87901_Forest Williams_20221012

0`°"t4i4etHCAMA I I DREDGE & FILL 'R-t N9 87901 ,e, C D
G E N E RAL PERMIT Previous permit ,
Zc (�j 00 Date previous permit issued
_New Modification n Complete Reissue n 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:
ISA NCAC n Rules attached. n General Permit Rules available at the following link:www.deq.nc.gov/CAMArules
Applicant Name Authorized Agent
Address "" Project Location(County):
City - State ZIP Street Address/State Road/Lot#(s)
Phone#(_)
Email Subdivision
City ZIP
Affected n CW n EW In PTA n ES n PTS Adj.Wtr.Body (natlman/unk)
AEC(s): n OEA n IHA n UW n SPIMA I I PWS Closest Maj.Wtr.Body
ORW:yes/no PNA:yes/no
Type of Project/Activity ;-.'
(Scale: •� )
Shoreline Length )
I
Access Length 1 -r . fl�4 - f I , 1)f
(dock)length - • - _ / f I r 1-
Pier
gt .,` {l" 1 r #'• [ i 1 j i-
Fixed Platform(s) I - _fi-.__ .__ ;—.—+ 1
jr �_,4-----4'
Floating Platform(s)
1
•
Finger pier(s) •
Total Platform area 1y' , lr -' •
Groin length/# 1 f !ok c 1`-
Bulkhead/Riprap length • — I J y •c N.,,,,t''1 ` '
Avg distance offshore I S.. ;'>
Breakwater/Sill — j { I- • / ** i
L_!�� I_ _j. ` 1
Max distance/length ^� ;
Basin,channel 'i'''.
t ; 0 _ _ _
Cubic yards I 1 �}�1 �/A '—�
Boat ramp (
,may
/ 1
Boathouse/Boatlift �l` f 1 i
Beach Bulldozing T� - / T _T
1 +�
/
Other { .-
SAV observed: yes no
Moratorium: n/a yes no —` � r
Site Photos: yes no 1,
Riparian Waiver Attached: yes no _ I I
A building permit/zoning permit may be required by:
Permit Conditions n TAR/PAM/NEUSE/BUFFER(circle one)
nSee note on back regarding River Basin rules
nSee additional notes/conditions on back
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
Signature**Please read compliance statement on back of permit** Signature
Application Fee(s) Check#/Money Order Issuing Date Expiration Date

Statement of Compliance and Consistency
This permit is subject to compliance with this application and permit 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: 1) 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 from the adjacent riparian property owner(s)
has been obtained, or proof of delivery of certified mail notification of the adjacent riparian property owner(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 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. If you have any questions, please contact the Division of Water Resources at the
Washington Regional Office (252-946-6481) or the Wilmington Regional Office (910-796-7215).
Notes/Additional Permit Conditions:
Please ensure all debris associated with the removal or construction of the permitted development is contained within the authorized
project area and disposed of in an appropriate upland location.
Division of Coastal Management Offices
Morehead City Headquarters Washington District
400 Commerce Ave Morehead City, NC 28557 943 Washington Square Mall Washington, NC 27889
252-808-2808/1-888-4RCOAST Fax: [phone] 252-946-6481
(Serves: Carteret,Craven—south of the Neuse River, Onslow Fax: [phone]
Counties) (Serves: Beaufort,Craven—north of the Neuse River, Hyde, Pamlico,
Tyrrell and Washington Counties)
Elizabeth City District Wilmington District
401 S. Griffin St. Ste. 300 127 Cardinal Drive Ext.Wilmington, NC 28405-3845
Elizabeth City, NC 27909 910-796-7215
252-264-3901 Fax: [phone]
(Serves: Bertie,Camden,Chowan, Currituck, Dare,Gates, Hertford, (Serves: Brunswick, New Hanover and Pender Counties)
Pasquotank and Perquimans Counties)
http://portal.ncdenr.org/web/cm/dcm-home Revised 6/01/2021

„ 'risk FCAMA DREDGE & FILL �k) No 87901 ABC D
zs
: GENERAL PERMIT r, ---! Previous permitDate previous permit issued
New Modification 1 I 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 5A NCAC Rules attached. General Permit Rules available at the following link:www.deq.nc.gov/CAMArules
Applicant Name Authorized Agent
Address Project Location(County):
City State ZIP Street Address/State Road/Lot#(s)
Phone#( )
Email Subdivision
City ZIP
Affected CW EW PTA ES PTS Adj.Wtr.Body (nat/man/unk)
AEC(s): OEA IHA I I UW SPIMA I I PWS Closest Maj.Wtr.Body
ORW:yes/no PNA:yes/no
Type of Project/Activity
(Scale: # )
Shoreline Length
ty ” 1 i c- -.- /i .
Pier _j.
Access Length
�J
� j � f� I i -I i
Pier(dock)length '. ( �! . ! _ . , . j.. i i i `)
I
------- F I I t i
Fixed Platform(s) i I - - I I• r
Floating Platform(s) I I 1. I
I I ; ! i f
Finger pier(s) ! j i i
a j _ ,
! ! _.._.__.---t ! .._- I -__
Total Platform area 1 • ! - r , i. �_I T^
Groin length/# f Bulkhead/Riprap length i `. I i t i its i i I
Avg distance offshore r-- t ._. _..._ ___.._._.• .�; _.._..._..._j_. ._.._-...--1-4-_ _.. ...._....._._�._.___.. I _......_....._......-
Breakwater/Sill ! ! I
Max distance/length I i N• I
`
Basin,channel - f 1 ' ' ' t ..._._
I -
j1•i
_'-\Cubic yards z
1 •
Boat ramp 0 l i t'
I
Boathouse/Boatlift ,y
Beach Bulldozing
Other ) _ __.P i—.._...__ _._._
� I` 1
SAV observed: yes no ! '
Moratorium: n/a yes no ` f. ' h ! j '
Site Photos: yes no z ' i1 '',- u I
Riparian Waiver Attached: yes no • _i i
A building permit/zoning permit may be required by:
TAR/PAM/NEUSE/BUFFER(circle one)
Permit Conditions
See note on back regarding River Basin rules
See additional notes/conditions on back
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
Signature**Please read compliance statement on back of permit** Signature
Application Fee(s) Check#/Money Order Issuing Date Expiration Date

