87354C - O'Conner, John & Rene

AMA ❑ DREDGE & FILL
ENERAL PERMIT
Na 87354
Previous permit
Date previous permit issued
A B C�
New [:]Modification ❑ Complete Reissue ❑ Partial Reissue
the ^State IN rSlh ar(gkr+Jp Department of Environmental Quality and the Coastal Resources Commission in an area of environmental concern pursuant to:
/ +4 1 � �./ ❑ Rules attached. ❑ General Permit Rules available at the following link: vnwv deck gov/CAMAM1-PA
Affected ❑ cw
AEC(s): ❑OEA
ORW: yes/®
❑EW
❑ IHA
Type of Project/ Activity
Shoreline Length /bJ
Access Length �—
Pier (dock)length
�_
Fixed Platform(s)''—'
Floating Platform(s)
Finger piers)
PNA:
❑ PTA
❑ uw .
Total Platform area
Groin length/#
Bulkhead/ i{fra ngth
Avg distance o share 2
Breakwater/Sill �"--
Max distance/ length
Basin, channel
Cubicyards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing— �
Other
SAV observed: yes (Vn
Moratorium: n/a yes
Site Photos: yes Riparian Waiver Attached: yes
A building permit/zoning*Permitgay be requ
[AM
l
ICI
/ I f
/1r►_71 a �lI l
❑ See note on back regarding River Basin rules
.. n �. ❑ See additional notes/conditions on back
Feels)
compliance statement on
of permit' Signature qq
I nd S I � 1 V
Check#/Money Order IssuingD a Expi lion ate

Proposed work:
O'Connor residence
105 Circle Dr. Beaufort, NC. 28516
Justification: Increased tidal flow from the Turner Street Bridge improvement project has
caused accelerated erosion along the western edge and southwestern corner of my property.
The mean elevation of the land has dropped 18"-24" over the course of the last 4 years. The
area depicted in the attached drawing (yellow triangle) has been the area most affected.
Erosion from the marsh and tidal creek have caused undermining of the land, therefore causing
sinking and loss of land into the marsh. I have already lost an estimated 450 sq/ft of property,
with more sinking occurring regularly.
If actions are not taken, I will continue to lose maintained landscape and actual acreage.
Cont�inued loss of actual yard, parking area, and then eventually driveway and carport are
expected if this goes unaddressed.
Proposal:
My proposed actions will be the least invasive method possible to preserve my property, while
not affecting the marsh, tidal creek, or coastal waters.
The Red Line depicted in the drawing will be the extent of work to take place. Rock and Rip -rap,
sized between 8"-14" will be used as a base layer along the marsh edge. Prior to initially laying
the rock, 6oz geotextile will be laid down, rock applied over geotex, then extend 15' behind
reinforcement, towards the house and garage.
Additional rock will be placed, neatly and uniformly, until a height of 30" is achieved.
An estimated 40 cubic yards of native sand will then be brought in to back fill the improved
area, returning the affected area to the height it once was. The area will not be raised or
improved beyond the height that it was 3-5 years ago. The greatest proposed increase to grade
will be 24" closest to the improved rock perimeter.
All work will be performed by myself and a local licensed contractor.
RECEIVED
MAR 16 '1022
DCM-MHD CITY

10

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: )a, a Pe,e O�6 v�r• a r L
Address of Property: io ic; rcl
,
Mailing Address of Owner:
owner's emaill G.COP-Owner's Phone#:
Agent's Name:
Agent's Email:
Agent Phone#:
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adiacent 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.
r
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 400 Commerce Ave., Morehead City, NC 28557. 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.) n t
I DO wish to waive sometall of the 15' setback
Signature of Adjacent Rijp_aanaann P�ropertyy owner
11019
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner.
Typed/Printed name of ARPO:r
Mailing Address of ARPO: C D f ea lhl�f� 11 !"i �,J 1
ARPO's email:) Y'([` h 1 MVh(l J1 (�, ARPO's Phone#:
I'� MaA ICbYv-
Date: IZ 1 02 '�laiver is valid for up to one year from ARPO's Signature"
Revised May 2021
MAR 16 M??
DCM-MHO CITY

