Szczygiel, Jacob

®>JCAIVIAJ ❑ DREDGE & FILL No. 75749
A B ' C D
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 Environmental Quality
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC R
M Rules attached.
Applicant Name !' _ —> �� f f Project Location: County 1/ � r
Address T' r+ �'li tiAS Street Address/ State Road/ Lot #(s)
City State /,i ZIP
Phone # ( ) I - E-Mail Subdivision f 1 j r !� �/� 1.I
Authorized Agent CityZIP
❑ CW � EJEW 'El PTA ❑ ES ElPTS Phone # ( ) River Basin
Affected /
❑ OEA ❑ HHP ❑ IH ❑ UBA ❑ N/A
AEC(s): Adj. Wtr. Body r � ' '' t � `'-I r� Cct, )l nat /(nand/unkn)
❑ PWS: n . _
ORW: yes /. no' PNA yes / no Closest Maj. Wtr. Body �' f 1/` r VP a
Agent or Applicant Printed Name _., ' PermltOfficers Printed Name
Signature "Please read compliance statement on back of perm/it" Signature
Application Fee(s) Check# Issuing Date / Expii
1 �1
Date

Adjacent Riparian Property Owner's Statement
Adjacent Riparian Property Owner:
Section Number: 0 k Lot Number: 0 l 5
Name: Oct U N C J
Address: (605 Co-5 4'ny ta.e
Telephone Number:/ zS 7r- - (033- lj (p 7
E-mail Address: d -,-c/y 4_ e nA y.6c Cd�
I hereby certify that I own the property adjacent to:
Section Number: b k Lot Number: Ol (a
Owners Name:
Address: p bJ 5 G1(,OwG tA-.P
Telephone Number: 7,
1 5- Z- Z l �t - 2, 7 S S—
E-mail Address: J S'Z�zY1 v�� Ofc uw, Co
The individual applying for this permit has described to me the scope of work as shown on the attached copy of the
"Description and Drawing of Proposed Work" form and have no objections to the proposed work. I understand that
docks, pilings, tie poles or any other marine structure must be set back a minimum of fifteen feet (15'-0") from my
riparian line unless waived by me.
xI do not wish to waive the setback requirement.
I do wish to waive the setback requirement.
Adjacent Riparian Property
yOOwner:
Signature
Print Name ZdL-Oy'E-S) bR! Clts
Date e / d +

Adjacent Riparian Property Owner's Notification
by Certified Mail - Return Receipt Requested
Adjacent Riparian Property Owner:
Section Number: 0 111 Lot Number:
Name: &L COS�c
1 Address: 000 Ccssowc�, LaA-Q
Telephone Number:
E-mail Address: $012 C05TA U 5 N UAQ-T rrrAl l,• COYn
I hereby certify that I own the property adjacent to:
Section Number: 01 Lot Number: Ot
Owners Name:
i C I
Address: 600.3 64Ii0,.,-") tc`,f
Telephone Number: ZS-Z - Z ky -'L 7 5' S
E-mail Address: .� S Z-t e� I faa M
The individual applying for this permit has described to me the scope of work as shown on the attached copy of the
"Description and Drawing of Proposed Work" form.
K",oA %1. C�dl have no objections to the proposed work.
If you have objections to the work being proposed, please write the Division of Coastal Management, 400 Commerce
Ave., Morehead City, NC 28557, or call 252-808-2808 within ten (10) days of receipt of this notice. No response is
considered the same as "no objection" if you have been notified by certified mail.
I understand that docks, pilings, tie poles or any other marine structure must be set back a minimum of fifteen feet
(15'-0") from my riparian line unless waived by me.
! \ I do not wish to waive the setback requirement.
I do wish to waive the setback requirement.
Adjacent Riparian Property Owner:
Signature
gtvo
`n •
C_J�
Date: $ 1
Print Name
RA'Br-_1QJ
N
Co-`T q

Brownlow, Roy
From: Brownlow, Roy
Sent: Friday, November 15, 2019 11:16 AM
To: Jake Szczygiel
Cc: Connell, Brad
Subject: RE: [External] 6003 cassowary lane add additional piles
Attachments: DOC110519-11052019120040.pdf
Mr. Szczygiel:
Please find attached to this message the modification to CAMA General Permit No.75749-C issued to you
on 10/10/2019 by DCM Field Rep Brad Connell. The permit authorizes reconfiguration of existing wetslips.
You were originally authorized for 6 tie -pilings on slip No.1 and you requested a modification to install two
(2) additional tie -pilings to slip No.1 for a total of eight (8) tie -pilings. This request for the permit
modification has been authorized on 11 /15/2019. No other enlargement or expansion to the footprint or
any dimension has been authorized. Any other changes in this permitted project will require notification to
the Division of Coastal Management before commencing work.
If you have any questions or need further assistance, please call me or Brad Connell at the Morehead City
office.
Regards,
Roy Brownlow
District Manager, Division of Coastal Management
North Carolina Department of Environmental Qualityt,
252.808 2808 (Office)
Roy. Brownl ow fineden r. p ov
From: Jake Szczygiel <[e-mail]>
Sent: Thursday, November 14, 2019 4:55 PM
To: Brownlow, Roy <[e-mail]>
Subject: Re: [External] 6003 cassowary lane add additional piles
External email. Do not click links or open attachments unless you verify. Send all suspicious email as an attachment to
[e-mail]
Hi Roy, did I provide what you needed? Please let me know what I need for my association. Thank you
Kind Regards,

