77462_Bill Madsen_20210223

, CAMA / DREDGE & FUL -� NO. 77462 A B �cj D
GENERAL PERMIT Previous permit#
> •- -New ❑Modification ❑Complete Reissue ❑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 I 5A NCAC
f- I]Rules attached.
Applicant Name '1/ M Ii`I ' /` -'t" Project Location: County , "v,/
Address // 7 3ei�'Gv /-e_.e 1 ��� �Street Address/State Road/Lot#(s) ' / 2 ' -e eo
City ele.c,� -i e-r-7 State/✓C ZIP-2-S.<--'-y) / Gc// i,. / /
Phone#(?/7) Ss'S-351.V E-Mail Subdivision f /' (/'•/ / eir—-
Authorized Agent �%�i ��� I City ;k/P.c.1J13-c( " ZIP Y---52":6'6)
Affected ❑CW COEW gPTA LIES VPTS Phone# ( "/ )55.5 S�3// River Basin /mil°L,
AEC(s): ❑OEA HHF ❑IH ClUBA ❑N/A Adj.Wtr. Body /'e''/! 5J (' /4 (nat ,jman /unkn)
❑ PWS:
Closest Maj. Bod �� '�� �`
ORW: yes / no PNA yes / no 7 �' y
Type of Project/Activity -k Ve) /-
/ /� 7"/ /"/
' .<7`/1/i4-'/-(Scale: ,r 3 ei' )
Pier(dock)length i't4 :. //�� �+
Fixed Platform(s) • ! �ti,e,,-i''v,'� (� I /�
Floating Platform(s) I j I
Finger pier(s) O! C 0 m
Groin length 1 i
-----_. ......- -�----� ..-- ---- -.._.._ I
number
Bulkhead/Riprap length I { & -• j
-Till
i
avg distance offshore
{ I
max distance offshore I I I /
Basin,channel 1 I
cubic yards7 I
I I I 1 .) 1
{
.$)
Boat ramp Ii ,
'A 0 o
Boathouse/Boatlift --' ___._ _ __.. _.....
4 G /
Beach Bulldozing j 'f/, y K S II
Other//I, .J / //i '7 �/ ► V
)
/ I ld 'fa 11 i /
G
Shoreline Length / "l r r Pikl/ / f ``� }
! 4 r ,
SAV: not sure- yes no } i �/ /, /
r
Moratorium: n/a yes c- f ' V Y i P4
Photos: yes ( . e I; 1 ✓ ..... tijV 7l f+ a"
Waiver Attached: no r y
e'e 4 // / // ,dam
A building permit may be required by: 'A�//��+�J ���� �' � See note on back regarding River Basin rules.
(Note Local Planning Jurisdiction) / / &'Notes/Special Conditions IC 6 / f' t ?( / /e/ /2 7" II eWe-,J-,/ 4/ �/ /i,17/ 4,7- A/0/z—
/7r/e'er„ 1-
, — L , /
7z. /f.�/11 -1--'jam �,A,(3 S 6/�,/ ��,j/ r�c r _/ /\l J'�l�" �t t
Agent or Applicant Printed Name Permit Officer's Prin am�
/` -"--- .tee -- v- i y/ V
Signature **Please read compliance statement on back of permit** Signatures ,y% ] 2 7/ / IA-/ 1229--- -
a/ .;. y��- L.l J / /"�� i_ — '
Application Fee(s) Check# Issuing Date 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 I)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 Resources. Contact the Division of Water Resources at the Washington Regional Office (252-946-648I) 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/ I-888-4RCOAST 252-946-6481
Fax: [phone] Fax: [phone]
(Serves:Carteret,Craven,Onslow- (Serves: Beaufort, Bertie, Hertford, Hyde,
North of New River Inlet-and Pamlico Tyrrell and Washington Counties)
Counties)
Elizabeth City District Wilmington District
401 S. Griffin St. 127 Cardinal Drive Ext.
Ste. 300 Wilmington, NC 28405-3845
Elizabeth City, NC 27909 910-796-7215
252-264-3901 Fax: [phone]
Fax: [phone] (Serves: Brunswick, New Hanover,
(Serves:Camden, Chowan,Currituck, Onslow-South of New River Inlet-
Dare,Gates, Pasquotank and Perquimans and Pender Counties)
Counties)
http://portal.ncdenr.org/web/cm/dcm-home
Revised 7/06/17

