80262D - Blanchard

0 CAMA / -__ DREDGE &FilLL N° 80262 A B C 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 0714 12a •
v ❑RuII attached.
Applicant Name ''' Tif' i .>%h obte-Lf,.1/ Project Location: County 0;44(SYNL[.
Address/4 J p ciAn C nAti Street Address/State Road/Lot#(s)
City IV&V M1 if(i t) State r ZIP ';7&- 3Ct (2 wps+ Do 1 241 1'.
Phone # (2r-) f/14'$o E-Mails n/.4J4' 1dfl'- 1 Subdivision -
Authorized Agent C p(, L(rC s�'1Pl i e�. City Ga l( 14/Z,Pa ZIP ;<.616 .5
Affected ❑CW ®EW II PTA ❑ES ❑PTS Phone # ( ) _ River Basin •t1/,ve
AEC(s): ❑OEA IDHHF ❑IH ❑UBA El N/A Adj.Wtr. Body // f -s 457,(74 ElPWS. _Oat /man /unkn)
ORW: yes / no PNA 0/ no Closest Maj.Wtr. Body A4
Type of Project/Activity � eti 4, ("7315 . • .. , / . , , )6 I(
(Scale: /\ )
Pier(dock)length(7k(3/
Fixed Platforms
Floating Platform(s) V/.* 1a / j ( ,L f j "u
it v
Finger pier(s) ".r- ..4p- . •
Y _� r 1 (K` r , ,f•
) I.
Groin length =�- I ' f
I r "' t
number ------ r} T...-.. I i
Bulkhead/Riprap length �_ ' -- I 4 I
P P gt _ '��+iiiIm - '
avg distance offshore , I .c.--_
t
max distance offshore�'_ iti N. t et ,�t01 s
Basin,channel l � � j i ''} f `
`�
cubic yards_ 1 1 Y t `' q w , "� /
Boat ramp .-�` J ` '• i' . G J . ,
Boathous oatl' `��/IZ / : _.__ ,i_.. ..- �® —,
i }
I ___a f I
Beach Bulldozing I , C_1„ q_�
�1z M� C
Other `�f. f i i ,
Nt 1 •
" 1' kilt 1 . 1 i ' i i. i
Shoreline Length >0 j I
SAV: not sure yes no . --_ a- .E A. 't -pi t_ t -
Moratorium: n/a yes ono 1"` Ia t �L
Photos: yes 6fo �' v i L.Waiver Attached: yes no } 11 I C.A building permit may be required by: 761"'`f ace f.' _/•�a/ ' L See note on back regarding River Basin rules.
(Note Local Planning Jurisdiction) �• �j /�' _ - / /
Notes/Special Conditions 4 9 XS 0i /7,/g�, Not 0.4-C� /7 P,AQLcc745..
/k/ 2 4 ,a,'2e/5/i35-
C 15 Sell 1 r-'ll k ,F tyirk AwlIC4
Agent or Applicant Printed Name Permit Officer's Printed Name
<- izi
Signature *Please read compliance statement on back of permit** Sig ature
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(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

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Kerry and Kristin Blanchard
Name of Property Owner Requesting Permit:
4 Possum Lane
Mailing Address:
New Milford,CT 06776
zo 3-417-435o
Phone Number:
Email Address: [e-mail]
I certify that I have authorized CPG, LLC and Chris Lovell
Agent/Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: new docking facility
at my property located at
Brunswick
in County.
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 related to this
permit application.
Property Owner Information:
Kerry Blanchard(Apr 1,2021 14:58 EDT;
Signature
Kerry Blanchard
Print or Type Name
Property Owner
Title
4 2021
Date
4 1 2022
This certification is valid through I I

