79-14 Jackson, Robert

Permit Class Permit Number
NEW 79-14
STATE OF NORTH CAROLINA
Department of Environment and Natural Resources
and
Coastal Resources Commission COPY
Permit
for
X Major Development in an Area of Environmental Concern
pursuant to NCGS 113A-118
Excavation and/or filling pursuant to NCGS 113-229
Issued to Robert Jackson,186 Ainsley Rd, Hertford NC 27944
Authorizing development in Perquimans County adj. the Perttuimans River. at 186 Ainslev
Road in Hertford , as requested in the permittee's application dated 4/14/14 including the
attached workman drawing (4)all dated 4/14/14
This permit, issued on _Sep mb r 8 2014 is subject to compliance with the application (where consistent
with the permit), all applicable regulations, special conditions and notes set forth below. Anv violation of these terms may
5e subject to tines, imprisonment or civil action; or may cause the permit to be null and void.
Docking Facility
1) Unless specifically altered herein, this permit authorizes the construction of the boathouse and
additional finger pier and uses located in or over the water that are expressly and specifically set forth
in the permit application. No other structure, whether floating or stationary, shall become a
permanent part of this reconfigured docking facility without permit modification. No non -water
dependent uses of structures shall be conducted on, in or over public trust waters without permit
modification.
2) The boathouse shall not be completely enclosed or have side coverage more than one half the height
of the side, from the roof waterward.
(See attached sheets for Additional Conditions)
this permit action may be appealed by the permittee or
other qualified persons within twenty (20) days of the issuing
date. An appeal requires resolution prior to work initiation or
continuance as the case may be.
This permit must be accessible on -site to Department
personnel when the project is inspected for compliance.
Any maintenance work or project modification not covered
hereunder requires further Division approval.
All work must cease when the permit expires on
December 31, 2017
In issuing this permit, the State of North Carolina agrees
that your project is consistent with the North Carolina Coastal
Management Program.
Signed by the authority of the Secretary of DENR and the
Chairman of the Coastal Resources Commission.
raxton C. Davis, Director
Division of Coastal Management
ww RECEIVED
This permit and its conditions are hereby' ccepted.
SEP 11
2014
moony
Signature of Permittee

Robert Jackson
Permit # 79-14
Page 2 of 3
ADDITIONAL CONDITIONS
3) eShoe
zed boathouse shall be single story, and shall not be designed to allow for second story use.
4) adjacent property to the north be sold prior to the initiation of construction, the permittee
shall be required to obtain a signed riparian corridor waiver from the new property owner prior to the
placement of any structure within the 15 foot riparian corridor.
5) No attempt will be made by the permittee to prevent the full and free use by the public of all navigable
waters at or adjacent to the authorized work.
6) The permittee shall maintain the authorized work in good condition and in conformance with the terms
and conditions of this permit. The permittee is not relieved of this requirement if he abandons the
permitted activity without having it transferred to a third party.
7) This permit does not authorize the interference with any existing or proposed Federal project, and the
permittee shall not be entitled to compensation for damage to the authorized structure or work, or injury
which may be caused from existing or future operations undertaken by the United States in the public
interest.
8) The permittee shall install and maintain at his expense any signal lights or signals prescribed by the U.S.
Coast Guard, through regulation or otherwise, on the authorized facilities. At a minimum, permanent
reflectors shall be attached to the structure in order to make it more visible during hours of darkness or
inclement weather.
9) This permit does not authorize any additional slips.
Upland Development
10) Unless specifically altered herein, this permit authorizes the grading and other land disturbing activities
associated with the development of the above referenced property, including but not limited to the
addition to the existing garage and existing deck associated with the development of the above
referenced property, all as expressly and specifically set forth in the attached permit application and
workplan drawings. Any additional land disturbing activities and/or construction may require a
modification of this permit. Contact a Division of Coastal Management representative at (252) 264-
3907 for this determination.
Sedimentation and Erosion Control
11) In order to protect water quality, runoff from construction shall not visibly increase the amount of
suspended sediments in adjacent waters.
12) Appropriate sedimentation and erosion control devices, measures or structures must be implemented to
ensure that eroded materials do not enter adjacent wetlands, watercourses and property (e.g. silt fence,
diversion swales or berms).
13) All disturbed areas shall be properly graded and provided a ground cover sufficient to restrain erosion
within thirty days of project completion.

Robert Jackson
Permit # 79-14
Page 3 of 3
ADDITIONAL CONDITIONS
General
14) This permit does not authorize the interference with any existing or proposed Federal project, and the
permittee shall not be entitled to compensation for damage to the authorized structure or work, or injury
which may be caused from existing or future operations undertaken by the United States in the public
interest.
15) The permittee understands and agrees that, if future operations by the United States requires the
removal, relocation, or other alteration of the structure or work authorized by this permit, or if in the
opinion of the Secretary of the Army or his authorized representative, said structure or work shall cause
unreasonable obstruction to free navigation of the navigable waters, the permittee will be required, upon
due notice from the Corps of Engineers, to remove, relocate or alter the structural work or obstructions
caused thereby, without expense to the United States or the state of North Carolina. No claim shall be
made against the United States or the state of North Carolina on account of any such removal or
alteration.
16) This permit shall not be assigned, transferred, sold, or otherwise disposed of to a third party without the
written approval of the Division of Coastal Management.
17) The permittee and/or his contractor shall meet with a representative of the Division prior to project
initiation in order to discuss the conditions set forth in this permit.
NOTE: This permit does not eliminate the need to obtain any additional state, federal or local permits,
approvals or authorizations that may be required.
NOTE: Future development of the pemuttee's property may require a modification of this permit.
Contact a representative of the Division at [phone] prior to the commencement of any
such activity for this determination. The permittee is further advised that many non -water
dependent activities are not authorized within 30 feet of the normal water level.
NOTE: The N.C. Division of Water Quality has authorized the proposed project under General Water
Quality Certification No. 3900 (DWQ Project No. 14-0697), which was issued on 8/7/14.
NOTE: The U.S. Army Corps of Engineers authorized the proposed project under COE Action Id. No.
SAW-201401214.
RECEIVED
SEP 15 2014
DCM-MHD CTTY

Permit Class Permit Number
NEW 79-14
STATE OF NORTH CAROLINA
Department of Environment and Natural Resources
and
Coastal Resources Commission
trit
for
X Major Development in an Area of Environmental Concern
pursuant to NCGS 113A-118
Excavation and/or filling pursuant to NCGS 113-229
Issued to Robert Jackson,186 Ainsley Rd, Hertford, NC 27944
Authorizing development in Perquimans County adl. the Perquimans River, at 186 Ainsley
Road in Hertford , as requested in the permittee's application dated 4/14/14, includingthe
he
attached workman drawing (4)all dated314/14
This permit, issued on September 8. 2014 is subject to compliance with the application (where consistent
with the permit), all applicable regulations, special conditions and notes set forth below. Any violation of these terms may
�— --• ....... , u .F.uo ...u1..1 v. UI V U aILIUIL, U1 way UaUbU LIM PUL1111L LU UU I1U11 000 V01U.
Docking Facility
i) Unless specifically altered herein, this permit authorizes the construction of the boathouse and
additional finger pier and uses located in or over the water that are expressly and specifically set forth
in the permit application. No other structure, whether floating or stationary, shall become a
permanent part of this reconfigured docking facility without permit modification. No non -water
dependent uses of structures shall be conducted on, in or over public trust waters without permit
modification.
2) The boathouse shall not be completely enclosed or have side coverage more than one half the height
of the side, from the roof waterward.
(See attached sheets for Additional Conditions)
This permit action may be appealed by the permittee or
other qualified persons within twenty (20) days of the issuing
date. An appeal requires resolution prior to work initiation or
continuance as the case may be.
This permit must be accessible on -site to Department
personnel when the project is inspected for compliance.
Any maintenance work or project modification not covered
hereunder requires further Division approval.
All work must cease when the permit expires on
December 31, 2017
In issuing this permit, the State of North Carolina agrees
that your project is consistent with the North Carolina Coastal
Management Program.
Signed by the authority of the Secretary of DENR and the
Chairman of the Coastal Resources Commission.
fw raxton C. Davis, Director
Division of Coastal Management
This permit and its conditions are hereby accepted.
Signature of Permittee

Robert Jackson Permit # 79-14
Page 2 of 3
AIDIDITIONAL CONIDITIONS
3) The authorized boathouse shall be single story, and shall not be designed to allow for second story use.
" 4) Should the adjacent property to the north be sold prior to the initiation of construction, the permittee
shall be required to obtain a signed riparian corridor waiver from the new property owner prior to the
placement of any structure within the 15 foot riparian corridor.
5) No attempt will be made by the permittee to prevent the full and free use by the public of all navigable
. waters at or adjacent to the authorized work.
6). The permittee shall maintain the authorized work in good condition and in conformance with the terms
and conditions of this permit. The permittee is not relieved of this requirement if he abandons the
permitted activity without having it transferred to a third party.
7) This permit does not authorize the interference with any existing or proposed Federal project, and the
permittee shall not be entitled to compensation for damage to the authorized structure or work, or injury
which may be caused from existing or future operations undertaken by the United States in the public
y
interest.
x
8
8j The permittee shall install and maintain at his expense any signal lights or signals prescribed by the U.S.
Coast Guard, through regulation or otherwise, on the authorized facilities. At a minimum, permanent
' reflectors shall be attached to the structure in order to make it more visible during hours of darkness or
x inclement weather.
9) This permit does not authorize any additional slips.
Upland Development
10) Unless specifically altered herein, this permit authorizes the grading and other land disturbing -activities
associated with the development of the above referenced property, including but not limited to the
+ addition to the existing garage and existing deck associated with the development of the above
" referenced property, all as expressly and specifically set forth in the attached permit application and
workplan drawings. Any additional land disturbing activities and/or construction may require a
- modification of this permit. Contact a Division of Coastal Management representative at (252) 264-
3907 for this determination.
Sedimentation and Erosion Control
11) In order to protect water quality, runoff from construction shall not visibly increase the amount of
suspended sediments in adjacent waters.
12) Appropriate sedimentation and erosion control devices, measures or structures must be implemented to
ensure that eroded materials do not enter adjacent wetlands, watercourses and property (e.g. silt fence,
diversion swales or berms).
13) All disturbed areas shall be properly graded and provided a ground cover sufficient to restrain erosion
within thirty days of project completion.

