79013_Judy Henries_20210121

rv* log
ci-44cAmAE/ DREDGE&FILL No -()(j I ,RAL PERMIT Previous permit# ^ C D
New Modification Complete Reissue Partial Reissue Date previous permit issued A. A
As authorized by the State of North Carolina.Department of Environmental Quaiity .„ ' 7
and the Coastal Resources Commission in an area of envi,onmentl concern pursuant to I SA NCAC 1 Rules attached.
Applicant Name *�}r^�v r`it*''sr r _._S Protect Location: County fi�w--,.C::,:..,' 1
Address i S 9,e r 44 ,fir ' K.of- Street Address/State Road/Lot#(s) 175 �-e.. 1"r�
�.
City y/�7 i, State& C ZIP 7 X STr, R c7 , II
Phone#(LSL) j70rile? E-mail /I<nr,c 528J(2 fi,,ho.),"S bdivision .I*^'" .•4-* PDAn.r
i
Authorized Agent,- -
City F'ti'wY' 44- ZIP Z ASS 6
Affected CW Aw j(P7A VEs )'PTS Phone# (LS2) 6'70 9336/ L River Basin • `'(
AEC(s): ° NH IH USA N/A Adj.Wtr.Body '-r"`�' S rs,t /c
� .. 66i,fman ; )
PWS.
ORW: yes. no PNA yes no
Closest Maj.Wtr.Body 'd 1... .-- Cr.._h._-
Type of Project/Activity_Ail,I n .4- f%o/os� S/A if d' 1/e r ,,, 7 5 ik.. 2>:i ' -
. ft. (-Y..,`4: ' 2. S 'A'to /'j r/CIVYc",", , (Scale: '3J )
Pier(dock)'ength ' O r
Fixed Pat!orrrys. 7'S)' 2 -
FloatingPlatformfsi / r / I'
finger per s ( 4
Grog length 1----- , r 5 ,
number � (��+ �+{�7 1L.
Bu!khcad ILpnp length
` -7 .��i �<w` 17 i t -#v c.,- y ' t/LG
avg distance offshore I I J
max distance offshore g ,
Basin.channel ''llr�� 'k 7 ) /+ ^ .:'4 I,>, a7
Y Ir � r .5)L0. y r ;-gin
cubic aros )p ` ,
Boat ramp �i`)�. . (i.� y
Boathouse Boatldt I
'' ! \+ v' y
Beach Bulldozing "^ � `` li
,/ .
Other I s' ;
I �� _^--ae— V
ShorelneLengdt,� 3O' r-'4'41t t,( 'S
SAV, not sell yes no ,
J
Moratorium: Ne yes ( �J(! o
Photos: yes 6/
Waiver Attached: yes 40
A building permit may be required by: /ow.'i- �o' See note on back regarding River Basin rules.
(Note Local Planning Jurisdiction) 1 / /
Notes/Special Conditions i/ w/ <- Q/i'l 'te `)a S {A,,�f/t 9
ice+!5 .t_k_C, 7. 5 /l -(r,tt 0w'1/44- b.c.. moor., cta,S i- 3' onto-.)-,t--
Co a.51, -.,..tic..(-t."--01 °„w& Nd '—' -- il,-. &r kn./i ot.4.._
1 \ • L ,/
1�ll�y�Cvl..5 �t, YA v.0
Agent or • t PnntodName Permit OBteei s Pated ,
rs '"Please read compliance statement on back ofpemrt"�
t
Sao (2' p S 2-{a�3 J��/�7-�� - -; '7( 2 G z/
Application�(s) Chia/ Issuing axe Expiration Date

NC Division of Coastal Management
i
Cashiers Official Receipt 3827 :� BC0
i
Date: 20=
/ , /i �S t a
Received From: v.,' ` `‘ S i
Permit No.: .-r 0, Check No.: 40 s i- Ct�y
11
Applicant's Name: ,r r �; / �` County: ,-A-- -
Protect Address-
Please
7 S ; 1 O"L, 11 �i ' 1`� r""/ I Ai C
Please retain receipt for your records as proof of payment for permit Issued.
Signature of Agent or Applicant: Date: 2--/2— -'I
Signature of Field Represe w . - _-- Date:

