permit is subject to compliance with this application, site drawing and attached general and specific conditions. Any violation of these terms may subject the permittee to a fine or criminal or civil action; and may cause the permit to become null and void. This permit must be on the project site and accessible to the permit officer when the project is inspected for compliance. The applicant certifies by signing this permit that 1) prior to undertaking any activities authorized by this permit, the applicant will confer with appropriate local authorities to confirm that this project is consistent with the local land use plan and all local ordinances, and 2) a written statement or certified mail return receipt has been obtained from the adjacent riparian landowner(s) . The State of North Carolina and the Division of Coastal Management, in issuing this permit under the best available information and belief, certifythat this project is consistentwith the North Carolina Coastal Management Program. River Basin Rules Applicable To Your Project: ❑ Tar - Pamlico River Basin Buffer Rules ❑ Other: ❑ Neuse River Basin Buffer Rules If indicated on front of permit, your project is subject to the Environmental Management Commission's Buffer Rules for the River Basin checked above due to its location within that River Basin. These buffer rules are enforced by the NC Division of Water Quality. Contact the Division of Water Quality at the Washington Regional Office (252-946-6481) or the Wilmington Regional Office (910-796-7215) for more information on how to complywith these buffer rules. Division of Coastal Management Offices Raleigh Office Mailing Address: 1638 Mail Service Center Raleigh, NC 27699-1638 Location: 2728 Capital Blvd. Raleigh, NC 27604 919-733-2293 Fax:919-733-1495 Morehead City Headquarters 400 Commerce Ave Morehead City, NC 28557 252-808-2808/ 1-888-4RCOAST Fax: 252-247-3330 (Serves: Carteret, Craven, Onslow -above New River Inlet- and Pamlico Counties) Elizabeth City District 1367 U.S. 17 South Elizabeth City, NC 27909 252-264-3901 Fax:252-264-3723 (Serves: Camden, Chowan, Currituck, Dare, Gates, Pasquotank and Perquimans Counties) Washington District 943 Washington Square Mall Washington, NC 27889 252-946-6481 Fax: 252-948-0478 (Serves: Beaufort, Bertie, Hertford, Hyde, Tyrrell and Washington Counties) Wilmington District 127 Cardinal Drive Ext. Wilmington, NC 28405-3845 910-796-7215 Fax:910-395-3964 (Serves: Brunswick, New Hanover, Onslow -below New River Inlet- and Pender Counties) Revised 08/09/06 NC D%vision of Coastal Mgt. Habitat Impact Computer Sheet Applicant: Bill Forgione Date: March 3, 2011 General Permit #: 57101 C Describe below the HABITAT disturbances for the application. All values should match the name, and units of measurement found in your Habitat code sheet. Habitat Name DISTURB TYPE Choose One TOTAL Sq. Ft. (Applied for. Disturbance total includes any anticipated restoration or temp impacts) FINAL Sq. Ft. (Anticipated final disturbance. Excludes any restoration and/or temp impact amount) TOTAL Feet (Applied for. Disturbance total includes any anticipated restoration or temp impacts) FINAL Feet (Anticipated final disturbance. Excludes any restoration and/or temp impact amount HG Dredge ❑ Fill ❑ Both ❑ Other ® 116 116 OW Dredge ❑ Fill ❑ Both ❑ Other N 60 60 Dredge ❑ Fill ❑ Both ❑ Other ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ 252-808-2808 :: 1-888-4RCOAST :: www.nccoastalmanagement.net revised:02/03/10 UNITED USPS Sender: Please print your name, address, and ZIP+4 in this box 1[ l/ � M /\ I "Y\ c' \ \L/ /l \ \ ^J/ � � �� \ `��' \ >V� �� _/ / \ (/��`(�`` .^`. ` |"[U"|"1.1j".