Robert Jackson
1
Permit # 79-14
Page 3 of 3
ADDITIONAL CONDITIONS
General
14) This permit does not authorize the interference with any existing or proposed Federal project, and the
permittee shall not be entitled to compensation for damage to the authorized structure or work, or injury
which may be caused from existing or future operations undertaken by the United States in the public
interest.
15) The permittee understands and agrees that, if future operations by the United States requires the
removal, relocation, or other alteration of the structure or work authorized by this permit, or if in the
opinion of the Secretary of the Army or his authorized representative, said structure or work shall cause
unreasonable obstruction to free navigation of the navigable waters, the permittee will be required, upon
due notice from the Corps of Engineers, to remove, relocate or alter the structural work or obstructions
caused thereby, without expense to the United States or the state of North Carolina. No claim shall be
made against the United States or the state of North Carolina on account of any such removal or
alteration.
16) This permit shall not be assigned, transferred, sold, or otherwise disposed of to a third party without the
written approval of the Division of Coastal Management.
17) The permittee and/or his contractor shall meet with a representative of the Division prior to project
initiation in order to discuss the conditions set forth in this permit.
NOTE: This permit does not eliminate the need to obtain any additional state, federal or local permits,
approvals or authorizations that may be required.
NOTE: Future development of the permittee's property may require a modification of this permit.
Contact a representative of the Division at [phone] prior to the commencement of any
such activity for this determination. The permittee is further advised that many non -water
dependent activities are not authorized within 30 feet of the normal water level.
NOTE: The N.C. Division of Water Quality has authorized the proposed project under General Water
Quality Certification No. 3900 (DWQ Project No. 14-0697), which was issued on 8/7/14.
NOTE: The U.S. Army Corps of Engineers authorized the proposed project under COE Action Id. No.
SAW-201401214.

To: CAMA, Laic W r ,- 4- C R E6 F
Fr: Robert L Jackson
186 Ainsley Rd
Hertford, NC 27944
757 618-7569, robdibren(dlgmail.com
Subj: CAMA Major Permit Application
End (1) DCM MP-1
End (2) DCM MP-3
End (3) DCM MP-4
End (4) Existing configuration
End (5) Proposed configuration
End (6) Boat House front elevation
End (7) Boat House side elevation
End (8) Lot Survey
End (9) Site survey/sketch
End (10) Current Aerial View
End (11) CAMA 33759
End (12) CAMA 39502
End (13) CAMA 57221
End (14) Riparian Letter 174 Ainsley
End (15) Riparian Letter 192 Ainsley
End (16) Riparian Letter HOA Lot
End (17) Aerial View HOA Lot
End (18) Cover sheet of Deed of Trust
I
JUN 18 2014
GOFlSTN 'Rc-"=;ti7
�{q�D '��GI✓�QE'i�
91 KCLCY KUSSFt(
1. Respectively submitting request to accomplish modifications and additions to existing waterfront
structures as delineated below, and shown on Enclosures 4 thru 9.
2. Discussions of specific additions and changes, and rationale provided
a. Request permission to remove existing gable roof system over one boat lift, as
authorized in End 12. Request authorization to build a 24 foot by 33 foot gable roof with
2 foot overhangs over both existing boat lift. Second boat lift authorized via End 13.
b. Request permission to construct 3 foot finger pier on outboard side of second boat lift, 2
feet of which will be covered by new roof system.
c. Request permission to build 20 foot by 16 foot extension to existing garage that extends
to within 68 feet of waterline.
d. Request permission to build 12 foot by 10 foot extension to existing deck that extends to
within 68 feet of waterline.
3. These variances are requested to provide protection from the elements to watercraft already docked
on approved structures.
4. Your considerations of these requests are greatly appreciated and please contact me for any
additional information needed for evaluation. In addition to signatures on the riparian letters, 1 have
V"4
DcM-Nmctly

asked the adjoining neighbors to sign this document as well, to
changes requested.
V/R
Robert Jackson
FJUN18 2014
Fi
I have read and understand the changes/additions Mr Jackson is requesting and have no objections
Alva Renshaw 192 Ainsley Rd �� 7f1��, �.� Date -3 — ( 7 — / Si
G.A. Lane 174 Ainsley Rd �/ L� `�� Date
JON /I*crfi4ez- W„1r6ow (A-4 &7
MA-i k WitiStoA i (rbA- w7—
P-47F 5 I �

APPLICATION for
Major Development
(last revised 12/27/06)
pF'
1
JUN 18 2014
Ilna DIVISION OF COASTAL MANAGEMENT
1. Primary Applicant/Landowner Information
Business Name
Project Name (if applicable)
Na
NA
Applicant 1: First Name
MI
Last Name
Robert
L
Jackson
Applicant 2: First Name
MI
Last Name
NA
NA
NA
If additional applicants, please attach an additional page(s) with names listed.
Mailing Address
PC Box
City
State
186 Ainsley Rd
Hertford
NC
ZIP
Country
Phone No.
FAX No.
27944
USA
757-618-7569 ext.
NA -
StreetAddress (NdiHerentfmmabove)
City
State
ZIP
NA
Email
[e-mail]
2. Agent/Contractor Information
Business Name
NA
Agent/ Contractor 1: First Name
MI
Last Name
Agent/ Contractor 2: First Name
MI
Last Name
Mailing Address
PO Box
City
State
ZIP
Phone No. 1
-
- cod.
Phone No. 2
- - exl.
FAX No.
Contractor #
Street Address (ifdifferent from above)
City
Slate
ZIP
Email
JUL 0 7 2014
<Form continues on back>
DCM-MfMM Y
CA/GIL L1 1 252-80872808 .. 1.888-4RCOAST .. www.nccoastalmanagement.net

Form DCM MP-1 (Page 2 of 4) i' - l APPLICATION for
Major Development permit
JUN 18 2014
3 Pr'ojec! Location
� �'
_
'j.
County (can be multiple)
Street Address F C" "` " .
State Rd. 0
Perquimans
186 Ainsley Rd
SR 1416
Subdivision Name
City
State
Zip
Chesterfield His
Hertford
NC
27944-
Phone No.
Lot No.(s) (if many, attach additional page with list)
757 - 618 - 7569 ext.
8, 1 1 ,
a. In which NC river basin is the project located?
b. Name of body of water nearest to proposed project
Perquimans
Perquimans River
c. Is the water body identified in (b) above, natural or manmade?
d. Name the closest major water body to the proposed project site.
®Natural ❑Manmade ❑Unknown
Perquimans River
e. Is proposed work within city limits or planning jurisdiction?
f. If applicable, list the planning jurisdiction or city limit the proposed
®Yes ❑No
work falls within.
Perquimans County
4 SifeD_escripton
-
a.
Total length of shoreline on the tract (ft.)
b. Size of entire tract (sq.ft.) f Or ��
107
28,275 SF `
c.
Size of individual lot(s)
d. Approximate elevation of tract above NHW (normal high water) or
28,275 SF, I I
NWL (normal water level)
(if many lot sizes, please attach additional page with a list)
loft ❑NHW or ®NWL
e.
Vegetation on tract
Domestic and ornamental grasses
f.
Man-made features and uses now on tract
Residential: House, Garage, Drive Way, Septic, Pier
g.
Identify and describe the existing land uses adlacent to the proposed project site.
Residential
h.
How does local government zone the tract?
I. Is the proposed_ project consistent with the applicable zoning?
RA 25
(Attach zoning compliance certificate, if applicable)
®Yes ❑No ❑NA
j.
Is the proposed activity part of an urban waterfront redevelopment proposal? ❑Yes ®No
k.
Hasa professional archaeological assessment been done for the tract? If yes, attach a copy. . ❑Yes ®No DNA
If yes, by whom? '
1.
Is the proposed project located in a National Registered Historic District or does it involve a ®Yes ❑No DNA
National Register listed or eligible property?
<Form continues on next page>
E/vCLll) 252-808-2808 :: 1-688-4RCOAST :: www.nccohstalmana¢Uemen@.net

Form DCM MP-1 (Page 3 of 4)
�- J
J U N 18 2014
APPLICATION for
Major Development Permit
m. (i) Are there wetlands on the site? Yes ®No
(ii) Are there coastal wetlands on the site? - - - ❑Yes ®No
(iii) If yes to either (i) or (ii) above, has a delineation been conducted? []Yes []No
(Attach documentation, if available)
n. Describe existing wastewater treatment facilities.
Gravity Flow Septic System
o. Describe existing drinking water supply source.
County Water
p. Describe existing stone water management or treatment systems.
Existing swale along front of property draining to a vegetated drainage ditch that extends to the river
& Activities and Impacts
a. Will the project be for commercial, public, or private use? ❑Commercial ❑PubliclGovemment
®Private/Community -
b. Give a brief description of purpose, use, and daily operations of the project when complete.
Request removal of existing roof, request new gable roof system over existing boat lifts per attached drawing. One roof
system over both existing lift of approximately 28' by 37'. Add 42'" finger pier outboard on second boat lift. Request
permission to add to existing garage, per drawing, within the 75" AEC buffert. Request permission to add to existing deck,
per drawing, within the 75" AEC buffer.
c. Describe the proposed construction methodology, types of construction equipment to be used during construction, the number of each type
of equipment and where it is to be stored.
Wood construction. No equipment other than hand tools. Concrete footers for garage extension will be delivered to site by
wheel barrows
d. List all development activities you propose.
One new roof system over existing boat lifts. One 42" by 24' finger pier. Extension to existing garage, 12' by 16', to encroach
within the 75' AEC buffer. Extension to existing deck, 10' by 12', to encroach within the 75' AEC buffer.
a. Are the proposed activities maintenance of an existing project, new work, or both? Both
f. What is the approximate total disturbed land area resulting from the proposed project? 600 ®Sq.Ft or ❑Acres
g. Will the proposed project encroach on any public easement, public accessway or other area ❑Yes ®No []NA
that the public has established use oft
h. Describe location and type of existing and proposed discharges to waters of the state.
Surface runoff, no changes
I. Will wastewater or stonnwater be discharged into a wetland? ❑Yes ®No ❑NA
If yes, will this discharged water be of the same salinity as the receiving water! ❑Yes ❑No ❑NA
j. Is there any mitigation proposed? ❑Yes ®No ❑NA
If yes, attach a mitigation proposal. -
<Form continues on back> JUL 0 7 2014
0CM-MUD MY
252-808-2808 :; 1.888-4RCOAST :: www.nccoastaimanagement.ne