ROY COOPER
c.ovemor
MICHAEL S. REGAN
Secretary
Coastal Management emat>Knertrnn.owLm DAVISIk BRAXTON DAVIS
or
BUFFER AUTHORIZATION 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 Resources(DWR)regulations 15A NCAC 028.0233&.0259.The
Division of Coastal Management(DCM), through a Memorandum of Understanding with the Division of Water
Resources(DWR)has reviewed your project proposal and has determined that the project as proposed complies
with the aforementioned regulations.
Those activities covered by your Coastal Area Management Act(CAIv1A)permit have received Buffer Authorization
provided the project is constructed in a manner that continues to meet all of the conditions listed below.Failure to
comply with this Buffer Authorization may subject the property owner and the party(contractor)performing the
construction and/or land clearing to 3 civil penalty by DWR of up to$25,000 per day per violation
Crossing is Perpendicular: Pier and docking facility access way must cross the 50 ft. *'parian 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 practcable.
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.
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. �/�
• Pre-project site conditions:_ � x _(74�/" /1 —#
By your signature below you agree to be held responsible for meeting all of the conditions isted abo• and verify
that all information provided is complete and accurate.
sir
Agent orApsplicant TintedName it O c ignature
/Date��
Issas 72f
g or Applicant Signature
CAMA GENERAL PERMIT#: (382-1
State of North Carolina Environmental Quality Coastal Management
Washington Office 443 Washington Square Mall Washington NC 27584 '52 44n.6481
Wilmington Office 121 Cardinal Orme Ext.Wilmington.NC 28405-3845 AO-Mri215
Morehead Otv Office .100 Commerce Asenue Morehead CAN.w:28S57 2.'i2-808-2608
7