ACJACIa T RIPARIAN PROPERTY OWNER STATa EWT
I ncfety corer)hot 1 ono popaty adjacent a..t.el Ghr.namo.I.w .a
sn.W.Deletes L.I i..a (Nan*el Property Owner)
[moody tr pried
o, N^►Vo� (ANnn.Lot,mOakUriilock l NC.
(yr rboey) ICIly'OMn index County)
me-+= I Ius aesaloe 110 me.as 9lowli beaw,tie arrelopTi c propose]a lie above .
M e^ Y'1°Ie I p/7C-e J'¢S S
1 have to adlon logos nms pioposx ld i�h 7�
I Rive of ians to its proposal vh ea/e
DESCRt'T1O1 ARMOR DRAWING or PROPOSED DEVELOPMENT
(IndMdwl proposing development must NI In deccrlpben below or attach a site drawn;;
See attached drawing of proposed docking facility.
Comments:
�fAllowing up to q'into setback with corridor
extending from property boundaries into waterway.
WAIVER SECT;ote
I understand Cut a pew.dock.mooring ptnya.boat coop orcNr.ata.booriwse.lot.or grdr
rnlbl be set bark a nwsrnurn dstaxe of 15 from cry reed of riparian access wriest waived by
me.fit tau NISn to row;l a ae:LaU,VOL must MIMII jar ait�ropiiale IaarlA t,eUw) d,,,� // r-Fe',,,.'
ul�� �,to waive to,7././0nrt arquirmsma�7/�!CJ� A/i �Aceio f PJ /Q//0/7
1 do not ws.1 to waive Vie 1 s setback requirement mN&!95t5 .-p J.�
(Prop* Owner Information) (A4 a ritPropertyOwnertIfaJnation) PPAleit R(y
.2Enanrre Kerry Blanchard s+r '^r* Psrrie Rives(Wicker Farrah'UC)
f hril a Type Wane 4 possum Lane Proet Type Name PC Box 133
Arabic AatY Bs3 New Milford,CT 06776 MOM Atldre� Lexington.NC 27293
" ' D kerry.blanthardLamercfrcom cittfsrawzigs 336250-5111
Tekplrxrc Numbe,/ewel a:deal Telgixvn;rr! adrssaa
(RevaedAug MO'Void fat orie calendar year ater synoh e•
,,ss s
•
� F
Y 9m. 9 / / {0 , 6M /I /`�`TJ - 17r i
I
7—h t,10 v

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent t0 Kerry and Kristen Blanchard ,5
property located at
3912 W.Dolphin I.-6 B-ioSR (Name of Property Owner)
Montgomery Slough (Address. Lot. Block. Road.etc.)
on ,in Oak Nand'Brunswick . N C
(Waterbody) (City/Town and/or County)
The applicant has described to me. as shown below. the development proposed at the above
l lnCl��rop
lion^
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 of proposed docking facility.
Comments:
3'into setback allowed based on shoreline and property bounds
extension into waterway
WAIVER SECTION
I understand that a pier, dock, moonng 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.)
ill gatikedzi;t ,
I do wish to waive the 15'setback requirement.
I do not wish to waive the 15'setback requirement
(Props Owner Information) (Adjacent Property Owner Information)
-- - SiiY/� fylrp�tl�t
Signature Kerry Blanchard Signature. Scott Blankenship
Print or Type Name 4 Possum Lane Print or Type Name 6513 Prestwick Place
Mailing Address New Milford,CT o6776 gAddress Fuquay Varina, NC 27526
City/State/LP [e-mail] City/StateZp 919-637-5069
Telephone Number/email address Telephone Number/email address
Dare 411 21 Date• 4/19/21
(Revised Aug. 2014)
'Valid for one calendar year after signature'

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' 4/20/2021 CPG
3912.W Dolphin ,..
Blanchard Proposed Docking Facility
• a,P`eNeaa\\�e'M
Stab\she VII I
8'x12'Floating Dock 12'x12'Boat-Lift ° m r,
o
.� J -
•
- Ram �. '"'
.- .; s
i
r f L*.
14 x14"Gazebo
Y!►A 4 . • Dr Aline Dimensions '
° „ �
11 .:` P . a 4 6'x63'Pier
a c head
i m ' r 9 Bu .,
i" ,�. 4 Ex4s - ..
tin 1k
1 , a.
�. \4 , ' '' v P/LLB„ :ua ,,r . 3r IOlwrboi in f :f n N;. - pw-. •
;; ,�w 0:+9 2WrDol"thin ##�n ` A"
�` fir". "'ti>13914 W:iDolp�h n *� �e ' J * a Blankenship: • • r
Google Earth„ Rves.° a d � I �. rt`�}4.
" cl°� CBI n
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y
*Note:
Approximate measurements from aerial imagery (GoogleEarth).

