57184_ANDERSON, NANCY_20110517

❑ CAMA / ❑ DREDGE & FILL
GENERAL PERMIT Previous permit#
❑New ❑Modification El 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 I SA NCAC
❑ Rules attached.
Applicant Name
Address
City
Phone # ( )_
Authorized Agent
Affected
❑ Cw
AEC(s):
❑ OEA
❑ PWs:
ORW:
yes / no
State ZIP
Fax # ( )
❑ EW ❑ PTA ❑ ES ❑ PTS
❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ FC:
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
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Agent or Applicant Printed Name Permit Officer's Signature
Signature ** Please read compliance statement on back of permit" Issuing Date 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, 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 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:[phone]
Morehead City Headquarters
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/ 1-888ARCOAST
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

NC Division i Coastal Mgt. Habitat Impact Computer Sheet
Applicant: Nancy Anderson
Date: May 17, 2011
General Permit #: 57184C
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)
HM
Dredge ❑ Fill ❑ Both ❑ Other M
525
525
WL
Dredge ❑ Fill ❑ Both ❑ Other ®
405
405
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 ❑
,,revised:a 1

■ Complete items 1, 2, and 3. Also complete A ignature
iter-;I d if Restricted Delivery Is desired. /t ( / ❑ ent
■ Paint your name and address on the reverse J Addressee
so that we can return the card to you, eived by Printed Name) C. o Div rY
■ Attach this card to the back of the mailpiece, ",\ L e el
i7
or on the front if space permits. ' r f
D. Is delivery address different f item 1? ❑ Yes
1. Article Addressed to: If YES, enter delivery address below: ❑ No
,Fc , A, S�
R — V6vt0
3�306�
3. ,S"ce Type
entitled Mail El Mall ,I�C
O"Registered ❑ Return Receipt for Merchandise
❑ Insured Mall ❑ C.O.D.
4. Restricted Delivery? (Extra Fee) ❑ Yes
2. Article Number
(Transfer from service label) 7 0 10 3090 000 0 0579 3235
PS Form 3811, February 2004 Domestic Return Receipt 10259"2-M-1540
■ 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.
1. Article Addressed to:
A I o v, E
t16
A. SI at )
X� ❑Agent
❑ Addressee
B. Received by ( Printed Name) C. Date f D livery
D. Is delivery address different from item 1? Ye
If YES, enter delivery address below: No
3. ery Type
Certified Mail El Express Mail
❑ Registered ❑ Return Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee) ❑ Yes
2. Article Number 7010 3090 0000 0579 3242
(Transfer from service label
PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1540

CERTIFIED MAiL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONANAiVER FORM
Name of Property Owner: Nancy Anderson
Address of Property:
Applicant phone #:
258 Wards Lane, Havelock, NC lot#5-008-108
(Lot or Street #, Street or Road, City & County)
252-444-1386
Mailing Address: 258 Wards Lane
Havelock, NC 38532
I hereby certify that i own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing_the development
they are proposing. A description or drawing, with dimensions, must be provided with this letter.
I have no objections to this proposal. I have objections to this proposal.
If you have objections to what is being proposed, you must notify the Division of Coastal Management
(DCM) in writing within 10 days of receipt of this notice. Contact information for DCM offices is
available at www.nccoastalmangement.neUcontact dcm.him or by calling 1-888-4RCOAST. No
response is considered the same as no objection if you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, or lift must be set back a
minimum distance of 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 wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Signature
Nancy Anderson
Print or Type Name
258 Wards Lane
Mailing Address
Havelock, NC 28532
City/SYate2ip
252-444-1386
Telephone Number
Date
(Riparian Property Owner Information)
Signature
James B. Jr. & Marianne Gamsey
Print or Type Name
909 NE 6th Street
Mailing Address
Pompano Beach, FL 33060
City/State2ip
Telephone Number
Date

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner:
Address of Property:
Applicant phone #:
Nancy Anderson
258 Wards Lane, Havelock, NC lot#5-008-108
(Lot or Street #, Street or Road, City & County)
252-444-1386
Mailing Address: 258 Wards Lane
Havelock, NC 38532
I hereby certify that I own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing_the development
they are proposing. A description or drawing, with dimensions, must be provided with this letter.
I have no objections to this proposal. I have objections to this proposal.
If you have objections to what is being proposed, you must notify the Division of Coastal Management
(DCM) in writing within 10 days of receipt of this notice. Contact information for DCM offices is
available at www.nccoastaimangement.net/contact dcm.htm or by calling 1-888-4RCOAST. No
response is considered the same as no objection if you have been notified by Certified Mall.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, or lift must be set back a
minimum distance of 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 wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Signature
Nancy Anderson
Print or Type Name
258 Wards Lane
Mailing Address
Havelock, NC 28532
City/Statelop
252-444-1386
Telephone Number
Date
(Riparian Property Owner Information)
Signature
Alan E. Franks
Print or Type Name
1733 Delaware Avenue
Mailing Address
Fort Myers, FL 33916
City/State/Zip
Telephone Number
Dote

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FRANKS. ALAN E !i
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• ,. Craven County does NOT warrant the information shown on this map
and should be used ONLY for tax assessment purposes.
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NANCY ANDERSON'�%F
KENNETH LANDERSON / !
PO BOX 1766
LELAND, NC 28451
1pf'
2276
66-112/531
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M.RANCH BANKING AND TRUST BANKING
COMPANY ACCESS
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AJi'A
NCDENR
BUFFER AUTHORIZATION HORIZATION CERTIFICATE
FOR PIER :AND DOCKING FACILITIES ACCESS WAY
A riparian buffer authorization is required for pier and docking facilities access ,Nays 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 and
verify that all information provided is complete and accurate.
Nq4ov
Agent or pelican rinted Name
Agent oo pli a Signature
.4 cw,/
Permit Officer's Signature
z5—// ��/// —
Issu ate
1,7
CAMA GENERAL PERMIT #: ` / kl C
Washington Office
943 Washington Square Mall
Washington, NC 27889
Phone [phone]
Morehead City Office
400 Commerce Avenue
Morehead City, NC 28557
Phone [phone]
Version 5, 0912009
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