Statement of Compliance and Consistency
This permit is subject to compliance with this application and permit 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: 1) 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 from the adjacent riparian property owner(s)
has been obtained, or proof of delivery of certified mail notification of the adjacent riparian property owner(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 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. If you have any questions, please contact the Division of Water Resources at the
Washington Regional Office (252-946-6481) or the Wilmington Regional Office (910-796-7215).
Notes/Additional Permit Conditions:
Please ensure all debris associated with the removal or construction of the permitted development is contained within the authorized
project area and disposed of in an appropriate upland location.
Division of Coastal Management Offices
Morehead City Headquarters Washington District
400 Commerce Ave Morehead City, NC 28557 943 Washington Square Mall Washington, NC 27889
252-808-2808/1-888-4RCOAST Fax: [phone] 252-946-6481
(Serves: Carteret, Craven—south of the Neuse River,Onslow Fax: [phone]
Counties) (Serves: Beaufort, Craven—north of the Neuse River, Hyde, Pamlico,
Tyrrell and Washington Counties)
Elizabeth City District Wilmington District
401 S. Griffin St.Ste. 300 127 Cardinal Drive Ext. Wilmington, NC 28405-3845
Elizabeth City, NC 27909 910-796-7215
252-264-3901 Fax: [phone]
(Serves: Bertie, Camden, Chowan, Currituck, Dare,Gates, Hertford, (Serves: Brunswick, New Hanover and Pender Counties)
Pasquotank and Perquimans Counties)
http://portal.ncdenr.org/web/cm/dcm-home Revised 6/01/2021

\__/
N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent)
Name of Property Owner: )Q'ties 7L 1,'! /a','1 3--
Address of Property: !0/ V pZ,O �3
iV NG G
Mailing Address of Owner: ��? AO C (� /' iQ f ' 16
Owner's email: Owner's Phone a1 CP,^'g29- GA.2o
2
Agent's Name: ,
9 /�(� +� II" Agent Phone#: ZIQ2 a eiR 7yC.Jo
Agent's Email:
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
descriptio 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 943 Washington Square Mall, Washington, NC 27889. DCM representatives can also be
contacted at(252) 946-6481. 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.)
1 DO wish to waive some/all of the 15'setb /
n re of Adj pa ' n roperty Ow r ,/
-O R-
I do not wish to waive the 15'setback requirement(initial the blank)
Signature of Adjacent Riparian Property Owner. S,._./ .
Typed/Printed name of ARPO:
Mailing Address of ARPO: 7,77 /ljf/2AXs'a ) s"7�C1 C7' /224.,d71-g exp ic. a Ss'L5-
ARPO'ss email: ARPO's Phone#: 252-6 7,3"^ ?17 7
Date: 9 2-7 J/2,2 *waiver is valid for up to one year from ARPO's Signature*
Revised July 2021
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N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be co pleted by owner or their agent)
Name of Property Owner: ,L tCS' r 14/7/,Q L�_5 A
Address of Property: 4'G/ WQ lerSf- 4 blor c, /va. 2$S,-s
tstl'2 floe PS lire ilk a7670 e 17 761
MailingAddress of Owner: / •
. Owner's email: /� Owners Phone#: 25"2-- ?.q-• C p220
Agent's Name: Chris S17c../ 4i in Agent Phone#: cba^?'/Q- 7Zlo0
Agent's Email: •
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. ,
•
f/7 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 943 Washington Square Mall, Washington, NC 27889. DCM representatives can-also be
contacted at(252) 946-6481. 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 1 — •
®
Signature ofAdjacen avian ope 0 er
=0R-
I do not wish to waive the 15'setback requirement(initial the blank)
Signature of Adjacent Riparian Prope Owner:
Typed/Printed name of ARPO: qY y d q47(�) dQ �!/�1 .
Mailing Address of ARPO: cl air ,�%r/j) rc s(cl br'D /'f/t
ARPO's
���� /
email:
yARPO's Phone#:) $�"' C S 1`5 j c
Date: 7,0waiver is valid for up to one year from ARPO's Signature*
�
.27 Revised July 2021