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_:4'CAMA / DREDGE & FILL
GENERAL PERMIT
��New-lModification ❑Complete Reissue ❑Partial Reissue
No. 75616
A ) B C D
Previous permit #
Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC ��
E�,Kules attached.
Applicant Name ,--7,-� 4 f f &a e r
Andress j i 9 ��: r_ . ��> r^ C-f
City -State VA ZIP Q-333LZ_
Phone # (`) E-Mail
Authorized Agent '_ 'ram 3Cr—`Lr\\gS
Affected ElCW -Fwfi � FrPTA " es OPTS
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS:
ORW: yes / no PNA yes / no
Project Location: County LL
Street Address/ State Road/ Lot #(s) Q G ) Jt,C
Subdivision
city :���r1,. SAC,& S _ ZIP IU��
Phone # (` ) 1. River Basin
Adj. Wtr. Body c. Na ( 4 G Teo, 67-e ClA man /unkn)
Closest Maj. Wtr. Body f L I i� 4 c- c k 1;�_,r, j
Type of Project/ Activity k,,-
r. Pier (dock) length
Floating Platform(s) ■1'/rl■■■■�■■■��■■■■■■■■■■■■■■ JIII J■■�■■■
■■■■■■■■■■■■■■■■■■■■■�i��■■■■■■Gig■■■■■■■
M. r■rr��■■■■■■■■rr■■■■■`a■■■ -.
�r�i�rr,�■r■■■■■■■■�■■■■■ter■■■■�I■■■®■■�o■r■
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■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■
MMMEM
rel
—
Agent or
an
ted Name
Signatu
PI
a read compliance statement on back of permit
Application Fee(s)
Check #
�0)7e I + Cf be,
Pe itOfftcer's P inted Name
Signature
11- s-
Issuing Date
3-5-I`y
* Expiration Date
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 fronn 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 r—] 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 Resources. Contact the Division of Water Resources 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
Morehead City Headquarters Washington District
400 Commerce Ave 943 Washington Square Mall
Morehead City, NC 28557 Washington, NC 27889
252-808-2808/ 1-888-4RCOAST 252-946-6481
Fax: 252-247-3330 Fax: 252-948-0478
(Serves: Carteret, Craven, Onslow - (Serves: Beaufort, Bertie, Hertford, Hyde,
North of New River Inlet- and Pamlico Tyrrell and Washington Counties)
Counties)
Elizabeth City District
401 S. Griffin St.
Ste. 300
Elizabeth City, NC 27909
252-264-3901
Fax: 252-264-3723
(Serves: Camden, Chowan, Currituck,
Dare, Gates, Pasquotank and Perquimans
Counties)
Wilmington District
127 Cardinal Drive Ext.
Wilmington, NC 28405-3845
910-796-7215
Fax: 910-395-3964
(Serves: Brunswick, New Hanover,
Onslow - South of New River Inlet -
and Pender Counties)
http://portal.ncdenr.org/web/cm/dcm-home
Revised 7/06/ 17
N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Uatc_ fZs 1 %'�
Name of Property 01yner Applying; for Permit:
Mailing; Address:
GUe 44�L-� C+.
C His At�A��c . ✓A
1 certify that 1 have authorized (went) 4b i'.j J IEN�t1�-N�1�_ to act on my
behalf, for the purpose of applying; for and obtaining; all CAMA Permits necessary to
kynn
install or construct (activity) 6(/) '�v,,.:—,
at (my property located at) ��10 �U&(C I,�Cf,(� c;��•
This certification is valid thru (date) l Ue/�
/A
Owner Signature Date
p iI
1'e4 be l
4051 6lk.ww)5 DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
CERTIFIED MAIL - RETURN RECEIPT REQUESTED or HAND DELIVERED
Name of Property Owner:
41 S�
Address of Property: 4 OL'LAC d . SG✓YLIn S�v-,(
(Lot or Street #, Street or Road, City & County)
Agent's Name #:
Agent's phone #:
Mailing Address:
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.
xI 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. Correspondence should be mailed to 401 S.
Griffin St., Ste 300, Elizabeth City, NC, 27909. DCM representatives can also be contacted at (252) 264-
3901. 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, boat ramp, breakwater, boathouse, lift, or groin
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 /
Print or Type Name
(Adjacent Property Owner Information)
Signature
e
Print or Type Name
Mailing Address Mailing Address
City/State/Zip City/State/Zip
Telep ne Number/Email Address �� '` Telephone Number/Email Address,,,�.�u&2, t/Le-r-
gIIIIG. -
Da Date*
*Valid for one calendar year after signature* Revised Jan. 2017
Crr5,� Gut""- DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
CERTIFIED MAIL - RETURN RECEIPT REQUESTED or HAND DELIVERED
Name of Property Owner:
Address of Property: ooUC G" " • -�J✓) '. 5 �I
(Lot or Street #, Street or Road, City & County)
Agent's Name #:
Agent's phone #:
Mailing Address:
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.
1/ 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. Correspondence should be mailed to 401 S.
Griffin St., Ste 300, Elizabeth City, NC, 27909. DCM representatives can also be contacted at (252) 264-
3901. 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, boat ramp, breakwater, boathouse, lift, or groin
must be set back a minimum distance of 15from 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.
