56067_NICHOLS, WILLIAM_20100809

❑CAMA / ❑ DREDGE & FILL
GENERAL PERMIT �Previouspermit #
❑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 Namle Project Location: County
Address! �>�� rP?'>:l Street Address/ State Road/ Lot #(s)
City State ZIP r
Phone # ( ) Fax # ( ) Subdivision
Authorized Agent City c..t1 C ZIP
CW - EW E PTA —ES ElPTS Phone # ( ) '�^ River Basin
Affected OEA - HHF - IH - UBA N/A
AEC(s): Adj. Wtr. Body (nat /man /unkn)
C- PWS: -FC:
ORW: yes / no PNA yes / no Crit.Hab. yes / no Closest Maj. Wtr. Body
e of Project/ Activity
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Agent or Applicant Printed Name
Si nature "Please read compliance statement on back of permit
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Application Fee(s) Check #
Permit Officer's Signature
s 77 /
Issuing Date Expiration Date
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Local Planning Jurisdiction Rover File Name

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 consistent with 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 comply with these buffer rules.
Division of Coastal Management Offices
Raleigh Office Morehead City Headquarters
Mailing Address: 400 Commerce Ave
1638 Mail Service Center Morehead City, NC 28557
Raleigh, NC 27699-1638 252-808-2808/ 1-888ARCOAST
Location: Fax: [phone]
2728 Capital Blvd.
Raleigh, NC 27604
919-733-2293
Fax:[phone]
(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: [phone]
(Serves: Camden, Chowan, Currituck,
Dare, Gates, Pasquotank and Perquimans
Counties)
Washington District
943 Washington Square Mall
Washington, NC 27889
252-946-6481
Fax: [phone]
(Serves: Beaufort, Bertie, Hertford, Hyde,
Tyrrell and Washington Counties)
Wilmington District
127 Cardinal Drive Ext.
Wilmington, NC 28405-3845
910-796-7215
Fax:[phone]
(Serves: Brunswick, New Hanover,
Onslow -below New River Inlet- and
Pender Counties)
Revised 08/09/06

WILLIAM C. NICHOLS
FRANDEE NICHOLS
NCDL 2905187 2676675
1429 WOODFORD RD. PH. 336-946-0828
CLEMMONS, NC 27012
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4553

BUFFER AUTHORJZATION CERTIFICATE
FOR PIER AND DOCKING FACILITIES ACCESS WAY
A riparian buffer authorization is required for pier and docking facilities access ways through the Tar -Pamlico &
Neuse River Riparian buffer per Division of Water Quality (DWQ) regulations 15A NCAC 02B.0233 & .0259.
The Division of Coastal Management (DCM), through a Memorandum of Understanding with the Division of
Water Quality (DWQ) has reviewed your project proposal, determined that the project as proposed complies
with the aforementioned regulations, and made a "no practical alternatives" determination per those
regulations.
Those activities covered by your Coastal Area Management Act (CAMA) permit have received Buffer
Authorization as long as the project is constructed in a manner that continues to meet all of the conditions
listed below. Failure to comply with this Buffer Authorization shall subject the property owner & the party
(contractor) performing the construction Wor land clearing to a civil penalty of up to $25,000 per day per
violation.
1. Crossing is Perpendicular: Pier and docking facility access way must cross the 50 ft. riparian buffer
perpendicularly (which is defined as between 75 and 105 degrees) unless otherwise approved by DCM.
The alignment shall minimize the removal of woody vegetation to the greatest extent practicable.
2. Pervious Materials: All reasonable measures shall be taken to ensure the access way is made of
pervious materials like open -slatted wood or composite, mulch, or grass to meet the intent of the rules
to the maximum extent practicable.
3. Access Width: The width of the pier or docking facility access way shall be limited to six (6) feet.
4. Project Drawing: The drawing on the CAMA General Permit is considered the project drawing of your
property indicating the relative location of the pier or docking facility and any requested access way.
This drawing will be used to aid in compliance and monitoring efforts.
By your signature below you agree to be held responsible for meeting all of the conditions listed above an
verify that all information provided is complete and accurate.
Agent (o ppplic rinted Name Permit Officer's Signature
gent ® plic n: ignature Issue ate
CAMA GENERAL PERMIT #: W lc,
Washington Office Morehead City Office
943 Washington Square Mall 400 Commerce Avenue
Washington, NC 27889 Morehead City, NC 28557
Phone [phone] Phone [phone]
An Equal Opportunity/Affirmative Action Employer — 50% Recycled/10% Post Consumer Paper
Version 5, 0912009

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSIBOATLIFT/BOATHOUSE)
I hereby certify that I own property adjacent to 1� � I l i �-- C-6 N «Il61�*
(Name of Property Owner)
property located at 1
—� (Lot, Block, Road, etc.)
on 1 .��� C��z=K , inC-,�.��-I s ►�� sF+t �+ , N.C.
(Waterbody) (Town and/or County)
Applicant's phone #: Mailing Address: 1 `4Z-`t
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 / boatlift / boathouse
must be set back a minimum distance of fifteen feet (15') from my area of riparian access unless
waived by me. (If you wish to waive the setback, you must initial the appropriate blank
below.)
i do not wish to waive
I do wish to waive that setback requirement.
(DESCRIPTION ANTI/OR DRAWING OF PROPOSER DEVELOPMENT:
(To be filled in by individual proposing development)
(Information for Property Owner Applying
for Permit)
Mailing Address
C
City/State/Zip
Telephone Number
(Riparian Property Owner Information)
Signature
Print or Type ame
Telephone Number
Signature Date Date

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIFRIMQQRING PILINGS QATLIFTBOATIIQUSE)
I hereby certify that I own property adjacent to l
(Name of Property Owner)
property located at
(Lot, dock, Roads etc.)
on 6 ) ✓� F�� , in ,�e .� �e� s r� , N.C.
(Waterbody) - (Town and/or County)
Applicant's phone #: -S3(--4 Mailing Address: I.4�z-g l J—„=-oQb
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 / boatlift / boathouse
must be set back a minimum distance of fifteen feet (I 5') from my area of riparian access unless
waived by me. (If you wish to waive the setback, you most initial the appropriate blank
below.)
I do not wish to waive
I do wish to waive that setback requirement.
DESCRIPTION ANDJOR DRAWING OF PROPOSED DEVELOPMENT:
(To befilled in by inJividual proposing development)
8 , /
(information for Property Owner Applying (Riparian Property Owner Information)
for Permit)
I.4Zq
Mailing Address
City/State/Zip
3 3c, - 9 1-1L - 8zrJ
Telephone Number
Signature Date
1611
Signature
Jen��ee��e(
Print or Type Name
5,�---� �I--Q�a5
Telephone Number
1- 0- /U
Date