toC3CAMA/ II DREDGE & FILL l�1Q"� N . 77462 A B C' D
GENERAL PERMIT �(J O t Previous permit#
��== ❑New JModification _IComplete Reissue ❑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 I 5A NCAC
❑Rules attached.
Applicant Name Project Location: County
Address Street Address/State Road/Lot#(s) •
City State ZIP
Phone# ( ) E-Mail Subdivision
Authorized Agent City ZIP
Affected E CW EW ❑PTA LEES CZ PTS Phone# ( ) River Basin
AEC(s): ❑OEA ❑HHF ❑IH ❑UBA ❑N/A Adj.Wtr. Body (nat /man /unkn)
❑ PWS:
ORW: yes / no PNA yes / no Closest Maj.Wtr. Body
Type of Project/Activity /
(Scale: `.• ;.,,,;i' )
Pier(dock)length // • •
Fixed Platform(s) / /V. //"/ ``'�/ C'',,, I T it,/ I 1
Floating Platform(s) ( -
1i
C) D 8 O
Finer pier(s)
g P () -
Groin length } i ) t
number , • — — t ; ! ---
I
i r
_.__._—
Bulkhead/Riprap length / ; — — t ; <I(� _...._`
avg distance offshore t i i
max distance offshore i ''
Basin,channel i •
cubic yards 4 / {
Boat ramp I �
®i i i �� I
Boathouse/Boatlift _ . +- i - --- ---` � ___...__ _.._.._--�--i-
.. i
Beach Bulldozing j �✓ � 1//,- )L-' / _ I• '
Other _ f/ 1' 1 i
Tj/,i, t i 1 7 f
{7 Jn' / I I I ( �^^ PJ. •t' Y r I i
r 3 ` I ---..—� I
Shoreline Length i I
SAV: not sure yes no .._ ____..- I ; 'i` I (' '-.-._ t '� - --
Moratorium: n/a yes no4 : : ---- —
Photos: yes no , l i > ! j 1.—_ /
Waiver Attached: yes no I t . , I i'
f
A building permit may be required by: . 7 See note on back regarding River Basin rules.
(Note Local Planning Jurisdiction)
Notes/Special Conditions
Agent or Applicant Printed Name Permit Officer's Printed Nam ��J
Signature **Please read compliance statement on back of permit** Signature //- ;,c/�, � l 6'I
- ..e.
Application Fee(s) Check# Issuing Date 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 I)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 Resources. Contact the Division of Water Resources at the Washington Regional Office (252-946-6481) or the
Wilmington Regional Office(9 I 0-796-72 I 5)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/ I-888-4RCOAST 252-946-648 I
Fax: [phone] Fax: [phone]
(Serves:Carteret,Craven,Onslow- (Serves: Beaufort, Bertie, Hertford,Hyde,
North of New River Inlet-and Pamlico Tyrrell and Washington Counties)
Counties)
Elizabeth City District Wilmington District
401 S. Griffin St. 127 Cardinal Drive Ext.
Ste. 300 Wilmington, NC 28405-3845
Elizabeth City, NC 27909 910-796-7215
252-264-3901 Fax: [phone]
Fax: [phone] (Serves: Brunswick, New Hanover,
(Serves:Camden,Chowan,Currituck, Onslow-South of New River Inlet-
' Dare,Gates, Pasquotank and Perquimans and Pender Counties)
Counties)
http://portal.ncdenr.org/web/cm/dcm-home
Revised 7/06/17

AGENT AUTHORIZATION FORM FOR PERMIT APPLICATIONS
NAME OF PROPERTY OWNER APPLYING FOR PERMIT Bill Madsen
MAILING ADDRESS 5112 Bicco Reef Rd
New Bern,NC 28560
TELEPHONE NUMBER 347-585-3884
I certify that I have authorized Dan Foley (agent/contractor) ,
to act on my behalf, for the purpose of applying and obtaining all CAMA permits
necessary for the proposed development of Dock
at my property located at Same
This certification is valid through (1) Year (date).
(Property Owner Information)
Signature
ll1iGG�Ai� .T. /"/1 .a,.S6/V
Print or Type Name
)( hV E,'
Title, co. owner or trustee for property
Date
Telephone Number
Email Address

Wier's statement
Adjacent Riparian,Property 0
Owner:
cent Riparian
Property Lot Number
Number:Section
Name:
Address:
Telephone Number:
E-mail Address:I hereby property adjacent to:
Section Number:
certify that I own the
Lot Number: �---
•
Owners Name:
Address:
Telephone Number.. attached copy of the
as shown on the that
of proposed work. I understand
E-mail Address: e the scope15'_p")from ray
of work the of fifteen feet
for this permit has describe and have no objectionsinimum
le Proposed work t form ust be set back a m
The individual applyingof Prop cture m
tion and Drawing other marine stru
"Description s tie poles or any
docks,pilings,riparian line unless waived by me.
to waive the setback requirement.
I do not wish`-
I do wish to waive the setback requirement.
Adjacent Riparian Property Owner:
Signature
Print Name Do Al 1"4"f "�'p
Date /!U-2 to
i
I

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Adjacent Riparian Property Owner's Statement
Adjacent Riparian Property Owner:
Section Number:
Lot Number:-.__._-`—_.__—
7
Name: -.
Address: \\_ 31� C e
Telephone Number:
E-mail Address: —
I hereby certify that I own the property adjacent to:
Section Number: 6 Lot Number: 1710
Owners Name: I O\\\ \�.m ` V, aV'C)
Address: S \\L U\C CO Fe d.
Telephone Number:
E-mail Address:
The individual applying for this permit has described to the 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.
I not wish to waive the setback requirement.
I do wish to waive the setback requirement.
Adjacent Riparian Prop ty Owner:
Signature !!// /'
Print Name E�i�t 6 e''k Avs-�•t (mob el z.ei ev.co-,
Date /!/d/202o

r.k.�T ,,4
L ,1?6S gtd a/1,0.06 tpcp
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•

ROY COOPER
Governor
.:v
MICHAEL S. REGAN
Secretary
Coastal Management BRAXTON DAVIS
EkwRONMENtu QUALITY Director
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 02B.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 (CAMA) 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 a civil penalty by DWR of up to $25,000 per day per violation.
i. 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 ensurethe 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.
• Pre-project site conditions: !-074. au/4' awe-) /---e-e-n •
responsible for meetingall of the conditions listed above and verify
your signature below you agree to be held espo
that all information provided is complete and accurate.
Agent or Applicant/Printed Name Permit Offic is Signature
Na✓, e wZU
Agent or Applicant Signature Issue Date,
CAMA GENERAL PERMIT#:
State of North Carolina l Environmental Quality I CoastalManagernent
Washington Office 1943 Washington Square Mall Washington.NC 27889 252-946-6481
Wilmington Office 1127 Cardinal Drive Ext.Wilmington.NC 28405-3845 910-796-7215
Morehead City Office 1400 Commerce Avenue Morehead City.NC 28557 i 252-808-2808