locality Permit Number OTHER PERMITS MAY BE REQUIRED:The activity you are planning may require permits other than the('AMA
minor development permit,including,but not limited to:Drinking Water Well,Septic Tank(or other sanitary waste
Ocean Hazard Estuarine Shoreline ORW Shoreline Public t rust Shoreline Other treatment system),Building,Electrical,Plumbing,Heating and Air Conditioning,Insulation and Energy Conservation,FIA
(For official use only) Certification.Sand Dune,Sediment Control,Subdivision Approval.Mobile Home Park Approval,Highway Connection,and
others.Check with your Local Permit Officer for more information.
GENERAL INFORMATION
STATEMENT OF OWNERSHIP:
LAND OWNER-MAILING ADDRESS I.the undersigned,an applicant for a CAMA minor development permit,being either the owner of property in an AEC or a
Name Jody Henries person authorized to act as an agent for purposes of applying for a CAMA minor development permit,certify that the person
listed as landowner on this application has a significant interest in the real property described therein.This interest can be
Address 1590 Alligator loop rd. described as:(check one)
City Merritt state N.C. Zip 28556 phi [phone] — X an owner or record title,Title is vested in name of Jody Henries
Email [e-mail] see Deed Book 000595 page 340 in the Pamlico County Registry of Deeds.
AUTHORIZED AGENT an owner by virtue of inheritance.Applicant is an heir to the estate of
:probate was in —County.
Name
if other interest,such as written contract or lease,explain below or use a separate sheet&attach to this application.
Address
City State Zip Phone NOTIFICATION OF ADJACENT RIPARIAN PROPERTY OWNERS:
I I arthmnore certify that the following persons are owners of properties adjoining this property.I affirm that I have given
Email ACTUAL NOTICE to each of them concerning my intent to develop this property and to apply for a CAMA permit.
(Name) (Address)
LOCAT it)r OF PROJECT:(Address,street name and/or directions to site;name of the adjacent waterbody,)
(I) Gregory Derman-1480 North Ridge Meadows Path,Hernando.FL.34442
175 Timber pt rd.Merritt,NC 28556 (2, Eric Johnson—4924 CHAMPIONS RUN MIDDLETON,WI 53562
Mason Bay Bay River Pamlico County (3)
(4)
DESCRIPTION OF PROJECT:(List all proposed construction and land disturbance.) build a dock that is 49' ACKNOWLEDGEMENTS:
total length that includes a platform at the end 5'by 20'on the edge of water with a 2'step dov/nthe undersigned,acknowledge that the land owner is aware that the proposed development is planned for an area which
may be susceptible to erosion and/or flooding.I acknowledge that the Local Permit Officer has explained to me the particu-
lar hazard problems associated with this lot.This explanation was accompanied by recommendations concerning stabiliza-
SIZE OF LOT/PARCEL: square feet 2.3 acres tion and floodproofing techniques.
PROPOSED USE:Residential l9 (Single-family❑ Multi-family❑) Commercial/Industrial 0 Other ❑ I furthermore certify that I am authorized to grant,and do in fact grant,permission to Division of Coastal Management staff,
the Local Permit Officer and their agents to enter on the aforementioned lands in connection with evaluating information
COMPLETE EITHER(1)OR(2)BELOW(Contact your Local Permit Officer if you are not sure which AEC'applies related to this permit application. 1
to your property): i
40
(1) OCEAN HAZARD AECa:TOTAL FLOOR AREA OF PROPOSED STRUCTURE: NA square feet(includes _ This the Sd day of c)..,_ ,20
air conditioned living space,parking elevated above ground level,non-conditioned space elevated above ground level but
-
excluding non-load-bearing attic space) Lartdown r authorized to act as his/her agent for purpose of filing a CAMA permit application
(2)COASTAL SHORELINE AECs:SIZE OF BUILDING FOOTPRINT AND OTHER IMPERVIOUS OR BUILT
UPON SURFACES: NA square feet(includes the area of the foundation of all buildings,driveways,covered decks, This ap anon includes:general information(this form),a site drawing as described on the back of this application,the
concrete or masonry patios,etc.that are within the applicable AEC.Attach your calculations with the project drawing.) ownership statement,the Ocean Hazard AEC Notice where necessary,a check for$100.00 made payable to the locality,and
any information as may be provided orally by the applicant.The details of the application as described by these sources are
STATE STORMWATER MANAGEMENT PERMIT:Is the project located in an area subject to a state incorporated without reference in any permit which may be issued.Deviation from these details will constitute a violation of
Stormwater Management Permit issued by the NC Division of Energy,Mineral and Land Resources(DEMLR)? any permit.Any person developing in an AEC without permit is subject to civil,criminal and administrative acction.
YES NO NA
If yes,list the total built upon area/impervious surface allowed for your lot or parcel: square feet.

175 T.,,,N..tt
3•AN.I VIt....e.tr*,
Cr:A) 1.,-1.1—1-
/sr 5' t.tesi. S i:Lc
ti 1 i TO41.1 !I t+Oltk'
k e•
4,
1 E
7'
I II
I :
i
1....„ ._,...
n.
r—
i .....„,....
••• 4/ . • \ i.
4 17:1:. LtIto-u.i.., '0(....c_t s
J
-'•(." Sl4 c '1.1, 4-

7
li 1 0 Ilt f ;
i A i t', J', •t•
, , t
P .' ) : .• pr.V.,
\ ‘
/
4 4
a
11 i
0
ti i 11
..,,,,A of/
1
1 1 i
C '11-0V,
0,,•i.9
, i, ____ lut•rii h c....0
+6 i'q w LL g 4 1
41°15 --ek'-a
.1,V crj ,Cpi i,i..7 i
1 !
-:'1:, ••:"K3
0
o
.....1„ ___ . , ,...,...... '
________ ............ ..._..... .., \,
. .. ,. - . .
_ i::,01' • • 8
, _____ ......... ....... _ .
1 -lil__ - 1. • lb \
_...