Form DCM MP-1 (Page 4 of 4) g (_ _e APPLICATION for
r— Major Development Permit
II In1 1 2 2014
A. Additional lnform'ation
In addition to thrs'cdMp—!eted application form, (MP 1) the follow ng de sr�below rf pphcsbje-rrPst, a submr red in order ibi a apphcati
package, to be complete Items (a) s applrcable.t r any meJofdevelopmenf appl¢ation.=Pleas consult the app6cahon =
instruction booklet on how to properly prepare the regmreditem(C below. - - - _
a. A project narrative. - - — - -+
b. An accurate, dated work plat (including plan view and cross -sectional drawings) drawn to scale. Please give the present status of the
proposed project. Is any portion already complete? If previously authorized work, cleady indicate on maps, plats, drawings to distinguish
between work completed and proposed.
c. A site or location map that is sufficiently detailed to guide agency personnel unfamiliar with the area to the site.
d. A copy of the deed (with state application only) or other instrument under which the applicant claims title to the affected properties.
e. The appropriate application fee. Check or money order made payable to DENR.
f. A list of the names and complete addresses of the adjacent waterfront (riparian) landowners and signed return receipts as proof that such
owners have received a copy of the application and plats by certified mail. Such landowners must be advised that they have 30 days in
which to submit comments on the proposed project to the Division of Coastal Management.
t Name Alva Renshaw - ..Phpne.No. 252862-6327,
r Address 192 Ainsley Rd
Name G.A. Lane Phone No. 252 426-5505
Address 174 Ainsley Rd
f Name John Michael and Mark Winslow = - 'Phone No. 252-337-0163
Address 222 Ainsley Rd = -
`�
g. A list of previous state or federal permits issued for work on the project tract. Include permit numbers, pennittee, and issuing dales.
Copies Attached '
h. Signed consultant or agent authorization form, if applicable.
1. Wetland delineation, if necessary.
j. A signed AEC hazard notice for projects in oceanfront and inlet areas. (Must be signed by property owner)
k. A statement of compliance with the N.C. Environmental Policy Act (N.C.G.S. 113A 1-10), if necessary. If the project involves expenditure
of public funds or use of public lands, attach a statement documenting compliance with the North Carolina Environmental Policy Act.
I understand that any permit issued in response to this application will allow only th
The project will be subject to the conditions and restrictions contained in the permit.
I certify that I am authorized to grant, and do in fact grant permission to representatives of state and federal review agencies to
enter on the aforementioned lands in connection with evaluating information related to this permit application and follow-up
monitoring of the project.
I further certify that the information provided in this application is truthful to the best of my knowledge.
Date _14 April 2014 Print �NamePbert L. JacksoQ
Signature
Please indicate application attachments pertaining to your proposed project.
❑DCM MP-2 Excavation and Fill Information ❑DCM MP-5 Bridges and Culverts
®DCM MP'3 Upland Development
®DCM MP-4 Structures Information
eve, 1-0) 262-808.2803 .. 1.388-4RC®AST :. www.nceeistalmonagemenf.net

i r
Form DCM MP-3
JUN 18 2014
UPLAND DEVELOPMENT
(Construction and/or land disturbing activities)
Attach this form to Joint Application for CAMA Major Permit, Form DCM MP-1. Be sure to complete all other sections of the Joint
Application that relate to this proposed project. Please include all supplemental information.
GENERAL UPLAND DEVELOPMENT
a. Type and number of buildings, facilities, units or structures
proposed.
Addition to existing garage, 14' by 17' includes overhangs
(drip line). Actual size 12' by 16. Addition to existing deck,
10" x 12
c. Density (give the number of residential units and the units per
acre).
NA
e. If the proposed project will disturb more than one acre of land, the
Division of Land Resources must receive an erosion and
sedimentation control plan at least 30 days before land -disturbing
activity begins.
(i) If applicable, has a sedimentation and erosion control plan been
submitted to the Division of Land Resources?
[]Yes []No ❑NA
(i) If yes, list the date submitted: NA
g. Give the percentage of the tract within the coastal shoreline AEC to
be covered by impervious and/or built -upon surfaces, such as
pavement, building, rooftops, or to be used for vehicular driveways
or parking.
Less than 5%
i. Give the percentage of the entire tract to be covered by impervious
and/or built -upon surfaces, such as pavement, building, rooftops,
or to be used for vehicular driveways or parking.
19%
Describe proposed method of sewage disposal
NA
I. Describe location and type of proposed discharges to waters of the
slate (e.g., surface runoff, sanitary wastewater, industriall
commercial effluent, 'wash down" and residential discharges).
No Changes
b. Number of lots or parcels.
1
d. Size of area to be graded, filled, or disturbed including roads,
ditches, etc.
600 sq fit, includes footer and disturbed adjacent land
f. List the materials (such as marl, paver stone, asphalt, or concrete)
to be used for impervious surfaces.
Concrete for Tooter of garage
h. Projects that require a CAMA Major Development Permit may also
require a Stonnwater Certification.
(1) Has a site development plan been submitted to the Division of
Water Quality for review?
❑Yes []No ®NA
(ii) If yes, list the date submitted:
k. Have the facilities described in Item (i) received state or local
approval?
❑Yes []No ®NA
If yes, attach appropriate documentation.
m. Does the proposed project include an innovative stormwater
design?
[]Yes ❑No ®NA RECEIVED
If yes, attach appropriate documentation.
JUL 0 7 2014
ACM-MHD CITY
252-808-28082::1.888-4RCOAST:: vv w.nccoastalmanaoement.net revised: 12/26/06

F-6AM OCM NIP-3 (Upland Development, Page 2 of 2)
m. Describe proposed drinking water supply source (e.g., well, n. (1) Will water be impounded? ❑Yes ®No ❑NA
community, public system, etc.) (ii) If yes, how many acres?
Public - existing
o. When was the lot(s) platted and recorded?
1986
14'April 2014-
une
A'ppll
p. If proposed development is a subdivision, will additional utilities be
installed for this upland development?
❑Yes ®No ❑NA
(6/ZolZolq)
EJUN2 0 2014
252-808-2606 -- 1-388-4RCOA6T :.- %vww.nccoaMnlmanaqement.ne revised: 112126106

Form DCM MP-4
STRUCTURES
(Construction within Public Trust Areas)
_f
JUN 18 2014
Attach this form to Joint Application for CAMA Major Permit, Form DCM MP-1. Be sure to complete all other sections of the Joint
Application that relate to this proposed project. Please include all supplemental information.
1. DOCKING FACILITY/MARINA CHARACTERISTICS ❑This section not applicable
a. (i) Is the docking facility/marina: b. (i) Will the facility be open to the general public?
❑Commercial ❑PubliclGovemment ®Private/Community ❑Yes ®No
c. (1) Dock(s) and/or pier(s)
d. (I) Are Finger Piers included? ®Yes ❑No
(t) Number 1 Existing
If yes:
(III) Length
(I) Number 1
(iv) Width
(tit) Length 24'
(v) Floating ❑Yes [--]No
(iv) Width 42"
(v) Floating []Yes ®No -
e. (i) Are Platforms included? ®Yes []No
f. (t) Are Boatlifts included? ®Yes []No
If yes:
If yes:
(ii) Number 2 existing
(li) Number 2
(Ili) Length
(Ili) Length 24'
(iv) Width
(iv) Width 12'
(v) Floating []Yes []No
Note: Roofed areas are calculated from dripffne dimensions.
g. (1) Number of slips proposed
h. Check all the types of services to be provided.
0
❑ Full service, including travel lift and/or rail, repair or
III) Number of slips existing
maintenance service
2
❑ Dockage, fuel, and marine supplies
❑ Dockage ("wet slips") only, number of slips:
❑ Dry storage; number of boats:
❑ Boat ramp(s); number of boat ramps:
® Other, please describe:
Private residential
I. Check the proposed type of siting:
j. Describe the typical boats to be served (e.g., open runabout,
❑ Land cut and access channel
charter boats, sail boats, mixed types).
[]Open water; dredging for basin and/or channel
PWC. Pontoon, Center Console
[]Open water; no dredging required
❑Other; please describe:
NA
k. Typical boat length: 20
m. (i) Will the facility have tie pilings?
[]Yes ®No
(ii) If yes number of lie pilings?
(i) WIII the facility be open to the general public?
[]Yes ®No iiiiiitz RECEIM
JUL 0 7 2014
252-808-2808 ::
:: www.nccoastaimanasrement.net
DCM-NMMY
revised: 12/27/06

F0Ir na DCM P-4 (Stmctums, Paglti 2 of 4)
a. Check each of the following sanitary facilities that will be Included in the proposed project.
❑ Office Toilets i - -
r—�
❑ Toilets for patrons; Number. _; Location:
❑Showers JUIN 18 2014
❑ Boatholding tank pumpout; Give type and location:
b. Describe treatment type and disposal location for all sanitary wastewater.
c. Describe the disposal of solid waste, fish offal and trash.
d. How will overboard discharge of sewage from boats be controlled?
e. (i) Give the location and number of'No Sewage Discharge'signs proposed.
(ii) Give the location and number of °Pumpout Available' signs proposed.
f. Describe the special design, if applicable, for containing industrial type pollutants, such as paint, sandblasting waste and petroleum products.
g. Where will residue from vessel maintenance be disposed of?
h. Give the number of channel markers and "No Wake" signs proposed.
I. Give the location of fuel -handling facilities, and describe the safety measures planned to protect area water quality.
j. What will be the marina policy on overnight and live -aboard dockage?
k. Describe design measures that promote boat basin flushing?
I. If this project is an expansion of an existing marina, what types of services are currently provided?
m. Is the marinaldocking facility proposed within a primary or secondary nursery area?
❑Yes []No \
�NLL (3'J
252-808-2808 :: 4-888-4RCOAST :: v✓ww.nccaastnirroanageenent.ne4 revised: 12/27/06

