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Home My WebLink About57170_SIMPKINGS, ANN_20110315❑CAMA / ❑ DREDGE & FILL GENERAL PERMIT Previous permit# ❑New ❑Modification [-]Complete Reissue El 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. A 1: N A pp scant ame Address City State ZIP Phone # O Fax # ( ) Authorized Agent Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A ❑ PWS: ❑ FC: ORW: yes / no PNA yes / no Crit.Hab. yes / no Project Location. County Street Address/ State Road/ Lot #(s) Subdivision 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) Finger pier(s) - - Groin length number Bulkhead/ Riprap length avg distance offshore t max distance offshore Basin, channel cubic yards Boat ramp Boathouse/ Boatlift Beach Bulldozing Other i Shoreline Length - ---•- --- - ___ _ .__I_ __ _.,_ _; _ SAV: not sure yes no ? 11-7 Sandbags: not sure yes no Moratorium: n/a yes no Photos: yes no Waiver Attached: yes no A building permit may be required by: `' ❑ See note on back regarding River Basin rules. Notes/ Special Conditions J Agent or Applicant Printed Name Signature ** Please read compliance statement on back of permit Permit Officer's Signature Issuing Date d Expiration Date Application Fee(s) Check # 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, certify that 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 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/ 1-888ARCOAST 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) 1�_ Revised 08/09/06 RCDENR North Carolina Department of Environment and Natural Resources Division of Coastal Management Beverly Eaves Perdue, Governor James H. Gregson, Director Dee Freeman, Secretary Date 3 • i +. Applicant Name � Mailing Address S N.C.. 2�S1Z I certify that I have authorized (agent) rr,," -- to act on my behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to n install or construct (activity) at (location) I % ,--i R�^ R-� F � <� 1\1 (- Z-S � 1 Z . This certification is valid thru (date) Signature 400 Commerce Avenue, Morehead City, North Carolina 28557 Phone: 252-808-2808 \ FAX: 252-247-3330 \ Internet: www.nccoastalmanagement.net An Equal Opportunity \ Affirmative Action Employer — 50% Recycled \ 10% Post consumer Paper ADJACENT RJPARL IN PROPERTY OWNER STATEMENT(FOR A PIE, RMDO lVG PILIdVGSIBO,4TLIFTBOATHOUSE) I hereby certify that I own grope ty adjacent to N N J 4 *� , 5 J (Name of Property Owner) property located at . —J 5- on �AK/Q- (Waterbody) Applicant's phone #: He has described to me, as shown be have no objections to his proposal. I must be set back a minimum distanc waived by me. (If you wish to wain below.) Lot, Block, Road, etc.) in VS ,N.C. (Town and/or County) D,-T -Mailing-Address: p K`j y IJ 24512, Dw, the development he is proposing at that location, and, I .nderstand that a pier/mooring pilings / boatlift / boathouse of fifteen feet (15') from my area -of riparian access unless the setback, you must initial the appropriate blank I do not wish to waive I do wish to waive that set aek requirement. DESCRIPTION AND/OR )RAWING OF PROPOSED DEVELOPMENT: (To be filled in 5y individual proposing development) 4 HIE ---------------------------------------------------- -------I-------------------------------------------------- - (Information. for Property owner r - plying . (Riparia Pro rty-0?1ALr Info .matio for Permit) �-eh IYlailing Address Signature K- 5 City/State/Zip IJ Print or Type Name Telephone Number Telephone Number Signature Date Date ADJACENT RIPARIAN PROPERTY OWNER STATEMENT (FOR A PIFRIIVIOORING P-ILINGSi$OATLIFTIBOAT.HOUSE) i hereby certify that i own property adjacent to N N S .1 , f-i S is (Name of Pro erty Owner) property located at F2 _T,9 �� o (Lot, Block, Road, etc.) on 4 M Q- �- , in , N.C. (Waterbody) (Town and/or County) Applicant'sphone#: Z� MailingAddress: 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 setback 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 AND/OR DRAWING OF PROPOSED DEVELOPMENT: (To be filled in by individual proposing development) < �C.- � IN -------------------------------------------------------------- I -------------------------------------------------- (Information for Property Owner Applying (Riparian Property Owner Information) for Permit) tz Mailing Address Signature '-P K S1/� City/State/Zip Print or Type Nanie -�ZCo ---) --) --) --) Telephone Number -]a-)/ y - y 19 a Telephone Number Signature Bate Date INC Division of Coastal Mgt. Habitat Impact Computer Sheet Applicant: Ann Simpkins Date: March 15, 2011 General Permit #: 57170C 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 OW Dredge ❑ Fill ❑ Both ❑ Other ® 169 169 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 ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ 252-808-2808 :: 1-888-4RCOAST :: www.nccoastaimanagement.net revised:02/03/10 MUD BUCKET DREDGING INC 507 HEDRICK BLVD MOREHEAD CITY, NC 28557-3045 Pay to the Order of Date 3,15 it )E &I A $ 2'o-0 Do BRANCH BANKING AND TRUST COMPANY 1-800-BANK BBT BBT,com FOR - i lei 51,�f tir 0000489 l" 1:053 l0 1 1 2 11:0005 293 21834lum 4891 66-1121531