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RECEIVImp
JAN 06 2022
®CIW-MHD CITY

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: �Jt'� `r� �^e / CIO V'\ r (
Address of Property: a `C` e 1� f �' Y—ALIT i
Mailing Address of Owner: v—=
- J/1�pzod
Owner's email0\-%^oC• COINner'sPhone#:
Agent's Name:
Agent's Email:
Agent
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.
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 400 Commerce Ave., Morehead City, NC 28557, 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
-O R-
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner:
Typed/Printed name of AR
Mailing Address of ARPO:
PO: aq�,Ae4d
103 i�irc121yr �Pa i��.28Sf�
ARPO's email: ° e J� c OARPO's Phone#: oZZ��/o2
I .
Date:waiver is valid for up to one year from ARPO's Signature* [[oo�
Re REP5byl�g)2I
,JAN 06 2022
pa
DCM-MHD CITY

T I -.

Proposed work:
O'Connor residence
105 Circle Dr. Beaufort, NC. 28516
Justification: Increased tidal flow from the Turner Street Bridge improvement project has
caused accelerated erosion along the western edge and southwestern corner of my property.
The mean elevation of the land has dropped 18"-24" over the course of the last 4 years. The
area depicted in the attached drawing (yellow triangle) has been the area most affected.
Erosion from the marsh and tidal creek have caused undermining of the land, therefore causing
sinking and loss of land into the marsh. I have already lost an estimated 450 sq/ft of property,
with more sinking occurring regularly.
If actions are not taken, I will continue to lose maintained landscape and actual acreage.
Continued loss of actual yard, parking area, and then eventually driveway and carport are
expected if this goes unaddressed.
Proposal:
My proposed actions will be the least invasive method possible to preserve my property, while
not affecting the marsh, tidal creek, or coastal waters.
The Red Line depicted in the drawing will be the extent of work to take place. Rock and Rip -rap,
sized between 8"-14" will be used as a base layer along the marsh edge. Prior to initially laying
the rock, 6oz geotextile will be laid down, rock applied over geotex, then extend 15' behind
reinforcement, towards the house and garage.
Additional rock will be placed, neatly and uniformly, until a height of 30" is achieved.
An estimated 40 cubic yards of native sand will then be brought in to back fill the improved
area, returning the affected area to the height it once was. The area will not be raised or
improved beyond the height that it was 3-5 years ago. The greatest proposed increase to grade
will be 24" closest to the improved rock perimeter.
All work will be performed by myself and a local licensed contractor.
RECEIVED
JAN 06 ZOO
DCM-MHD CITY

Asa
15A
CAMA ❑ DREDGE & FILL N° 87354 A B
Previous permit
GENERAL PERMIT Date previous Permit issued -
[j New ❑ Modification ❑ Complete Reissue ❑ Partial Reissue
e by the State Department of Environmental Quality and the Coastal Resources Commission in an area of environmental concern pursuant to:
lu1 lLly V ❑ Rules attached. ❑ General Permit Rules available at the following link: vvw_wckg n" °ov/CAMA roles
Applicant Name it
Address
City .
Phone # CZ1
Email
Affected ❑CW
AEC(s): ❑OEA
ORW: yes/�
❑ EW
❑ IHA
PNA:
Type of Project/ Activity
❑ PTA
❑ uW
ES
SPIMA
❑ PTS
❑ PWS
Adj. Wtr. Body J_]? u
Closest Mai. Wtr. Body
Shoreline Length"
Access Length-
r---- J
Pier (dock) length /+11�
Fixed Platform(s) _ �/ - / / l/ - /
Floating Platforms) - _.. ,\// - / - .•/ -
Finger pier(s)
Total Platform area
Groin length/#
Bulkhead/ Era ngth. CJh �
Avg distance o shore y .N lJw� -
Breakwater/Sill
Max distance/length
Basin, channel-
Cubicyards
Boat ramp / ( f `t^V/ Boathouse/ 8oatlift /�' /_ / I\ Beach 8ulldozing—� e�t
Other /�.Jt
Vl�
MoSAVratorium:
obseratoriu : yes n
Moratorium: n/a yes
Site Photos: yes n -�
Riparian Waiver Attached: yes no
A building permit/zonin ermit ay be requir d y: ❑ TAR/PAM/NEUSE/BUFFER (circle one)
Permit Conditions
❑ See note on back regarding River Basin rules
❑ See additional notes/conditions on back
compliance statement on back of permit * Signature T/
rt;ark u/Monev Order lssul�Date Expihtton bate