Form DGM MP-4 (structures, Page 3 of 4) I JUN 18 2014
n. Is the marinaldocking facility proposed within or adjacent to any shellfish harvesting areal[]Yes []No
❑No .III
o. Is the marina/docking facility proposed within or adjacent to coastal wetlands/marsh (CW), submerged aquatic vegetation (SAV), shell bottom
(SB), or other wetlands (WL)? If any boxes are checked, provide the number of square feet affected.
❑CW ❑SAV ❑SB
❑WL ❑None
p. Is the proposed marinaldocking facility located within or within close proximity to any shellfish leases? ❑Yes []No
If yes, give the name and address of the leaseholder(s), and give the proximity to the lease.
3. BOATHOUSE (including covered lifts) []This section not applicable
a. (i) Is the boathouse structure(s):
❑Commercial ❑PubliclGovernment ®Private/Community
(ii) Number 1
(III) Length 28'
(iv) Width 37'
Note: Roofed areas are calculated from ddpline dimensions.
4. GROIN (e.g., wood, sheetpile, etc. If a rock groin, use MP-2, Excavation and Fill.) ®This section not applicable
a. (i) Number
(ii) length
(III) Width
5. BREAKWATER (e.g., wood, sheetpile, etc.) ®This section not applicable
a. Length b. Average distance from NHW, NWL, or wetlands
c. Maximum distance beyond NHW, NWL or wetlands
6. MOORING PILINGS and BUOYS ®This section not applicable
a. Is the structure(s):
❑Commercial ❑Public/Government ❑Private/Community
c. Distance to be placed beyond shoreline
Note: This should be measured from marsh edge, if present.
e. Arc of the swing
7. GENERAL
b. Number
d. Description of buoy (color, inscription, size, anchor, etc.)
LLCEIVED
JUL 0 7 2014
,JUL
LCS!-SN! DC."
6wCC (, "�
M-8084808 :: 14
:: vvww.nceoastaimanaeement.ne4
revised: 12/27/06

FOrM ®CM MP-4 (Structures, Page 4 of 4)
a. Proximity of structures) to adjacent riparian property lines
5' and 50'
Note: Forbuoy or mooring piling, use arc of swing including length
of vessel.
c. Width of water body
3/4 mile
e. (1) Will navigational aids be required as a result of the project?
❑Yes ®No ❑NA
(ii) If yes, explain what type and how they will be implemented.
a. Give complete description:
see attached narrative
b. Proximity of structure(s) to adjacent docking facilities.
150,
d. Water depth at waterward end of structure at NLW or NWL
3'
252-808-2808 :: 1-888-4RC®ASi::w .nccoastalmanngoment.ne4
revised: 12/27/06

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ROBERT L. JACKSON
AND WIFE,
DIANA L. JACKSON
LOT NO. 8 • CHESTERFIELD HEIGHTS
PARKVILLE TOWNSHIP
PEROUIMANS COUNTY, NORTH CAROLINA
SCALE: r. 50' - ALr"T Od 2001
0 25 5o 100 150 200
I I REFERENCES,: PLAT CABINET 2, SLIDE 3, MAP 12
DEED BOOK 123, PAGE. 799
2 1 AREA = 29,275 SQUARE FEET 10.649 ACRE 1
/ 3 1 THIS TRACT LIES WITHIN F.E.MA. FLOOD ZONE'A-5"
(BASE FLOOD ELEVATION 7.0' M.S.L. )
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Perquimans County, NC d c „-b-r ;359-85-7732 M Plam�"_
I— Parcel Number 5-DO51-0008-CH Plat Map. 12
Owner Name: JACKSON, ROBERT L. & DIANA L. Plat Slide: 3
PROPERTY MAP G Owner Address: 186 AINSLEY ROAD Record Date:
Owner Address 2: HERTFORD, NC 27944 Sold Date:
'y _`y N Owner Address 3: Deed Acres:
N
.i. .< Tne �lmaas,,,a.a , W amd a— "'Pa.ea io� lm<�w,y o p,apmy a Owner Account: 527700 Tax Value: 458,900
oq V$ P , cpw,y,rx a ,< pllea fm "'Pall -an Pl n,A z a me, Pmllo & Description: #8 CHESTERFIELD HGHT Use Value:
ire 'r, w,a. do isfamf—fioraip,,,p,--hr,aa.hama rot ea aansaafa Deed Book: 120 Township: PARKVILLE One Inch=50
b,a Vue 4Jepppelly app,aiaal, 5urey, or for ZoNnp V Al bm, r)PP Pnna- AM Feet

Preli,ous #
permit
Ditid prev'lod.s permit Issued
Ac authorized by the State of North Carolina, Department of Environment
and Natural Resources .
and`the Cdastal�Resources Commission In' an area of environmental concern pursuant to ISA NCAC VA. W0.9
Cdunty Pe4*aj M 60 L C 01
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Affected
Phone ve asin
DOEA OHHF DIH EIUBA ON/A
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9RW., ONA Crit. H'ab.
Closest Mal.
yes Wtr,Body P&,"', r, of AV
yes yes
Type of Project/ Activity A)iFtO GtO �A e*,o
'(Scale: /i 5;,
Pier (dock) length_­
Platfornn(s) .,L
7-
8� 2014-
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qulr7ler
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Bulkhead/ R*W length t T 7
avg distance offshore_
max distance offshore
T—
Basin, channel ------ ------
cubic yards 4--r-
Boat mrnp
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..........
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Notes/ Special Conditions z
,a-t,l C /- C/ /

X CAMA / ❑ DREDGE is FILL .._.. N(l)A i�!� � w j
�GNERAL PERMIT d'Ir
Previous permit#
❑New ❑Modification *omplete Reissue i--eftf{ia elssue -_7 Date previous permit issued
As authorized by the State of North Carolina, Departmet)t of Environment a 21{ eso ces
and the Coastal Resources Commission in an area of en4onme tal cZitn uab.., 15A CAC OtV
p ��,�. 19 Rules attached.
Applicant Name//fv o 6n N County "`7 '4 ----
Address t $ 6 A I,N S/ e. IPORgsD StreetAddr.ess/ State Road/ Lot #(s) / 8 �tNf7S �ry
City Hep%FOAO _ State N G ZIP a l gqq
Phone # (a.Z) 33-3 - I&YYY Fax # ( ) Subdivision hews— — 4c
Authorized Agent City--- - ...- -- ZIP-
-
Affected CW NtIW RPTA Es P75
): - OEA ErHHF ❑ IH USA N/A
AEC(s)0PWS:. -FC: _
ORW: yes / dp PNA yes / V Crit. Hab. yes /
Phone # River Basin P a ywlC
Adj. Wtr. Body A /Ygy M/y1�f s(-lutt man Lr kn
Closest Mai, Wtr. BodytTl4c/N i'g _5a)&t Ajoo'
Type of Project/ Activity VP-W �Dl
(Scale: )
Fier (dock) length �O XiG-�__
+ _ °r /�r
� Platform(s)_k_
Finger pler(s)__ __ R I V a^ �- �a 4Li 7-Hciki Zed
Groin length _ 0 W P/FR 4-
number
Bulkhead/ Rip rap length__-_ ({A4THot¢g 2
avg distance offshoreJAL
max distance offshore____ 13U� Sep SKI
Basin, channel
cubic yards___ __
Boat ramp__
Boathouse/ 8oatlift
el
Beach Bulldozing_____. _ 'O 'tAle
Other fir'
Shoreline Length /Q
SAW. not sure yes ® -e— rP/ r-.dW�
Sandbags: not sure yes t�zDpqq��repn�rrm��
Moratorium: 0 yes no ( ,�yg; ewvas►py
Photos: �s no 3>♦t"
Waiver Attached: yes no ``nn---- - JUL U 7 201
A building permit may be required by: �4lIlNJgA s re t! Wy ( . See note on back regarding River Bassin rules.
Notes/ Special Conditions 7 N, /;L a
Betfmf$)till -
Agent or Applicant Printed Name
Permit
ignature *" Please read compliance statement on back of permit*' Issun
Application Peels) �NCL 'L Check-- Local
er's 5igna/tsure / 1y/'
ERpI'auon
is lurisdiction Rover File Name

.VICAMA DREDGE & FILL
OIL C�dE`�' ER
New ❑Modification ❑Complete Reiss
As authorized by the State of North Carolina, Department
and the Coastal Resources Commission in an area of envirc
Affected _ -" V,—. yc---- —.._
AEC(s) ❑OFA ❑HHP ❑IH ❑UBA ❑N/A
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ORW: yes /,K,'' "PMA ye"s'CritHab. yes
Type of Project/ Activity
Pier (dock) length
Platform(s)
Finger pier(s)
r
Groln length
number
n.
Bulkhead/Riprap length �
avg distance offshore
max distance offshore
Basin, channel
cubic yards
Boat ramp
Boathouse/Boatlift IZ Y2O
r
Beach Bulldozing =
Other
A
Notes/ Special Conditions
Previous permit #
irftial kelssue y Date previous permit issued
St' reetPddre'ss/ State Road/ Lot #(s) V `
F 1 `6Co ns e.0
Subdivision
Gty ,. ZIP-:
Phone # �_) River Basin
i Adj Atr;`$ody Q t 1 na 4 an . unkn
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Perquimans County, NC PIN Number. 7859-86S864 Plat Cab: 2 V
Parcel Number. 5-DO51-0000-CH Plat Map: 12
Owner Name: WINSLOW, JOHN MICHAEL & Plat Slide: 3
wv+s PROPERTY MAP 222 AJNS Owner Address: DIL LARD M Y LEYR Record Date: 0
O wner Address 2: D Sold Date:
Owner Address 3: HERTFORD, NC 27943 Deed Acres:
a"'datap Owner Account: 052720 Tax Value: 10000
meearamw�aeaon Can' axrtprepareala the l.. real apedol,nd Other
p vtor
Pee matmh dare s(ormman.n�aiaWInand R�oat,-shouleaat,a�aomas.� reeems Deed Book: WATER ACCESS LOT -CH Use Value:
for a we Me season, mope r•nasnomafim be ��e�nlmea Deed Book' 125 Township: PARIMLLE
sly apparelled. s„�,w. as r�:amop.eneaaaan_ D Peas, 673 P� One Inch = 50 Feet

9�A1[1LINO ➢D)(STRTRI T[ON SHFI T
Permit=
Agents:
FDCM Field Offices
Elizabeth City (with revised work plan drawings)
Morehead City
Washington
Wilmington
US ACOIE Offffiees:
Washington: Raleigh Bland ✓
Wilmington: Ronnie Smith
Cultural Resources: Renee Gledhill -Early or([e-mail])
Public Water Supply: Diane Williams (WIRO) /
Joey White (WAARO) ✓
NC IDOL: Ken Pace
Shellfish Sau tation: Patti Fowler
State Property: Tim Walton
Water Resources: Karen Higgins (Raleigh) +/ n
John Hennessy (NC DOT)
Washington: Anthony Scarborough d�
Wilmington: Joanne Steenhuis — 401
Chad Coburn - 401
Linda Lewis - Stormwater
Wildliffe Resources: Maria Dunn (WARD)
LPO:
Fax Distribution: Pemritee #:
Agent #