|".U/i111111ill" 11110kill 111511tild I ■ Complete items 1, 2, and 3. Also complete item 4 if Restricted Delivery is desired. ■ Print your name and address on the reverse so that we can return the card to you. ■ Attach this card to the back of the mailpiece, or on the front if space permits. Article Addressed to: S 3 A. Signature ❑ Agent ❑ Addressee B. Received by ( Printed Name) C. Date of Delivery K-rllt�'�''�t" L S�! / - 2I_ D. Is delivery address differeff m item 1? ❑ Yes If YES, enter delivery address below: ❑ No 3. Service Type ❑ Certified Mail ❑ Express Mail ❑ Registered ❑ Return Receipt for Merchandise ❑ Insured Mail ❑ C.O.D. 4. Restricted Delivery? (Extra Fee) ❑ Yes 2. Article Number (Transfer from service label) 7 6 0100 0 4 9789 7 3 8 3 PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1540 NCDENR North Carolina Department of Environment and Natural Resources Division of Coastal Management Michael F. Easley, Governor James H. Gregson, Director William G_ Ross Jr., Secretary Date )� / m / 11 Applicant Name R.11 Yor'1, o%C Mailing Address � Lohjy',+�%1 N(. ),? 173 I certify that I have authorized (agent) X �'' �� CU h S-� to act on my behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to install or construct (activity) V 54 -. NJ - at (location) log Nlo PA This certification is valid thru (date) Signature X 400 Commerce Avenue, Morehead City, North Carolina 28557 Phone: 252-808-28081 FAX: 252-247-33301 Internet: www.nccoastalmanagement.net An Equal Opportunity i Affirmative Action Employer— 50% Recycled 110% Post Consumer Paper ADJACENT RIPARIAN PROPERTY OWNER STATEMENT (FOR A PIER/MOORING PILINGSIBOATLIFTBOATHOUSE) I hereby certify that I own property adjacent to ;-AL. f 0 q � Q Vn C, 's (Name of Property Owner) property located at 1 0 &� &4c15 \ l �. (Lot, Block, Road, etc.) on M--' 6�ca- ,in ��`�� ,N.C. (Waterbody) (Town and/or County) He has described to me, as shown below, the development he is proposing at that location, and, I have no objections to his proposal. I understand that a pier/mooring pilings/boatlif 1boathouse must be set back a minimum distance of fifteen feet (15') from my area of riparian access unless i\�►,S� waived by I do not wish to waive the setback requirement. L/ V I do wish to waive that setback requirement. Z�-------------------- ------------------------------------------------------------------------------------ DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT: 15 h�,tir 1 b individual proposing development) To be rl ed in indivrd al Q ( .f' Y P P � 1 S yM'S FO V) O h --------------------------------------------------------------------------------------------------------� (Applicant Information) (Riparia r n or lion) / !� VPr 1 `10 UheS Mailing Address Sign re City/State/Zip Telephone Number 3�1)► Date Print or Type Name X 2--5 Z - (,.-S� • --+ -5 2xr 3 Telephone Number 31 L. k k Date ------------ Page i of 1 CITY ilWAXHAW STATE NC ZIP 128173 PARRECNUM 15577 NAME FORGIONE, WILLIAM J MAPNO 00-3-MV2-60 CONTROLNUM CLSCODE �- INRFRT I 1 '1 (1 PIN DISTTOWN D02 DBLCIR BLOCK 3 PARCELNO SITEADDR 11109 BALLAST POINT SITUSADDR II RITI ISROAD II BALLAST POINT II EXEMPT MV2-60 109 LEGDESCI LOT 60 MARINA VILLAGE SEC 2 IFLEGDESC2 PCA 149-1 TOTACRES 0 CRNTTOTUSE 0 CRNTTOTDEF 0 CRNTLANDVA 157500 CRNTBLDGVA 0 CRNTOBLDGV 0 TOTCRNTVAL 157500 FIRECODE S IIHOUSECODE ISEWERCODE SALEAMNT 400000 SALEDATE 4l28/2006 SALEDATE2 1174,996 SALECODE S ROADNUM 1317 PCTCOMP 0 WILLBOOK 10 11WILLPAGE 0 DB PG IF4681450 DEEDBOOK 468 DEEDPAGE 450 PLAT PCA 149-1 L MOBHOME 110 I 1 http://www2.undersys.comlscripts/testadvlusiwebpe.dlllusi?formis=ptmap&MouseX=0&... 1 /17/2011 1180 tax PO BOX 190 66-30/531 ORIENTAL, NC 28571 of A 472 �� Date %, Pay to the NC D E ! /y P , I $ v'` 00 Order of � Dollars �,a,s o t • v� First Citizens fir tc�itlz�emcom For 1:053100300,:004?120212501"D