3912 W. Dolphin 4/20/2021 CPG
Blanchard Proposed Docking Facility
re d P`e�Nead\one .+•
tab\‘S '�
.S
1
33`"54'57.88"N 78"11'56.83"W jrl33'54'57.88"N 78' 11'56. 8"W •- - - ?'
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vii\ Tji_lig.
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j33�54'56 :9"N 78 11'56.82"W ram^" _ A
1910 W.Do�hin
3912 W.Dolphin
A
__Ili
��' 3914W;Dolphin Rlankcnship
Google Earth 0. Rives Blanchard
N
100 ft
*Note:
Approximate measurements from aerial imagery (GoogleEarth).

Check
Date Rec.lead Date Deposited Cheek From(Name) Name of Permit Holder Vendor Check number amount Permit Number/Commenb Receipt or Refund/Reallocated
Columns Column) Column? Column) Column5 Columns Coomn7 Column8 Columns
4/27/2021 Andrew Grady Gordon Grady Gordon First National Baml 1015.$ 200.00 GP#79910D TP rct.12801.
4/27/2021 Chad Tracy :same Wells Fargo 105 $ 200.00 GP#79947D BB rct.13107
4/27/2021 1658 North Howe Street,Inc. IJhn and Beverly McCloskey BB&T 1586 $ 200.00 GP#802290 Tmac rct.13541
4/27/2021 Steven L.Cobb Steven&Robin Cobb !First Citizens Bank 1533 $ 200.00 GP#79909D PA rct.12762
4/27/2021. JW Harrison Mechanical Inc. James and Karen Harrison BB&T 5748,$ 200.00 GP#80261D PA rct.12764
4/27/2021 Town of Oak Island .same !�!BB&T 83802 $ 200.00 GP#79954D !PA rct.12759
4/27/2021 Coastal Marine Piers Bulkheads LLC Ricky Hancock !Wells Fargo 23815 $ 200.00 GP#80238D 1BH rct.12879
4/27/2021 AMW Docks and Marine Construction LLC Phillip and Cythia Price BB&T 6202!$ 200.00 GP#79904D BB rct.13108
4/27/2021 Bruce Marek,P.E. Bald Head Island Ltd. Wells Fargo 2105,$ 200.00 GP#80144D Tmac rct 13543
4/27/2021, McPherson Marine Services,LLC Robert Frankenfield First Citizens Bank 4042 $ 200.00 l GP#80228D I Tmac rct.13004
4/27/2021 CLTMC,Inc Kerry and Kristin Blanchard First Citizens Bank 1184 $ 200.00 I GP#80262D PA rct.12761
4/27/2021 CLTMC,Inc. Denise&Kirk Kloeppel First Citizens Bank 1181 $ 600.00 1 GP#80264D •PA rct.15757
4/27/2021 Duke Real Estate Inc. Gerald and Cathy Duke Wells Fargo 4836!$ 600.00 GP#80257D PA rct.12760
4/27/2021 Sea Dog Marine Construction,LLC Sae Mist Campground First Bank 1287 $ 200.00 1GP#80274D BB rct.13104
4/27/2021 Steven William Murray same PNC Bank 1073!$ 200.00!GP#80254D JD rct.13409
4/27/2021! Bob Drach same Fidelity Investments 13281.$ 200.00 1GP#80239D BH rct.12878
4/27/2021 Coastal Marine Piers Bulkheads LLC Singleton&Sebrell Coupland Etal Wells Fargo 23785 $ 200.00 1GP#761860 PA rct.11599
4/27/2021! Once Construction Davis&Susan Thomas BB&T • 14500 $ 200.00 I GP#801290 BB rct.12994