NCB NR
_.. -......North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
September 9, 2014
Robert Jackson
186 Ainsley Rd.
Hertford, N.C. 27944
Dear Sir or Madam:
John E. Skvarla, III
Secretary
The enclosed permit constitutes authorization under the Coastal Area Management Act, and where
applicable, the State Dredge and Fill Law, for you to proceed with your project proposal. The original (buff -colored,
form) is retained by you and it must be available on site when the project is inspected for compliance. Please sign
both the original and the copy and return the copy to this office in the enclosed envelope. Signing the permit and
proceeding means you have waived your right of appeal described below.
If you object to the permit or any of the conditions, you may request a hearing pursuant to NCGS 113A-
121.1 or 113-229. Your petition for a hearing must be filed in accordance with NCGS Chapter 150B with the Office
of Administrative Hearings, 6714 Mail Service Center, Raleigh, NC 27611-6714, [phone] within twenty
(20) days of this decision on your permit. You should also be aware that if another qualified party submits a valid
objection to the issuance of this permit within twenty (20) days, the matter must be resolved prior to work initiation.
The Coastal Resources Commission makes the final decision on any appeal.
The project plan is subject to those conditions appearing on the permit form. Otherwise, all work must be
carried out in accordance with your application. Modifications, time extensions, and future maintenance requires
additional approval. Please read your permit carefully prior to starting work and review all project plans, as
approved. If you are having the work done by a contractor, it would be to your benefit to be sure that he fully
understands all permit requirements.
From time to time, Department personnel will visit the project site. To facilitate this review, we request that
you complete and mail the enclosed Notice Card just prior to work initiation. However, if questions arise
concerning permit conditions, environmental safeguards, or problem areas, you may contact Department personnel
at any time for assistance. By working in accordance with the permit, you will be helping to protect our vitally
important coastal resources.
Enclosure
Sincerely,
j
AV
Douglas V. Huggett
Major Permits and Consistency Manager
400 Commerce Avenue, Morehead City, NC 28557
Phone: [phone] \ Internet: http://portal.nedenr.orz/web/cm/
An Equal Oppodunity 1 Afflrmalive Action Employer— Made in part by recycled paper

Govoni, Daniel ,
From: Bland, Raleigh W SAW[[e-mail]
Sent: Monday, September 08, 2014 10:34 AM
To: Govoni, Daniel
Subject: RE: Robert Jackson (UNCLASSIFIED)
Classification: UNCLASSIFIED
Caveats: NONE
SAW 201401214 PGP 198000291 Tier II Your Date
-----Original Message -----
From: Govoni, Daniel[mailto:[e-mail]]
Sent: Wednesday, September 03, 2014 8:45 AM
To: Bland, Raleigh W SAW; Pelletier, Josh R SAW
Subject: [EXTERNAL] Robert Jackson
Can I get comments ASAP, 75 day is today. Thanks!! Applicant proposes construct roof over
boatlifts, finger pier, and additions to garage and deck at 186 Ainsley Road, Perquimans
County
Daniel M. Govoni
Asst. Major Permits Coordinator
NC Division of Coastal Management
400 Commerce Ave.
Morehead City, NC 28557
[phone]
[phone] fax
daniel.eovoni(@ncdenr.gov
E-mail correspondence to and from this address may be subject to the North Carolina Public
Records Law and may be disclosed to third parties.
Classification: UNCLASSIFIED
Caveats: NONE
1

NCDENR
North Carolina Department of Environment and Natural Resources
Pat McCrory
Govemor
July 2, 2014
MEMORANDUM
TO:
I y;Z1131
SUBJECT:
Applicant:
Project Location:
Proposed Project:
John E. Skvarla, III
Secretary
Kevin Hart, Fisheries Resource Specialist
Division of Coastal Management, WaRO
Daniel Govoni
Assistant Major Permits Coordinator
Division of Coastal Management
CAMA Permit Application Review
Robert Jackson
186 Ainsley Road, Perquimans County
Construct roof over boat lifts, a finger pier, & additions to garage & deck
Please indicate below your agency's position or viewpoint on the proposed project and return this
form by 07/23/14 to 400 Commerce Avenue, Morehead City, NC 28557 (fax: [phone]).
If you have any questions regarding the proposed project, please contact Will Creef at (252) 264-
3901. When appropriate, in-depth comments with supporting data are requested.
REPLY: This agency has no objection to the project as proposed.
This agency has no comment on the proposed project.
This agency approves of the project only if the recommended changes are
incorporated. See attached.
This agency objects to the project for reasons described in the attached
comments.
SIGNED u CQ&Al DATE I
itECEiVED
1367 US 17 South, Elizabeth City, NC 27909
Phone: [phone]FAX: [phone];Internet: www.nocoastalmanagement.net JUL 10 2014
An Equal Opportunity \ Affirmative Action Employer
T)CM-MHD CITY

f
DIVISION OF COASTAL MANAGEMENT
FIELD INVESTIGATION REPORT
1. APPLICANT'S NAME: Robert Jackson
2. LOCATION OF PROJECT SITE: 186 Ainsley Rd. (SR#1363) Herford,
Perquimans County, Perquimans River.
Photo Index
2006: 160-6849 (R-16, Q-16)
2000: 160-1759 (S-17)
1995: 160-1648 (Q-16)
1989: 1-18-5 (J-15)
1984: N/A
1978: N/A
State Plane Coordinates - X: 275870 Y: 895890 Hertford UR
3. INVESTIGATION TYPE: CAMA
4. INVESTIGATIVE PROCEDURE: Dates of Site Visit — 6/20/2014
Was Applicant Present - No
5. PROCESSING PROCEDURE: Application Received Complete - 6/20/2014
Office - Elizabeth City
6. SITE DESCRIPTION:
(A) Local Land Use Plan — Perquimans County
Land Classification From LUP - Conservation
(B) AEC(s) Involved: Public Trust Area (PTA), Estuarine Waters (EW),
Estuarine Shore (ES)
(C) Water Dependent: Yes
(D) Intended Use: Private
(E) Wastewater Treatment: Existing - Septic
Planned - None
(F) Type of Structures: Existing - Single family dwelling with attached
deck, detached garage, pier/
platform, one covered boatlift, one
uncovered boatlift, and one jet ski life
mounted on pier
Planned - Roof for two existing boatlifts,
addition to the attached deck,
addition to detached garage, one
3.5'x24' finger pier.
(G) Estimated Annual Rate of Erosion: N/A
Source — N/A
ECE
rJi
UL 0 7 2014

It
0
HABITAT DESCRIPTION: [AREA, square feet]
DREDGED FILLED OTHER
Public Trust Area (PTA),
Estuarine Waters (EW)
75' Estuarine Shoreline AEC.
588 sq. ft.
(shaded/covered)
376 sq. ft.
(disturbed/covered)
(D) Total Area Disturbed: 964 sq. ft. (0.022 acres)
(E) Primary Nursery Area: NO
(F) Water Classification: SC Open: NO
PROJECT SUMMARY:
The applicant proposes to construct a roof over two existing boat lifts, a
finger pier, an addition to the existing detached garage, and an addition to the
existing attached deck.
Project Setting
The site of the proposed development is located on the Perquimans River, in
Perquimans County, at 186 Ainsley Rd. Hertford.
The property is approximately 28,275 square feet (0.64 acre) in size and is
elevated approximately 10 feet above Normal Water Level (NWL). Existing manmade
features on the property consist of a cement driveway leading to a single family dwelling
with an attached deck; a maintained yard vegetated with indigenous grasses, a 24'x30'
detached garage, 107 feet of shoreline stabilized with wooden bulkhead, a pier leading
to a 16'x24' platform,. a 6'xT platform, one jet ski lift, one covered 12'x24 boat lift, and
one uncovered 12'x24' boatlift. According to the United States Department of
Agriculture's Soil Conservation Service the soils on the property are from the conetoe
loamy sand series.
The immediate adjacent property to the south of the Jackson property is a
similarly developed lot with a single family dwelling and shoreline stabilized with
bulkhead. The immediate adjacent property to the north of the Jackson property is a
small portion of land with 60 feet of shoreline stabilized with riprap that is an HOA lot for
community water access. The next property to the. north of the HOA community lot is
the Lane property which is developed with a single family dwelling and shoreline
stabilized with bulkhead.
The Division of Environmental Management classifies the waters within this area
of the Perquimans River as SC and these waters are closed to shellfish harvest. The
average depth of water where the development is being proposed is 3 feet with no SAV

U
present.
Development Proposal
The applicant proposes to remove the existing roof over the south boatlift and
construct a new 28'x37' roof system over the two existing boat lifts. The applicant
proposes to construct a 3.5'x24' finger pier on the northern side of the two boatlifts; this
finger pier will be covered by the 28'x37' roof over the boat lifts. The applicant also
proposes to construct a 12'x16' addition to the existing garage, and a 10'x12' addition to
the existing attached deck.
Anticipated Impacts
1. The new roof system will cause an additional 588 sq. ft. of shading to EW and
PTA. Total shading due to platforms and covered boat lifts would be 1,314 sq. ft.
with the additional 588 sq. ft. from the new roof system.
2. The new deck addition will cause an additional 120 sq. ft. of covered area in the
75 foot AEC.
3. The new garage addition will cause an additional 256 sq. ft of covered area in
the 75 foot AEC.
4. The 3.5'x24' finger pier will be covered by the roof system over the existing boat
lifts and will not cause any additional shading of PTA or EW.
Submitted by: Will Creef
Date: 6/27/2014
010- RECEIVED
JUL 0 7 2014
_J