V I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Signature
v-�)Yww.,el L =
Print or Type Name
q lip 1+1 < VJe4, rT-
Mailing Address V
D_ka�� (C2 , V 14 33 d�
City/State/Zip
(Adjacen r erty O er formati�)
Sigiial ure
Print or Type Name
3 7 S-oLL_
Mailin re Adds \ n
S�P_k
N L
City/State/Zip
-)s-2 iai bA oZ 7oZ,), 2Lt67
Telephone Number/Email Address �`Telephone Number/Email Address
116Iry q 1'8 1
Date Un�c
*Valid for one calendar year after signature` Revised Jan. 2017
PL
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ATLANTIC
CURRITUCK OCEAN
SOUND &\
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SOUTHERN
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8' x 18' PARKING
SPACE (TYP)-
LOT 9
10' X 10'
TURN
AROUND
AR0�'%,,�,
,•Q SEAL 9�
L-2592
'RAY.,,,,�,.
0.1' BG
0.1' BG 1
REV. 10/14/19: SITE PLAN/SET WOOD STAKES
LEGEND
- EX. PIPE
- EX. 1/2" REBAR
0 - REBAR SET
- EX. 4" X 4" CONC. MON
❑ - SET WOOD STAKE
- EX. MAG NAIL
0 - MAG NAIL SET
�$( - SEWER SERVICE
® - WATER METER
PHONE PEDESTAL
- C.A.T.V.
- UTILITY POLE
C - GUY WIRE
'(f- FIRE HYDRANT
® - ELECT. TRANS.
AG - ABOVE GRADE
BG - BELOW GRADE
PL - PROPERTY LINE
NOTES:
1. THIS SURVEY IS SUBJECT TO ANY FACTS THAT MAY BE
DISCLOSED BY A FULL AND ACCURATE TITLE SEARCH.
2. AREA BY COORDINATE COMPUTATION = ±20,435 S.F.
3. F.I.R.M. ZONE: "AE" (B.F.E.:7.0')(PER F.I.R.M.) +2.0' FREEBOARD
4. PIN NO.: 20 986710 46 9109
5. RECORDED REFERENCE: PC D, SL 225; DB 1097, PG. 374
6. MINIMUM BUILDING LINES (MBL), IF SHOWN HEREON, ARE PER THE
CURRENT LOCAL ZONING REGULATIONS. OTHER SETBACKS
AND/OR RESTRICTIONS MAY APPLY AND MUST BE VERIFIED
PRIOR TO CONSTRUCTION.
7. ELEVATIONS (NAVD 1988): AS SHOWN
8. PROPOSED LOT COVERAGE:4,930 S.F. (24.1%)
CANAL
S 25_57'24° E 100.70---�--
X 3.9,
25' MBLUTIL. & DRAIN_ESMT._�
30 C.A.M.A. BUFFER
LOT 8
I I
11
X 5.8'
I
II
II
II
I
II
II
i
---C.A.M.A.-A.E.C.
--��
4' Iw
I6.1,
cn I
15.0'
N
18.4'
PORCH N_
20.6'
PORCH
C4
I IQ
QI I
Ir
39.0' X 6^
m o
,n II� ;
I� I�
b �I ml
n .;6I mI
R
X 3.1,
PROPOSED 2 STORY
N-ii
I I�
n P:
W/F/ DWELLING ON
rr
I
I
PILINGS W/
I�
80
of I
CONCGARAGE
SLAB
2I 0�
.0'
:2
15.0'
N
I I
o
X
.5 PORCH
l i I
N
1 1
23.0'
23.0'
1 1
7.1 I
4.5'.5'
V20
o Fn' 1----L
�'
I---- N U87 2�=W_�I 0.5' BG
0.1' BG 100.02
I
I
6w 3 3 I
d
O
r
m
LOT 7
100% PEAT BIOFILTER
REPAIR AREA - 360 SF
GRAVEL BED - 4 MODULES
4-
12.5' AI II PROP. SEPTIC ---------1t - 1111.0.
TANK
1 1
25' MBL/UTIL. &DRAIN. ESMT. PROP. BED SYSTEM
I PROP. ---- ' 11.8' (7) 35 LF DRAIN LINES
`CONCRETE 03' ON -CENTER
OD DRIVE
m �
I I X 9.0, 0.1' BG , 0.2' BG
DUCK WOODS DR..
(30' RAW)
LINE TABLE
LINE
LENGTH
BEARING
L1
25.19
N65.52'24"E
SURVEY FOR
%"V L7 n D !'I L11 n 0- C T-T rT 71 T) T T T T A T) 771 T)
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This map is prepared
from data used for the
126 Duck Woods DR
Owners: Haber, George D -Primary
Tax District: Southern Shores
4
rIt' 0/
inventory of the real
Southern Shores NC, 27949
Owner
Subdivision: So/sh Blk 227-b
- ` -
•�
�)
�
property for tax
Parcel: 022357010
Haber, Sherri L -Primary Owner
Lot BLK-Sec: Lot: 8 Blk: 227b Sec:
.�
purposes. Primary
information sources such
Pin: 986710469109
Building Value: $0
Property Use: Vacant Land (Private)
as recorded deeds, plats,
Land Value: $133,900
Building Type:
wills, and other primary
Misc Value: $0
Year Built:
public records should be
Total Value: $133,900
consulted for verification
of the information
NC Division of Coastal Mgt. f 1N-abitat Impact Computer Sheet
Applicant: — �� 4 �t r ► rFX Permit* b
Date:
Vc's/) `1
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
cts
FINAL Feet
(Anticipated final
disturbance.
Excludes any
restoration and/or
temp impact
amount
S
Dredge ❑ Fill Q" Both ❑ Other ❑
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��
Dredge ❑ Fill ❑ Both Other ❑
�j
U`
Dredge ❑ Fill ❑ Both ❑ Other M
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 :: 9-888-4RCOAST revisad: 3-103i•:c