ROY COOPER
Governor
ELIZABETH S. BISER
Secretary
BRAXTON DAVIS
Director
May 9, 2022
Ms. Pamela R. Wyrick
103 Circle Drive
Beaufort, NC 28516
Dear Ms. Wyrick:
NORTH CAROLINA
Environmenta/Quality
This letter is in response to your letter dated January 6, 2022 regarding your concerns about the
proposal by Mr. John O'Connor to install riprap along the high ground portion of his property
located at 105 Circle Drive in Beaufort, Carteret County. The proposed project has been
determined to comply with the Rules of the Coastal Resources Commission (7H. 1100), and as
such, a permit has been issued to authorize the development. I have enclosed a copy of the
permit, as well as the relevant statutes.
If you wish to contest our decision to issue this permit, you may file a request for a Third
Party Hearing. The request for a hearing will be considered by the Chairman of the Coastal
Resources Commission. The hearing request must be filed with the Director, Division of
Coastal Management, in writing and must be received within twenty (20) days after the
disputed permit decision is made. I have enclosed the applicable forms and instructions
that must be filed prior to that deadline. Please contact me at [phone], if you have
any questions, or if I can provide any additional information.
Sincerely,
0
Heather Styron
Field Specialist
«vammi a ewa�.+.�w mmaw�
North Carolina Department of Environmental Quality I Division of Coastal Management
Morehead City Office 1 400 Commerce Avenue I Morehead City. North Carolina 28557
252,515.5400

