86087D - Penegar

(°``°"'k �CAIVIA DREDGE & FILL l�� 86087 A B C(
Previous permit
G E N L PERMIT Date previous permit issued
New ❑ Modification ❑ Complete Reissue ❑ Partial Reissue
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 SA NCAC 07 i1—t t 00, • l ZOd l 1560 Rules attached. V General Permit Rules available at the following link: www.dea,nc.gov/CAMAn
Applicant Name
Address
City
Phone #AA
Email
Subdivision
Affected CW EW PTA ,W ES PTS Adj. Wtr. Body M-t!r% �3/L1C„fjtrr
AEC(s): F1OEA IHA 11 UW SPIMA PWS Closest Maj. Wtr. Body Sor,�i,�
PN es/
Type of
Shoreline Length •i'/—?S
Access Length
Pier (dock) length �/ •xis
Fixed Platform(s)
Floating Platform(s)
Finger pier(s)
Total Platform area
Groin length/q
4Z!55Dkrap length
Avg distance offshore
Breakwater/Sill
Max dis ce/ length
sm, nn ZS .Q
ds
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
Woks-r,�
'C.._ /✓EA) 6 eX/6 t
SAV observed: yes o
Moratorium: n/a yes .C..�- GP., 0-i
Site Photos: yes n
Riparian Waiver Attached: yes o
A building permit/zoning permit may be required by:
Permit Conditions
J l -'r
or Applicant
'Mlease rp.461compliance statement on bac -of permit" 164
(Scale:! .idle
riew 4o
TAR/PAM/NEUSE/BUFFER (circle one)
See note on back regarding River Basin ru
See additional notes/conditions on back
I�REVIEWED COMPLIANCE STATEMENT.
1 tL--
i ficer's PRINTED Name
ign r tib� . •'�l �� ' /�

o1*000Sr"1�,❑LAMA ❑ DREDGE & FILL
N° 86087 A B
GENERAL PERMIT Previous permit
Date previous permit issued
El New ❑ Modification ❑ Complete Reissue ❑ Partial Reissue
As authorized by the State of North Carolina, Department of Environmental Quality and the Coastal Resources Commission in an area of environmental concern pursuant
15A NCAC / t i y ` ❑ Rules attached. ❑ General Permit Rules available at the following link: www.deq.nc.Qov/CAM,
Applicant Name 9 { /' z%/--" Authorized Agent
Address 7 l_S Project Location (County):
City�1 State ZIP Street Address/State Road/Lot #(s)
Phone #'(_)
Email Subdivision
City it �)'l/rj /"%�� ZIP
Affected ❑CW ❑EW PTA ❑ ES Adj. Wtr. Body.I Wl t-AV,*L, nC""
AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS Closest Maj. Wtr. Bodyfi�
ORW: yes/no PNA-'yes/no
Type of Project/ Activity f f't�- (�f %UC• ,(L,- f�TG �if� f,%fJ�%': i
t ; i r .e f.✓ (Scale: i
Shoreline Length
Access Length
Pier (dock) length A Y (,�.•'
Fixed Platform(s)
Floating Platform(s) '= V
Finger pier(s)
Total Platform area
Groin length/#
Bulkhead/.Riprap length
Avg distance offshore
Breakwater/Sill
Max distance/ length
Basin, channel
Cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
SAV observed: yes
Moratorium: n/a yes
Site Photos: yes
Riparian Waiver Attached: yes
A building permit/zoning permit m
Permit Conditions
❑ TAR/PAM/NEUSE/BUFFER (circle one
❑ See note on back regarding River Basii
❑ See additional notes/conditions on ba
I AM AWARE OF STATUTES, CRC RULES AND CONDITIONS THAT APPLY TO THIS PROJECT AND REVIEWED COMPLIANCE STATEMENT. (Please Initial)
Agent or Applicant PRINTED Name
Permit Officer's PRINTED Name

�ment of Compliance and Consistency
permit is subject to compliance with this application and permit conditions. Any violation of these terms may
?ct the permittee to a fine or criminal or civil action; and may cause the permit to become null and void.
permit must be on the project site and accessible to the permit officer when the project is inspected for
)liance. The applicant certifies by signing this permit that: 1) prior to undertaking any activities authorized by this
fit, the applicant will confer with appropriate local authorities to confirm that this project is consistent with the
land use plan and all local ordinances, and 2) a written statement from the adjacent riparian property owner(s)
feen obtained, or proof of delivery of certified mail notification of the adjacent riparian property owner(s).
Aate of North Carolina and the Division of Coastal Management, in issuing this permit under the best available
mation and belief, certify that this project is consistent with the North Carolina Coastal Management Program.
Basin Rules Applicable To Your Project:
Tar - Pamlico River Basin Buffer Rules 1-1 Neuse River Basin Buffer Rules
dicated on front of permit, your project is subject to the Environmental Management Commission's Buffer Rules
:he River Basin checked above due to its location within that River Basin. These buffer rules are enforced by the
division of Water Resources. If you have any questions, please contact the Division of Water Resources at the
;hington Regional Office (252-946-6481) or the Wilmington Regional Office (910-796-7215).
es/Additional Permit Conditions:
ensure all debris associated with the removal or construction of the permitted development is contained within the authorized
:t area and disposed of in an appropriate upland location.
Dn of Coastal Management Offices
head City Headquarters
ommerce Ave Morehead City, NC 28557
08-2808/ 1-888-4RCOAST Fax: [phone]
!s: Carteret, Craven — south of the Neuse River, Onslow
ies)
ieth City District
. Griffin St. Ste. 300
eth City, NC 27909
64-3901
�s: Bertie, Camden, Chowan, Currituck, Dare, Gates, Hertford,
Washington District
943 Washington Square Mall Washington, NC 27889
252-946-6481
Fax: [phone]
(Serves: Beaufort, Craven — north of the Neuse River, Hyde, Pamlico,
Tyrrell and Washington Counties)
Wilmington District
127 Cardinal Drive Ext. Wilmington, NC 28405-3845
910-796-7215
Fax: [phone]
(Serves: Brunswick, New Hanover and Pender Counties)