OVER
North Carolina Department of Environment and Natural Resources
PatMcCrory John E. Skvada, III
Governor Secretary'
August 7, 2014
Robert L. Jackson
186 Ainsley Road
Hertford, NC 27944
DWQ Project # 14-0697
Perquimans County
Subject Property: Jackson Residence 186 A. hsley Road (SR 1416)
. Perquimans River Basin, Perquimans River [PAS 52, 30-6-(7); SB]
Approval of 401 Water Quality Certification (GC3900) with Additional Conditions
Dear Mr. Jackson:
You have our approval,in accordance with the attached,conditions and those listed below, to
construct 3.5 foot x 24 foot finger pier and expand existing roof to cover second boat slip with
proposed shading impact of 688 square feet (0.0135 acres). The proposed project is as.
described within your CAMA'Major application dated July 2, 2014 and received by the N.C.
Division of Water Resources (DWR) on July7, 2014. The Impacts• described in your application
are covered by General Water, Quality Certification Numbers) 3900 (GC3900). This.
Certification(s) is issued in conjunction with the CAMA Major' Permit and General Permit(s)
198000291,.issued by the US Army Corps of Engineers (USACE). This.Certification allows
you to use the CAMA Major Permit when the Division of Coastal Management Issues it
In addition; you should obtain or.otherwise comply with any other required federal, state or local
permits before you go ahead with your project including (but not limited to) Erosion and
.Sediment Control, Non -discharge regulations. Also, this approval to proceed with your
proposed impacts or to conduct impacts to waters as depicted In your application shall
expire upon expiration of the 40.4 or CAMA Permit
This approval is for the purpose and design that you described in your application. Approved
plans and specifications for this project.are incorporated. by reference and are enforceable parts
of the permit. If you change your project, you must notify us and you may be required to send
us a new application: If the property is sold, -the new owner must be given a copy of this
Certification and approval letter and is thereby responsible for complying with all conditions: If
total fills for this project (now or in the future): exceed one acre of wetland or.150 linear feet of
stream, compensatory mitigation may be required as described in 15A NCAC 2H .0506 (h).
This approval•requires you to follow -the conditions listed in the attached certification and any
additional conditions listed below.
DNtston otWater Resources —Water Quality Regional Operations Sedtbn—Washhoton Reglonat Office
943 Washington Square Mall, Washington, NC27889 .
Phone: [phone] %Pax: 252-975-3716% Internet: www.ncdenr.gov

r

Robert L. Jackson,
186 Ainsley Road
August7, 2014
Page 2 of 3
The Additional Conditions of the Certification are:
1. Impacts Approved
The following impacts are hereby approved as long as all of the other specific and general
conditions of this Certification (or Isolated Wetland Permit) are met. No other Impacts are
approved including Incidental impacts:
Amount Approved
(Units)
Plan Location or Reference
-
Stream
feet
404/CAMA Wetlands
acres
Waters
0.0135 acrds shading
Application Plan Sheets
Buffers.
(square ft.
2. Water.Quaitty Certification
The proposed project must comply with all of the conditions of General Water Quality
Certification (GC) 3900.
3. Certificate of Completion
Upon completion of all work approved within the 401 Water Quality Certification or
applicable Buffer Rules, and any subsequent modifications, the applicant is required to
return the attached certificate of completion to the 401 Oversight/Express Review Permitting
Unit, North Carolina Division of Water Quality, 1650 Mail Service Center, Raleigh, NC;
27699-1650.
4. Washing of. boats within docking facility is prohibited as the wash water is considered to be a
wastewater and must be collected and disposed of properly.
Violations of any condition herein set forth may result in revocation of this Certification and may
result in criminal and/or civil penalties. The authorization to proceed with your proposed
impacts or to conduct impacts to waters as depicted in.your application and as authorized by
this Certification shall expire upon expiration of the 404 or CAMA Permit.
If you do not accept any of the conditions of this Certification (associated with the approved
water impacts), you may ask for an adjudidatory hearing. You most act within 60 days of the
date that you receive this letter. To ask for a hearing, send a written petition; which conforms to
Chapter 150B of the North G`arolina General Statutes to the Office of Administrative Hearings,
6714 Mail Servjce Center; Raleigh, N.C. 27699-6714. This certification and its conditions are
final and binding unless you ask for a hearing.

Robert L. Jackson
186 Ainsley Road
August 7, 2014
Page 3 of 3
This letter completes the review of the Division of Water Resources under Section 401 of the
Clean Water Act. If you have any questions, please telephone Roberto Schaller of the
Washington Regional Office at 252=948-3940 or Karen Higgins of the Wetlands, Buffers,
Stormwater, Compliance and Permitting (Webscape) Unit at 919-607-6364.
Sincerely,
Robert Tankard
Assistant Regional Supervisor
Division of Water Resources
Enclosures: Certificate of Completion
GC 3900
cc: Raleigh Bland, Corps of Engineers, Washington Field Office
DWR Webscape Unit
DCM, Doug Huggett, Morehead Office
DCM, Will Creef, Elizabeth City Office
File copy

DIVISION OF COASTAL MANAGEMENT
APPLICATION TRANSMITTAL AND PROCESSING RECORD
A) APPLICANT: Robert Jackson
County: Perquimans
LOCATION OF PROJECT: 186 Ainsley Road, SR #1363, adjacent Perquimans River
DATE APPLICATION RECEIVED COMPLETE BY FIELD REP: 06/20/14
FIELD RECOMMENDATION: Attached: NO To Be Forwarded: YES
CONSISTENCY DETERMINATION: Attached: NO To Be Forwarded: YES
FIELD REPRESENTATIVE: Will Creef DIS ICT OFFICE: Elizabeth City
DISTRICT MANAGER REVIEW: r — Date: 7— /
B) DATE RECEIVED BY MAJOR PERMITS UNIT: FEE REC'D: $ 250 (100%)
PUBLIC NOTICE RECD: Advertise: 07/09/14
ADJ. RIP. PROP NOTICES REC'D:
APPLICATION ASSIGNED TO:
C) 75 DAY DEADLINE: 09/03/ 4
MAIL OUT DATE: Circulation: 07/02/14
FEDERAL DUE DATE:
END OF NOTICE DATE: Comments due: 07/29/14
DEED REC'D:
150 DAY DEADLINE:
STATE DUE DATE: Comments due:07/23/14
FED COMMENTS REC'D:
PERMIT FINAL ACTION: ISSUE DENY
DRAFT ON
AGENCY
DATE
COMMENTS
RETURNED
OBJECTIONS:
YES NO
NOTES
Coastal Management - Regional Representative
—
Coastal Management - LUP Consistency
--)- t N
Division of Community Assistance
Land Quality Section
Division of Water Quality
Storm Water Management (DWQ)
State Property Office
Division of Archives & History
Division of Environmental Health
�t
Division of Highways
Wildlife Resources Commission
—(
i/
Local Permit Office
Division of Marine Fisheries
Corps of Engineers
JUL 0 7 2014
Dcs:•h:;l�crn•

r
NCDENR
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
August It, 2014
Mr. Robert Jackson
186 Ainsley Road
Hertford, NC 27944
Subject: EXEMPTION from Stormwater Management Permit Regulations
CAMA Major- Dredge & Fill / Bulkhead / Pier
Jackson Improvements
Stormwater Project No. SW7140705
Perquimans County
John E. Skvarla, III
Secretary
Dear Mr. Jackson:
The Washington Regional Office received a copy of your CAMA Major application for the proposed roof
over boat lifts, a finger pier and additions to garage and deck, project located at 186 Ainsley Road,
Perquimans County, on July 9, 2014. Staff review of the plans and specifications has determined that the
project, as proposed, consists of activities that will not pose surface water quality threats from stormwater
runoff since no significant new impervious area is proposed.
The Director has determined that projects that are reviewed and approved by the Division as not posing
water quality threats from stormwater runoff should not be subject to the stormwater management
permitting requirements of 15A NCAC 21-1.1000 and SL 2008-211. For this reason, we are informing you
by way of this letter that your project will not require a State Stormwater management permit at this time.
The stormwater rules require the Division to permit the common plan of development, therefore, any
future development on the property, regardless of whether a SEC plan or CAMA Major permit is also
required, will require a Stormwater Management Permit application and permit issuance from the
Division of Energy, Mineral, and Land Resources prior to any construction. Any construction on the
subject site, prior to receipt of the required permit, will constitute a violation of 15A NCAC 2H.1000 and
SL 2008-211 and may result in appropriate enforcement actions by this Office.
Please keep in mind that this determination does not affect your legal requirements to obtain other permits
which may be required by the Division of Water Quality, the Division of Land Resources, Coastal Area
Management Act or any other Federal, State or Local Government.
Please reference the Stormwater Project Number above on all correspondence. If you have any questions
or need additional information concerning this matter, please contact me at [phone].
Sincerely,
Samir Dumpor, PE
Environmental Engineer
PHM/ sd: G:\SD\ EXEMPTED\SW7140706
cc: Daniel Govoni, DCM — Morehead
Washington Regional Office
Division of Energy, Mineral, and Land Resources . Land Quality Section
Washington Regional Office
943 Washington Square Mall, Washington, North Carolina 27889 • Phone: [phone]/ FAX [phone]
Internet: htto.11oonal.ncdenrora/web4rlland-oualily
An Equal Opportunity 1 Affirmative Action Employer - 50% Recycled 110% Post Consumer Paper

NCDENR
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
July 2, 2014
TO:
FROM:
SUBJECT:
Applicant:
Project Location:
Proposed Project:
John E. Skvarla, III
Secretary
JUL - 7 2014
Shellfish Sanitation 6 R'� eation L
Water puality Sacaon
Patti Fowler, Section Chief
Marine Fisheries — Shellfish Sanitation & Recreational Water Quality
Daniel Govoni
Assistant Major Permits Coordinator
Division of Coastal Management
itECEIV&D
CAMA Permit Application Review
Robert Jackson JUL 16 2014
186 Ainsley Road, Perquimans County i1CM-Mmc"
Construct roof over boat lifts, a finger pier, & additions to garage & deck
Please indicate below your agency's position or viewpoint on the proposed project and return this
form by 07/23/14 to 400 Commerce Avenue, Morehead City, NC 28557 (fax: [phone]):
If you have any questions regarding the proposed project, please contact Will Creef at (252) 264-
3901. When appropriate, in-depth comments with supporting data are requested.
REPLY: ` This office has no objection to the project as proposed.
JThis office has no comment on the proposed project.
This office approves of the project only if the recommended changes are
incorporated. See attached.
This office objects to the project for reasons described in the attached
comments.
SIGNED avk— Yam.___ R` P'l}' DATE
7/ 1y/ (4
1367 US 17 South, Elizabeth City, NC 27909
Phone: [phone] FAX: [phone] ; Internet: www.nocoastalmanagement.net
An Equal Opportunity 1 Affirmative Action Employer

w
NCDENR
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
G, ty.o-J.o8,01
July 2, 2014
TO: Maria Tripp Dunn
NC Wildlife Resources Commission
FROM: Daniel Govoni
Assistant Major Permits Coordinator
Division of Coastal Management
SUBJECT: CAMA Permit Application Review
Applicant: Robert Jackson
Project Location: 186 Ainsley Road, Perquimans County
John E. Skvarla, III
Secretary
JUL 2014
RECEMob Mtn
comwva 0n
Proposed Project: Construct roof over boat lifts, a finger pier, & additions to garage & deck
Please indicate below your agency's position or viewpoint on the proposed project and return this
form by 07/23/14 to 400 Commerce Avenue, Morehead City. NC 28557 (fax: [phone]).
If you have any questions regarding the proposed project, please contact Will Creef at (252) 264-
3901. When appropriate, in-depth comments with supporting data are requested.
scnt;wvnu
REPLY: This office has no objection to the project as proposed. r
JUL 16 2014
_,Z'This office has no comment on the proposed project.
This office approves of the project only if the recommended chanDgeess arse
CrrY
incorporated. See attached.
This office objects to the project for reasons described in the attached
comments.
SIGNED DATE II- 73
1367 US 17 South, Elizabeth City, NC 27909
Phone: [phone] \ FAX: [phone] ; Internet: www,nocoastalmanagement.net
An Equal Opportunity \ Affirmative Action Employer