15A NCAC 07H .1101 PURPOSE
A permit for construction of bulkheads and riprap revetments under this section shall allow the
construction of bulkheads and riprap revetments for shoreline protection in the public trust waters and
estuarine waters AECs subject to the procedures outlined in Subchapter 071, Section .1100 and according
to the Rules in this Section. This permit shall not apply to shoreline protection along the oceanfront or to
waters and shorelines adjacent to the Ocean Hazard AEC with the exception of those shorelines that
feature characteristics of the Estuarine Shoreline AEC. Such features include the presence of wetland
vegetation, lower wave energy, and lower erosion rates than the adjoining Ocean Erodible Area,
History Note: Authority G.S. 113A-107(a); 113A-107(b); 113A-113(b); 113A-11&1; 113A-124; 113-229;
Ejf. March 1, 1984; -
AmendedEff July 1, 2009; April 1, 2003;
Readopted Ef. April 1, 2022.
15A NCAC 07H .1102 APPROVAL PROCEDURES
(a) An applicant for a General Permit under this Subchapter shall contact the Division of Coastal
Management and request approval for development.
(b) The applicant shall provide:
(1) provide site location, dimensions of the project area, and the appiic urfs name and
address, confirmation that the applicant has obtained a written statement, signed by the
adjacent riparian property owners indicating that they have no objections to the proposed
work; or
(2) confirmation that the applicant has notified adjacent riparian property owners by certified
mail of the proposed work. The notice shall instruct adjacent property owners to provide
written comments on the proposed development to DCM within 10 days of receipt of the,
notice and indicate that no response shall be interpreted as no objection. DCM shall
review all comments and determine, based on their relevance to the potential impacts of
the proposed project, if the proposed project can be approved by a General Permit. If
DCM determines that the project exceeds the guidelines established by the General
Permit process provided in 15A NCAC 07J .1100, DCM shall notify the applicant that an
application for a major development permit shall be requited.
(c) No work shall begin until an on -site meeting is held with the applicant and a DCM representative so
that the proposed alignment may be marked. A General Permit to proceed with the proposed development
shall be issued if the DCM representative finds that the application meets all the requirements of this
Rule. Construction of the bulkhead or riprap revetment shall be completed within 120 days of the
issuance of the general permit or the authorization shall expire and it shall be necessary to re-examine the
structure alignment to determine if the general permit may be reissued.
History Note: Authority G.S. 113A-107(a); 113A-107(b); 113A-113(b); 113A-118.1; 113A-124; 113A-
118; 113A-120; 113-229;
Ef. . March 1, 1984;
Amended Eff. July 1, 2009; October 1, 2007; September 1, 2006, January 1, 1990; December 1,
1987;
Readopted Ef, April 1, 2022.
15A NCAC 07H .1103 PERXfT FEE
The applicant shall pay a permit fee of two hundred dollars ($200.00) for riprap revetments sited at or
above normal high water or normal water level, or a permit fee of four hundred dollars ($400.00) for
riprap revetments sited below normal high water or normal water level. The applicant shall pay a permit

fee of four hundred dollars ($400.00) for bulkheads. Permit fees shall be paid by check or money order
payable to the Department.
History Note: Authority G.S. 113A-107; 113A-113(b); 113A-118. 1; 113A-119; 113-119.1; 113A-124;
113-229;
Eff. March 1, 1984;
Amended Eff. October 5, 2009; September 1, 2006; August 1, 2000; March 1, 1991;
Readopted Eff. April 1, 2022.
15A NCAC 07H .1304 GENERAL CONDMONS
(a) This permit authorizes only the construction of bulkheads and riprap revetments conforming to the
standards in this Section.
(b) Individuals shall allow authorized representatives of the Department of Environmental Quality to
make inspections at any time in order to ensure that the activity being performed under authority of this
general permit is in accordance with the tens and conditions prescribed herein.
(c) There shall be no interference with the use of the waters by the public by the existence of the bulkhead
or the riprap revetment authorized herein. Bulkheads and riprap revetments authorized in this Section
shall not interfere with the established or traditional rights of navigation of the waters by the public.
(d) This permit shall not be applicable to proposed construction where the Division of Coastal
Management has determined, based on an initial review of the application, that notice and review
pursuant to G.S. I I3A-119 is necessary because there are unresolved questions concerning the proposed
activity's impact on adjoining properties
or on water quality, air quality, coastal wetlands, cultural or historic sites, wildlife, fisheries resources, or
public trust rights.
(e) This permit shall not eliminate the need to obtain any other required State, local, or federal
authorization. -
(f) Development carried out under permit set forth in this Section shall be consistent with all State,
federal, local requirements, and local land use plans current at the time of authorization.
Development carried out under the permit set forth in this Section shall be consistent with all State,
federal, local requirements, and local land use plans current at the time of authorization.
History Note: Authority G.S. 113A-107(a); 113A-107(b); 113A-113(b); 113A-118. 1; 113A-124; 113-229;
Eff. March 1, 1984;
Amended Eff. May 1, 1990; December], 1987;
RRC Objection due to ambiguity Eff. May 19, 1994;
Amended Eff. July 1, 2009; August 1, 1998; July 1, 1994;
Readopted Eff. April 1, 2022.
15A NCAC 07H .1105 SPECIFIC CONDITIONS
(a) Along shorelines void of wetland vegetation:
(1) New bulkheads shall have an average approximation of nonal high water or normal
water level. The bulkhead position shall not exceed a distance of five feet waterward of
normal high water or normal water level at any point along its alignment.
(2) New bulkheads or riprap revetments on shorelines within manmade upland basins,
canals, and ditches, shall be positioned so as not to exceed an average distance of two feet
and maximum distance of five feet waterward of normal high water or normal water
level.
(3) When replacing an existing bulkhead, the new alignment shall be positioned so as not to
exceed a maximum distance of two feet waterward of the current bulkhead alignment. To
tie into a like structure on the adjacent property, replacement bulkhead position shall not
exceed a maximum distance of five feet waterward of the current bulkhead alignment.