!�
.._._ *woo
at
41.31
i
. 05-4A-14
. '17, V? \ s.
01/ creek width 25'
WS
896
411. 41 175 timber pt
gir
-76:

Mason Bay
•
NNW
dle
. .
,d
. ,
raw
11111
4115111
ao
IP
li Overview Map
No* 4 =
i.
ALL , �11101
i
mrs

Jody Henries
1590 Alligator loop rd,Merritt.N.C.28556 I(252)670-4330 I [e-mail]
Gregory Derman
1480 North Ridge Meadows Path
Hernando,FL.34442
Dear,Mr.Gregory Derman
I(Jody Henries)am applying for a CAMA Minor permit to build a pier,located at 175 Timber pt.dr.on
Mason Bay in Pamlico county,North Carolina.The specifics of the proposed work are in
the enclosed application forms and drawings
As the adjacent riparian property owner to the aforementioned project,I am required to notify you of the
development in order to give you the opportunity to comment on the project.Please review the attached
permit application and drawings
Should you have any objections to this proposal,please send your written comments to
OCM Washington Regional Office
943 Washington Square Mall
Washington,NC 27889
252-946-6481
Fax:[phone]
Kent Vaughan,field agent(exL38S3)
Kelly Spivey,District Manager
[phone]
within 30 days of your receipt of this
notice.Such comments will be considered by the Department in reaching a final decision on the
application.No comment within 30 days of your receipt of this notice will be considered as no objection If
you have any questions on this project,please call me at(252)670-4330,ore-mail me at
[e-mail]
Sincerely,Jody Henries

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to Jody Henries 's
(Name of Property Owner)
property located at 175 timber Pt Dr,lot 7
(Address,Lot,Block,Road,etc.)
on Mason Bay ,in Merritt Pamlico County N C
(Waterbody) (City/Town and/or County)
The applicant has described to me,as shown below,the development proposed at the above
locatiop 7
}4r' - I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
See attached drawing and permits for details
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) (Adjacent Proper]Owner Information)
Signature Sign.atur-
Jody Hennes Gregory Derman
Print or Type Name Print or Type Name
1590 Alligator Iggg rd 1480 North Ridge Medows Path
Mailing Address Mailing Address
MemitLN.0 28558 Hernando.Fl..34442
City/State/Zip City/State/Zip
[phone] fir;- Y/9-3 0>'r
Telephone Number/email address Telephone Number/emei address
/Z/2//3-O
Dale _.. Dan•
(Revised Aug.2014)
'Valid for one calendar year after signature'

Jody Henries
1590 Alligator loop rd,Merritt,N.C.28556 [phone] J [e-mail]
Eric Johnson
4924 CHAMPIONS RUN
MIDDLETON.WI 53362
Dear Mr.Eric Johnson
I(Jody Henries)am applying for a CAMA Minor permit to build a pier located at 175 Timber pt.dr.on
Mason Bay in Pamlico county,North Carolina.The specifics of the proposed work are in
the enclosed application forms and drawings.
As the adjacent riparian property owner to the aforementioned project,I am required to notify you of the
development in order to give you the opportunity to comment on the project.Please review the attached
permit application and drawings.
Should you have any objections to this proposal,please send your written comments to
943 Washington Square Mall
•
Washington,NC 27889
252-946-6481
Fax:[phone]
Kent Vaughan.field agent(ext.3853)
1.1
Kelly Spivey,District Manager
[phone]
•
,within 30 days of your receipt of this notice.Such comments will be considered by the Department in
reaching a final decision on the application.No comment within 30 days of your receipt of this notice will be
considered as no objection.If
you have any questions on this project,please call me at(252)670-4330,or e-mail me at
hen [e-mail]
•
Sincerely,Jody Henries