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: Samuel Penegar
Mailing Address: 111 Mallard Bay Dr
Hampstead NC 28443
Phone Number: (704) 213 - 1348
Email Address:
probmanl @charter.net
I certify that I have authorized Southern NC Marine
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessaryfor the following Construction of floating dock, bulkhead
g proposed development:
& Dredging of 15-20 cubic
at my property
in Pender
at Ballast Point Road Hampstead NC 28443 ,
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:
Signature
Print or Type Name
Owner
Title
Date
This certification is valid through 12 / 31 / 2022

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
CERTIFIED MAIL - RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent)
Name of Property Owner:
Sam Penegar
Address of Property. 111 Mallard Bay Road Hampstead NC 28443
Mailing Address of Owner: 111 mallard Bay Road Hampstead NC 28443
Owner's email: probman1 @charter.net
Agent's Name: Southern NC Marine
Owner's Phone#:
(704) 4213 - 1348
Agent's Email: [e-mail]
Agent Phone#: (910) 512 - 7647
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(_Bottom portion to be completed bV the Adjacent Property Owner)
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.
✓ I DO NOT have objections to this proposal. I DO have objections to this proposal.
If you have objections to what is being proposed, you must notify the N.C. Division of Coastal
Management (DCM) in writing within 10 days of receipt of this notice. Correspondence should be
mailed to 127 Cardinal Drive Ext, Wilmington, NC 28405-3845. DCM representatives can also be
contacted at [phone]. No response is considered the same as no objection if you have been
notified by Certified Mail.
WAIVER SECTION
I understand that any proposed 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
(this does not apply to bulkheads or riprap revetments). (If you wish to waive the setback, you must sign
the appropriate blank below.)
I DO wish to waive some/all of the 15' setback
-OR-
Signature of Adjacent Riparian Property Owner
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner.-
Typed/Printed name of ARPO: Gwenn Colston
Mailing Address of ARPO: 109 Mallard Drive Hampstead NC 28443
ARPO's email: r4
{ gtvenv q SFW ..(_ean ARPO's Phone#: Qt0 - Z 7& 5LH q
Date: 3Fl I'ZZ *waiver is valid for up to one year from ARPO's Signature*
Revised May 2021
PID # 4213 - 25 - 2572 - 0000

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
CERTIFIED MAIL - RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent)
Name of Property Owner:
Sam Penegar
Address of Property: 111 Mallard Bay Road Hampstead NC 28443
Mailing Address of Owner:
111 mallard Bay Road Hampstead NC 28443
robmanl @charter.net (704) 4213 - 1348
Owner's email: P Owner's Phone#:
Agent's Name: Southern NC Marine
Agent's Email: _Southern [e-mail]
Agent Phone#. (910) 512 - 7647
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adjacent Property Owner)
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.
'hk I DO NOT have objections to this proposal. I DO have objections to this proposal.
if you have objections to what is being proposed, you must notify the N.C. Division of Coastal
Management (DCM) in writing within 10 days of receipt of this notice. Correspondence should be
mailed to 127 Cardinal Drive Ext., Wilmington, NC 28405-3845. DCM representatives can also be
contacted at [phone]. No response is considered the same as no objection if you have been
notified by Certified Mail.
WAIVER SECTION
I understand that any proposed 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
(this does not apply to bulkheads or riprap revetments). (If you wish to waive the setback, you must sign
the appropriate blank below.)
I DO wish to waive some/all of the 15' setback
Signature of Adjacent Riparian Property Owner
-OR-
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner: � d ' , d z^ e x- -
Typed/Printed name of ARPO: James Lancaster
Mailing Address of ARPO: PO Box 311 H[am( stead NC 28443
ARPO's email: -LAN (� (.`t1 .(ete_ARPO's Phone#:
Date, 'waiver is valid for up to one yearfrorm ARPO's Signature*
Revised May 2021
P I D # 4213 - 25 - 3691 -0000

x 10' Pier
Total Length
✓I Bulkhead
NOTES:
- Dredge 15-20
Cubic Yards under
floating dock to be
used as backfill for
new bulkhead
- New Bulkhead to
be driven directly in
front of existing
bulkhead

,ad
Date Deposited CMck F— Name
Name o/ Permit Holder
Vend—
Check number
Check
ount
Pertnk Numbw/Commenta
Receipt - Re/und/Reall—ted
Coumn2 Caf m 3
Column
Columns
Co1umn8
Cortenn7
Columns
Column9
)22
Backwater Marine of NC LLC
_ Jeffrey Vogel
Bartlett BB&T 1460
same _ _ _ _ _ _ South State Bank 511
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$ 800.00 ' 087D
#86
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1405
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same
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1 3544
$ 200.00
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400.00
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