When replacing a bulkhead where lands landward of the bukhead were lost in the last
year, bulkheads shall be positioned a maximum of two feet wwcnvwd of the original or
existing alignment.
(4) Riprap revetments shall be positioned so as not to exceed a maximum distance of 10 feet
waterward of the normal high water or normal water level at any point along its
alignment.
(b) Along shorelines with wetland vegetation, bulkheads and riprap revetments shall be positioned so that
all construction is to be accomplished landward of such vegetation.
(c) Bulkheads shall be constructed of vinyl, steel sheet pile, concrete, stone, timber, or other materials
approved by the Division of Coastal Management.
(d) Rpprap revetments shall be constructed of granite, marl, concrete without exposed rebar, or other
materials approved by the Division of Coastal Management. -
(e) Revetment material shall be free from loose dirt or other materials not approved by the Division of
Coastal Management.
(f) Revetment material shall be of size approved by the Division of Coastal Management to prevent
movement of the material from the site by wave action or currents.
(g) Construction design for riprap revetments shall take into consideration the height of the area to be
protected i.e., bulkhead height, escarpment height, water depth, and the alignment shall allow for a slope
no flatter than three feet
horizontal per one fact vertical and no steeper than 1 %: feet horizontal per one foot vertical.
(h) All backfrll material shall be obtained from an upland source pursuant to I SA NCAC 07H .0208. The
bulkhead or riprap revetment shall be constructed prior to any backfilling activities and shall be
structurally tight so as to prevent seepage of backbll materials through the structure.
(i) No excavation, grading or fill shall be permitted except for that which may be required for the
construction of the bulkhead or riprap revetment This permit shall not authorize any excavation
waterward of the approved alignment.
0) Runoff from construction shall not increase the amount of suspended sediments in adjacent waters.
Sedimentation and erosion control devices, measures, or structures shall be implemented to ensure that
eroded materials do no enter adjacent wetlands, watercourses and property, e.g. silt fence, diversion
swales or berms, sand fence, etc.
(k) If one contiguous acre or more of property is to be excavated or filled, an erosion and sedimentation
control plan shall be filed with and approved by the Division of Energy, Mineral, and Land Resources, or
local government having and a delegated program prior to commencing the land -disturbing activity.
(1) For the purposes of these Rules, the Atlantic Intracoastal Waterway (ANJW) is considered a natural
shoreline.
(m) Construction authorized by this general permit shall be limited to a maximum shoreline length of 500
feet.
History Note: Authority G.S. 113A-107(a); 113A-107(b); 113A-113(b); 113A-118. 1; 113A-124,,113-229;
Eff. March 1, 1984;
Amended Eff. August 1, 2012 (see S.L. 2012.143, s.1.(n); July 1, 2009; April 1, 2005; December
1, 1991; January 1, 1989; December 1, 1987;
Readopted Ef.. April 1, 2021.