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to Jody Henries s
(Name of Property Owner)
property located at 175 timber Pt Dr,lot 7
(Address,Lot,Block,Road,etc.)
on Mason Bay ,in MerrittPamlico County ,N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
Ioc ,on
XI have no objection to this proposal
I have objections to this proposal
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
See attached drawing and permits for details
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) (Adjacent Property Owner Information)
Signature Si ature•
Jody Henries Eric Johnson
Print or Type Name Print or Type Name
1590 Alligator loop rd 4924 CHAMPIONS RUN
Meiling Address Mailinrrgg Address
Merrritt.N.C.28556 MTDOLETON,va 53562
City/State/Zip City/State/Zip
12521670-4330 St9.4.o-8GI-q ar;�k .�r+K�•.t t 12 Q ,,.,.;1 c=rr.
Telephone Number/email address Telephone Number/email address
Dale Dare•
(Revised Aug.2014)
'Valid for one calendar year after signature'

SITE DRAWING/APPLICATION CHECKLIST
Please make sure your site drawing includes the following information required for a CAMA minor development permit. -o
The Local Permit Officer will help you,if requested.
PHYSICAL DIMENSIONS APPLICATION FORhl
Label roads CAMA MINOR
Label highways right-of-ways z
_ Label local setback lines DEVELOPMENT
Label any and all structures and driveways currently existing on property
__Label adjacent waterbody Coastal Management
ENVIRONMENTAL QUALITY
PHYSICAL CHARACTERISTICS PERMIT
Draw and label normal high water line(contact LPO for assistance) In 1914,the North Carolina General Assembly passed the Coastal Area Management Act
Draw location of on-site wastewater system
(CAMA)and set the stage for guiding development in fragile and productive areas that
If you will be working in the ocean hazard area: border the state's sounds and oceanfront.Along with requiring special care by those who
Draw and label dune ridges(include spot elevations) build and develop,the General Assembly directed the Coastal Resources Commission
Draw and label toe of dunes (CRC)to implement clear regulations that minimize the burden on the applicant.
NA_Identify and locate first line of stable vegetation(contact LPO for assistance)
NA Draw and label erosion setback line(contact LPO for assistance) This application for a minor development permit under('AMA is part of the
NA Draw and label topographical features(optional) Commission's effort to meet the spirit and intent of the General Assembly.It has been
designed to be straightforward and require no more time or effort than necessary from
If you will be working in a coastal shoreline area: the applicant.Please go over this folder with the Local Permit Officer(LPO)for the
NA Show the roof overhang as a dotted line around the structure locality in which you plan to build to be certain that you understand what information he r-
NA Draw and label landward limit of AEC or she needs before you apply.
Draw and label all wetland lines(contact LPO for assistance) r•.
Draw and label the 30-foot buffer line Under CAMA regulations,the minor permit is to be issued within 25 days once a —7C
DEVELOPMENT PLANS complete application is in hand.Often less time is needed if the project is simple.The "
process generally takes about 18 days.You can speed the approval process by making
Draw and label all proposed structures certain that your application is complete and signed,that your drawing meets the
Draw and label areas that will be disturbed and/or landscaped specifications given inside and that your application fee is attached.
_Note size of piling and depth to be placed in ground
Draw and label all areas to be paved or graveled Other permits are sometimes required for development in the coastal area.While these
Show all areas to be disturbed are not CAMA-related,we urge you to check with the Local Permit Officer to determine
Show landscaping
which of these you may need.A list is included on page two of this folder.
NOTE TO APPLICANT
We appreciate your cooperation with the North Carolina Coastal Management Program
I lave you and your willingness to build in a way that protects the resources of our beautiful and
• completed all blanks and/or indicated if not applicable? productive coast.
• notified and listed adjacent property owners?
• included your site drawing? Coastal Resources Commission
• signed and dated the application? Division of Coastal Management
• enclosed the S100.00 fee? y
• completed an AEC Hazard Notice,if necessary?(Must be signed by the property owner) > -e
FOR STAFF USI
I,, -
Site Notice Posted Final Inspection Fee Received 1(,
LJntn
Site Inspections m
X IT
zo
m C
IDzc
Date of Action:Issued Exempted Denied Appeal Deadline(20 days from permit action) ocnt Fore tvB1952•2015 Revises