L
Q�i
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Resources
Pat McCrory
Governor
July 14, 2014
MEMORANDUM:
To: Daniel Govoni
Assistant Major Permits Coordinator
Coastal Management Division
400 Commerce Avenue
Morehead City, INC 28557
From: Dyk Luben, P.E., Acting Regional Engineer, PWSS/WaRO
Subject: CAMA Application Review
Applicant: Robert Jackson
Project Location: 164 Hertford Beach Road, SR #1353, Perquimans County.
John E. Skvarla, III
Secretary
Proposed Project: Reconfigure existing moorings, adding 2 new moorings for a total of 20 moorings
for jet skis & small motor boats, & construct 3 finger piers.
REPLY: This office has no objection to the project as proposed.
X This office has no comment on the proposed project.
This office approves of the project only if the recommended changes are
incorporated. See attached.
This office objects to the project for reasons described in the attached
comments.
SIGNED
z Z/1,,—
Public Water Supply Section
Washington Regional Office
943 Washington Square Mall, Washington, North Carolina 27889
Phone: [phone] FAX: [phone]Internet: wwwncwatenorg/pws/
An Equal Opportunity 1 ARumabve Action Employer
DATE ����0/
It�CEIWsD
rkh. 16 2014
ti

Ir
2
DIVISION OF COASTAL MANAGEMENT
FIELD INVESTIGATION REPORT
1. APPLICANT'S NAME: Robert Jackson
2. LOCATION OF PROJECT SITE: 186 Ainsley Rd. (SR#1363) Herford,
Perquimans County, Perquimans River.
Photo Index
2006: 160-6849 (R-16, Q-16)
2000: 160-1759 (S-17)
1995: 160-1648 (Q-16)
1989: 1-18-5 (J-15)
1984: N/A
1978: N/A
State Plane Coordinates - X: 275870 Y: 895890 Hertford UR
3. INVESTIGATION TYPE: CAMA
4. INVESTIGATIVE PROCEDURE: Dates of Site Visit — 6/20/2014
Was Applicant Present - No
5. PROCESSING PROCEDURE: Application Received Complete - 6/20/2014
Office - Elizabeth City
6. SITE DESCRIPTION:
(A) Local Land Use Plan — Perquimans County
Land Classification From LUP - Conservation
(B) AEC(s) Involved: Public Trust Area (PTA), Estuarine Waters (EW),
Estuarine Shore (ES)
(C) Water Dependent: Yes
(D) Intended Use: Private
(E) Wastewater Treatment: Existing - Septic
Planned - None
(F) Type of Structures: Existing - Single family dwelling with attached
deck, detached garage, pier/
platform, one covered boatlift, one
uncovered boatlift, and one jet ski life
mounted on pier
Planned - Roof for two existing boatlifts,
addition to the attached deck,
addition to detached garage, one
3.5'x24' finger pier.
(G) Estimated Annual Rate of Erosion: N/A
Source — N/A
RECEM
JUL 16 2014
DCM-M0 CITY

7. HABITAT DESCRIPTION: [AREA, square feet]
DREDGED FILLED
Public Trust Area (PTA),
Estuarine Waters (EW)
75' Estuarine Shoreline AEC
OTHER
588 sq. ft.
(shaded/covered)
376 sq. ft.
(disturbed/covered)
(D) Total Area Disturbed: 964 sq. ft. (0.022 acres)
(E) Primary Nursery Area: NO
(F) Water Classification: SC Open: NO
8. PROJECT SUMMARY:
The applicant proposes to construct a roof over two existing boat lifts, a
finger pier, an addition to the existing detached garage, and an addition to the
existing attached deck.
Proiect Setting
The site of the proposed development is located on the Perquimans River, in
Perquimans County, at 186 Ainsley Rd. Hertford.
The property is approximately 28,275 square feet (0.64 acre) in size and is
elevated approximately 10 feet above Normal Water Level (NWL). Existing manmade
features on the property consist of a cement driveway leading to a single family dwelling
with an attached deck; a maintained yard vegetated with indigenous grasses, a 24'x30'
detached garage, 107 feet of shoreline stabilized with wooden bulkhead, a pier leading
to a 16'x24' platform, a 6'xT platform, one jet ski lift, one covered 12'x24 boat lift, and
one uncovered 12'x24' boatlift. According to the United States Department of
Agriculture's Soil Conservation Service the soils on the property are from the conetoe
loamy sand series.
The immediate adjacent property to the south of the Jackson property is a
similarly developed lot with a single family dwelling and shoreline stabilized with -
bulkhead. The immediate adjacent property to the north of the Jackson property is a
small portion of land with 60 feet of shoreline stabilized with riprap that is an HOA lot for
community water access. The next property to the north of the HOA community lot is
the Lane property which is developed with a single family dwelling and shoreline
stabilized with bulkhead.
The Division of Environmental Management classifies the waters within this area
of the Perquimans River as SC and these waters are closed to shellfish harvest. The
average depth of water where the development is being proposed is 3 feet with no SAV

r
present.
Development Proposal
The applicant proposes to remove the existing roof over the south boatlift and
construct a new 28'x37' roof system over the two existing boat lifts. The applicant
proposes to construct a 3.5'x24' finger pier on the northern side of the two boatlifts; this
finger pier will be covered by the 28'x37' roof over the boat lifts. The applicant also
proposes to construct a 12'x16' addition to the existing garage, and a 10'x12' addition to
the existing attached deck.
Anticipated Impacts
1. The new roof system will cause an additional 588 sq. ft. of shading to EW and
PTA. Total shading due to platforms and covered boat lifts would be 1,314 sq. ft.
with the additional 588 sq. ft. from the new roof system.
2. The new deck addition will cause an additional 120 sq. ft. of covered area in the
75 foot AEC.
3. The new garage addition will cause an additional 256 sq. ft of covered area in
the 75 foot AEC.
4. The 3.5'x24' finger pier will be covered by the roof system over the existing boat
lifts and will not cause any additional shading of PTA or EW.
Submitted by: Will Creef
Date: 6/27/2014
RECEIVED
JUL 16 2014
DCM-MHD CITY

To: CAMA, "y. "�— W r < < C EF f=
Fr: Robert L Jackson
186 Ainsley Rd
Hertford, NC 27944
757 618-7569, robdibrenCcDgmail.com
Subj: CAMA Major Permit Application
End (1) DCM MP-1
End (2) DCM MP-3
End (3) DCM MP-4
End (4) Existing configuration
End (5) Proposed configuration
End (6) Boat House front elevation
End (7) Boat House side elevation
End (8) Lot Survey
End (9) Site survey/sketch
End (10) Current Aerial View
End (11) CAMA 33759
End (12) CAMA 39502
End (13) CAMA 57221
End (14) Riparian Letter 174 Ainsley
End (15) Riparian Letter 192 Ainsley
End (16) Riparian Letter HOA Lot
End (17) Aerial View HOA Lot
End (18) Cover sheet of Deed of Trust
JUN 18 2014
PA,gD �ELI�E�ED
' 1 kE«y Ru ssFc-
1. Respectively submitting request to accomplish modifications and additions to existing waterfront
structures as delineated below, and shown on Enclosures 4 thru 9.
2. Discussions of specific additions and changes, and rationale provided
a. Request permission to remove existing gable roof system over one boat lift, as
authorized in End 12. Request authorization to build a 24 foot by 33 foot gable roof with
2 foot overhangs over both existing boat lift. Second boat lift authorized via End 13.
b. Request permission to construct 3 foot finger pier on outboard side of second boat lift, 2
feet of which will be covered by new roof system.
c. Request permission to build 20 foot by 16 foot extension to existing garage that extends
to within 68 feet of waterline.
d. Request permission to build 12 foot by 10 foot extension to existing deck that extends to
within 68 feet of waterline.
3. These variances are requested to provide protection from the elements to watercraft already docked
on approved structures.
4. Your considerations of these requests are greatly appreciated and please contact me for any
additional information needed for evaluation. In addition to signatures on the riparian letters, I have
rJU
RECEIVED
L 16 2014
flCbt-Ml)f6CtTY

V/R
asked the adjoining neighbors to sign this document as well, to ensure
changes requested. I _:.. _- . -`/
JUN 1 8 2014
GOFlSTPI _ 'ec—"; -"T
Robert Jackson
I have read and understand the changes/additions Mr Jackson is requesting and have no objections
Alva Renshaw 192 Ainsley Rd - -�%� (� 7f1/���1���� Date
G.A. Lane 174 Ainsley Rd Date `'
HAI /111cH7fEz- (i{/iNSLuw (F4 167
MA -I k (A/�•t•sc.i�f.9/ (t�bA LoT

gem MP-1
APPLICATION for
NOW Development
(last revised 12/27/06)
JUN 1 8 2014
]VISION OF COASTAL MANAGEMENT
1. Primary Applicant/Landowner Information
Business Name
Project Name (if applicable)
Na
NA
Applicant 1: First Name
MI
Last Name
Robert
L
Jackson
Applicant 2: First Name
MI
Last Name
NA
NA
NA
If additional applicants, please attach an additional pages) with names listed.
Mailing Address
PO Box
City
State
186 Ainstey Rd
Hertford
NC
ZIP
Country
Phone No.
FAX No.
27944
USA
757-618-7569 ext.
NA -
Street Address (d different from above)
City
State
ZIP
NA
Email
[e-mail]
2. Agent/Contractor Information
Business Name
NA
Agentl Contractor 1: First Name
MI
Last Name
Agent/ Contractor 2: First Name
MI
Last Name
Mailing Address
PO Box
City
State
ZIP
Phone No. 1
-
- ext.
Phone No. 2
- ext.
FAX No.
Contractor #
Street Address (d different from above)
City
State
ZIP
Email
JUL 1 b (Ult
<Form continues on back>
DCM-MHU CITY
CNG` /1 252-808-2808 . 1-888-4RCOAST .. www.nccoasfairvsarase;nent.net