CAMA THIRD PARTY
HEARING REQUEST FORM
PETITIONER'S NAME
DCM FORM 5
DCM FILE No -.—
COUNTY WHERE THE DEVELOPMENT IS PROPOSED
PLEASE TAKE NOTE that the undersigned, a person affected by the decision of (check one):
a Local Permit Officer acting on a CAMA Minor Development Permit application; or
the Division of Coastal Management acting on a CAMA Permit application
hereby requests permission from the Coastal Resources Commission (CRC) to file an appeal pursuant
to N.C.G.S. § 113A-121.1(b) and 15A N.C.A.C. 07J .0301. (Please attach a copy of the permit. Ifyou
cannot obtain a copy of the permit, please provide the name of the permittee, the project location, and
the permit number.) Requests are reviewed and determined by the chairman of the CRC to determine
whether a hearing should be granted. 15A N.C.A.C. 07J .0301(b). Approval of a Third Parry Hearing
Request allows a petitioner to file a contested case petition with the Office of Administrative Hearings
within twenty (20) days of receipt of the CRC's Order. N.C.G.S. § 113A-121.l(b). Denial of a Third
Party Hearing Request is a final agency decision which may be appealed to Superior Court under
N.C.G.S. § 113A-121.1(b) and Chapter 15013, Article 4.
For this application to be complete, the Petitioner must address each of the three factors listed below.
The CRC's chairman's decision to grant a hearing will be based on whether the Petitioner:
(1) Has alleged that the decision is contrary to a statute or rule [N.C.G.S. § 113A-121.1(b)(1)];
(Please cite the statute or regulation allegedly violated by,the permit decision.)
(2) Is directly affected by the decision [N.C.G.S. § 113A-121.1(b)(2)]; and
(Please describe how you are directly affected by the permit decision. Persons directly
'affected by a decision often include, but are not limited to, owners of real property in the
vicinity of the proposed development who can show that it is likely to have a significant
adverse effect on the value and enjoyment of their property, or persons who can
demonstrate a history of substantial use of public resources in the area directly affected
by the development.)
(3) Has alleged facts or made legal arguments that demonstrate that the request for the
hearing is not frivolous [N.C.G.S. § 113A-121.1(b)(3)]. (Summarize the evidence and
arguments you would present at a hearing in support of your appeal explaining why the permit
was improperly issued.)
Please answer these questions on a separate piece of paper and attach it to this form.

The Commission notes that there are some opinions of the State Bar which indicate that non -attorneys may not
represent others at quasi-judicial proceedings such as this Third Party Hearing Request before the Commission.
These opinions note that the practice of non -lawyer professionals, such as engineers, surveyors or contractors,
representing others in quasi-judicial proceedings through written argument may be considered the practice of
law. Before you proceed with this hearing request, you may wish to seek the advice of counsel before having a
non -lawyer represent your interests through preparation of this Petition.
DELIVERY OF THIS HEARING REQUEST
This request must be received by the Division of Coastal Management (DCM) within twenty (20) days
of the date of the disputed permit decision. N.C.G.S. § I13A-121.1(b). Failure to do so constitutes
waiver of the right to request a hearing. A copy of this request must also be sent to the Attorney
General's Office, Environmental Division. 15A N.C.A.C. 07J .0301(b).
Contact Information for DCM:
By mail, express mail or hand delivery:
Director
Division of Coastal Management
400 Commerce Avenue
Morehead City, NC 28557
By Fax:
[phone]
By Email:
Check DCM website for the email
address of the current DCM Director
www.nceoastalmanagement.net
Contact Information for Attorney General's Office:
By U.S. mail:
Environmental Division
9001 Mail Service Center
Raleigh, NC 27699-9001
By express mail:
Environmental Division
114 W. Edenton Street
Raleigh, NC 27603
By Fax:
[phone]
Based on the attached responses to the above factors, the undersigned hereby requests a third party
hearing.
Signature of Petitioner or Attorney
Printed Name of Petitioner or Attorney
Mailing Address
City State Zip
Updated: February 2011
Date
Email address of Petitioner or Attorney
Telephone number of Petitioner or Attorney
Fax number of Petitioner or Attorney