Agent orApplicant Printed Name PermitOFficer's Printed Name
Signature "" please read compliance statement on back of permit'"
Application Fee(s) Check #
Signature j
Issuing Date
Expiration Date

Brownlow, Roy
From: Jake Szczygiel <[e-mail]>
Sent: Thursday, November 14, 2019 9:26 AM
To: Brownlow, Roy
Subject: Re: [External] 6003 cassowary lane add additional piles
Please see attached additional information you requested. Thank you
No.'7s" Ndi
Rsb IA 16 .ea (a) .,aJ\-A►All NO
Jwc� S:urol�t
1
1
4
Kind Regards,
Jake Szczygiel
Tissue Regeneration Specialist
Organogenesis Inc.
85 Dan Road I Canton. MA 02021 1 United States
Phone: [phone]
www.organogenesis.com
Q1ts ��
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1

On Nov 14, 2019, at 9:21 AM, Brownlow, Roy <rov.brown [e-mail]> wrote:
Thank you for sending the information. Please indicate on the drawing the location of the
two additional pilings (ie, which ones are the additional requested pilings).
Does the addition of the pilings expand the footprint of the docking space in order to install
them; or are you reconfiguring the spacing of the previously permitted pilings in order to
keep the original footprint?
Thanks,
<image001.jpg>
From: Jake Szczygiel <[e-mail]>
Sent: Thursday, November 14, 2019 9:02 AM
To: Brownlow, Roy <rov.brown [e-mail]>
Cc: Jake Szczygiel <1Szczv¢[e-mail]>
Subject: [External] 6003 cassowary lane add additional piles
Thank you Roy, please see attached picture and let me know what I need to send to my homeowners
association for their records and approval for their next meeting. Thank you
Jake
Disclaimer
This e-mail message (and any attachment) is intended only for the individual(s) to whom it is addressed. This e-
mail may contain information that is privileged, confidential and exempt from disclosure under applicable law. If
you are not the intended recipient, you are hereby notified that any dissemination, distribution or copying of this
communication is strictly prohibited. If you received this e-mail by accident, please notify the sender immediately
and destroy this e-mail and all copies of it. For more information about Organogenesis, please visit us at
www.organogenesis.com.

Brownlow, Roy
From: Jake Szczygiel <[e-mail]>
Sent: Thursday, November 14, 2019 9:33 AM
To: Brownlow, Roy
Subject: Re: [External] 6003 cassowary lane add additional piles
Permit is for my residence. Please see attached picture of the permit Jacob szczygiel applicant and Brad Connell officer.
1
t
u
.
Kind Regards,
Jake Szczygiel
Tissue Regeneration Specialist
Organogenesis Inc.
85 Dan Road I Canton, MA 02021 1 United States
Phone: [phone]
www.organogenesis.com
1

On Nov 14, 2019, at 9:30 AM, Brownlow, Roy <roy.brown [e-mail]> wrote:
Who was the permit issued to, or whose name is on the permit.
need to pull the file to make the modification.
Thanks
<image001.jpg>
From: Jake Szczygiel <[e-mail]>
Sent: Thursday, November 14, 2019 9:26 AM
To: Brownlow, Roy <[e-mail]>
Subject: Re: [External] 6003 cassowary lane add additional piles
Please see attached additional information you requested. Thank you
<image002.jpg>
Kind Regards,
Jake Szczygiel
Tissue Regeneration Specialist
Organogenesis Inc.
85 Dan Road I Canton, MA 02021 1 United States
Phone: [phone]
www.organogenesis.com
On Nov 14, 2019, at 9:21 AM, Brownlow, Roy <roy.brown [e-mail]> wrote:
Thank you for sending the information. Please indicate on the drawing the
location of the two additional pilings (ie, which ones are the additional
requested pilings).
Does the addition of the pilings expand the footprint of the docking space in
order to install them; or are you reconfiguring the spacing of the previously
permitted pilings in order to keep the original footprint?
Thanks,
<image001.jpg>

From: Jake Szczygiel <[e-mail]>
Sent: Thursday, November 14, 2019 9:02 AM
To: Brownlow, Roy <[e-mail]>
Cc: Jake Szczygiel <[e-mail]>
Subject: [External] 6003 cassowary lane add additional piles
Thank you Roy, please see attached picture and let me know what I need to send to my
homeowners association for their records and approval for their next meeting. Thank
you
Jake
Disclaimer
This e-mail message (and any attachment) is intended only for the individual(s) to whom it is
addressed. This e-mail may contain information that is privileged, confidential and exempt from
disclosure under applicable law. If you are not the intended recipient, you are hereby notified
that any dissemination, distribution or copying of this communication is strictly prohibited. If you
received this e-mail by accident, please notify the sender immediately and destroy this e-mail
and all copies of it. For more information about Organogenesis, please visit us at
www.oroanooenesis.com.