Form DCM MP-1 (Page 2 of4)
";_a
APPLICATION for
Major Development Permit
JUN 18 2014
3. Project Lo'caton
County (can be multiple)
Street AddressState
Rd. #
Perquimans
186 Ainsley Rd
SR 1416
Subdivision Name
City
State -
Zip
Chesterfield Hts
Hertford
NC
27944 -
Phone No.
Lot No.(s) (if many, attach additional page with list)
757 - 618 - 7569 ext.
8, 1 1 ,
a. In which NC river basin is the project located?
b. Name of body of water nearest to proposed project
Perquimans
Perquimans River
c. Is the water body identified in (b) above, natural or manmade?
d. Name the closest major water body to the proposed project site.
®Natural ❑Manmade ❑Unknown
Perquimans River
e. Is proposed work within city limits or planning jurisdiction?
I. If applicable, list the planning jurisdiction or city limit the proposed
®Yes []No
work falls within. -
Perquimans County
4 Sffe;Descrlphon '�� � � 3 "'
y
a. Total length of shoreline on the tract (ft.)
b. Size of entire tract (sq.ft.)
'y�try .
107
28,275 SF C 0' 0 aae� ' �"
c. Size of individual lot(s)
d. Approximate elevation of tract above NHW (normal high water) or
28,275 SF,
NWL (normal water leveo
(If many lot sizes, please attach additional page with a list)
10 ft ❑NHW or ®NWL
e. Vegetation on tract
Domestic and ornamental grasses
L Man-made features and uses now on tract
-
Residential: House, Garage, Drive Way, Septic, Pier
g. Identify and describe the existing land uses adiacent to the proposed project site.
Residential
h. How does local government zone the tract?
I. Is the proposed project consistent with the applicable zoning?
RA 25
(Attach zoning compliance certificate, if applicable)
®Yes []No ❑NA
j. Is the proposed activity part of an urban waterfront redevelopment proposal? ❑Yes ®No
k. Has a professional archaeological assessment been done for the tract? If yes, attach a copy. ❑Yes ®No ❑NA
If yes, by whom?
I. Is the proposed project located in a National Registered Historic District or does it involve a Was []No ❑NA
National Register listed or eligible property?
<Form continues on next page>
ENcL(f) 252-8e8-2808 :: 1.888-4RCOAST :: www.nccoastalmanagement,net

Form DCM MP-1 (Page 3 of 4)
JUN 18 2014�
APPLICATION for
Major Development Permit
m. (i) Are there wetlands on the site? Yes ®No
(ii) Are there coastal wetlands on the site? ❑Yes ®No
(iii) If yes to either (i) or (ii) above, has a delineation been conducted? []Yes []No
(Attach documentation, if available)
n. Describe existing wastewater treatment facilities.
Gravity Flow Septic System
o. Describe existing drinking water supply source.
County Water
p. Describe existing storm water management or treatment systems.
Existing swale along front of property draining to a vegetated drainage ditch that extends to the river
5. Activities and Impacts
a. Will the project be for commercial, public, or private use? ❑Commercial ❑PublidGovemment
®Private/Community
b. Give a brief description of purpose, use, and daily operations of the project when complete.
Request removal of existing roof, request new gable roof system over existing boat lifts per attached drawing. One roof
system over both existing lift of approximately 28' by 3T. Add 42"' finger pier outboard on second boat lift. Request
permission to add to existing garage, per drawing, within the 75" AEC buffert. Request permission to add to existing deck,
per drawing, within the 75" AEC buffer.
c. Describe the proposed construction methodology, types of construction equipment to be used during construction, the number of each type
of equipment and where It is to be stored.
Wood construction. No equipment other than hand tools. Concrete footers for garage extension will be delivered to site by
wheel barrows
d. List all development activities you propose.
One new roof system over existing boat lifts. One 42" by 24' finger pier. Extension to existing garage, 12' by 16', to encroach
within the 76 AEC buffer. Extension to existing deck, 10' by 12', to encroach within the 75' AEC buffer.
e. Are the proposed activities maintenance of an existing project, new work, or both? Both
I. What is the approximate total disturbed land area resulting from the proposed project? 600 ®Sq.Ft or []Acres
g. Will the proposed project encroach on any public easement, public accessway or other area []Yes ®No ❑NA
that the public has established use of?
h. Describe location and type of existing and proposed discharges to waters of the state.
Surface runoff, no changes
i. Will wastewater or atornwater be discharged into a wetland? ❑Yes ®No ❑NA
If yes, will this discharged water be of the same salinity as the receiving water? ❑Yes ❑No ❑NA
j. Is there any mitigation proposed? ❑Yes ®No ❑NA
If yes, attach a mitigation proposal.
<Form continues on backs 'F JUL 1
1 6 2014
252-808-2808 .. 1-888.4RCOAST :. �,:. ,,nccoastalmanageme

Form DCM MP-1 (Page 4 of 4)
APPLICATION for
Major Development Permit
1 8 2014
6 Additronallnformahon
In addition'to thrs completed `appkcahon form (MF 1) the following de s beta ,rE.apphsapje-mus a subm ted in r for the a fib abor
package to be complete Items (a)-- (fJ aie ahvays appkcablea¢ any malordevejopment appkcahon Please consult the appkcahon _
instruction booklet on how to properly, prepare the required items below __._ - _ _ - _ -
a. A project narrative. - -
b. An accurate, dated work plat (including plan view and cross -sectional drawings) drawn to scale. Please give the present status of the
proposed project. Is any portion already complete? If previously authorized work, clearly indicate on maps, plats, drawings to distinguish
between work completed and proposed. ,
c. A site or location map that Is sufficiently detailed to guide agency personnel unfamiliar with the area to the site.
d. A copy of the deed (with state application only) or other instrument under which the applicant claims title to the affected properties.
e. The appropriate application fee. Check or money order made payable to DENR.
f. A list of the names and complete addresses of the adjacent waterfront (riparian) landowners and signed return receipts as proof that such
owners have received a copy of the application and plats by certified mail. Such landowners must be advised that they have 30 days in
which to submit comments on the proposed project to the Division of Coastal Management.
i Name Alva Reni iaw . _ ; Phone No; 252-862-6327-
'Address4192 Ainsley Rd
Name G.A. Lane Phone No. 252426-5505
Address 174 Ainsley Rd
Name JohnWichael and Mark Winslow _ Phone'No.252 337-4163
i Address 222 Ainsley Rd
g. A list of previous stale or federal permits issued for work on the project tract. Include permit numbers, permittee, and issuing dates.
Copies Attached
h. Signed consultant or agent authorization torn, if applicable.
i. Wetland delineation, if necessary.
j. A signed AEC hazard notice for projects in oceanfront and inlet areas. (Must be signedby property owner)
k. A statement of compliance with the N.C. Environmental Policy Act (N.C.G.S. 113A 1-10), if necessary. If the project involves expenditure
. of public funds or use of public lands, attach a statement documenting compliance with the North Carolina Environmental Policy Act.
1 understand that any permit issued in response to this application will allow only the development described in the application.
The project will be subject to the conditions and restrictions contained in the permit.
I certify that I am authorized to grant, and do in fact grant permission to representatives of state and federal review agencies to
enter on the aforementioned lands in connection with evaluating information related to this permit application and follow-up
monitoring of the project.
I further certify that the information provided in this application is truthful to the best of my knowledge.
Date _14 April 2014 Print Name —F3pbert L. Jackso4
Signature
Please indicate application attachments pertaining to your proposed project.
❑DCM MP-2 Excavation and Fill Information ❑DCM MP-5 Bridges and Culverts
EDCM MP-3 Upland Development
EDCM MP-4 Structures Information
252-808.2808 :: 1.888-4RC®A5T :: www.necoostalmanagement.net

Form DCM MP-3
UPLAND DEVELOPMENT
(Construction and/or land disturbing activities)
J U N 18 2014
Attach this form to Joint Application for CAMA Major Permit, Form DCM MP-1. Be sure to complete all other sections of the Joint
Application that relate to this proposed project. Please include all supplemental information.
GENERAL UPLAND DEVELOPMENT
a. Type and number of buildings, facilities, units or structures b. Number of lots or parcels.
proposed. I
Addition to existing garage, 14' by 17' includes overhangs
(drip line). Actual size 12' by 16. Addition to existing deck,
10" x 12"'
c. Density (give the number of residential units and the units per
acre).
NA
e. If the proposed project will disturb more than one acre of land, the
Division of Land Resources must receive an erosion and
sedimentation control plan at least 30 days before land -disturbing
activity begins.
(i) If applicable, has a sedimentation and erosion control plan been
submitted to the Division of Land Resources?
❑Yes ❑No ❑NA
(ii) If yes, list the date submitted: NA
g. Give the percentage of the tract within the coastal shoreline AEC to
be covered by impervious and/or buift-upon surfaces, such as
pavement, building, rooftops, or to be used for vehicular driveways
or parking.
Less than 5%
I. Give the percentage of the entire tract to be covered by impervious
and/or built -upon surfaces, such as pavement, building, rooftops,
or to be used for vehicular driveways or parking.
19%
j. Describe proposed method of sewage disposal.
NA
I. Describe location and type of proposed discharges to waters of the
state (e.g., surface runoff, sanitary wastewater, industrial/
commercial effluent, 'wash down" and residential discharges).
No Changes
d. Size of area to be graded, filled, or disturbed including roads,
ditches, etc.
600 sq ft, includes footer and disturbed adjacent land
f. List the materials (such as marl, paver stone, asphalt, or concrete)
to be used for impervious surfaces.
Concrete for footer of garage
h. Projects that require a CAMA Major Development Permit may also
require a Stornwater Certification.
(i) Has a site development plan been submitted to the Division of
Water Quality for review?
[]Yes ❑No ®NA
(ii) If yes, list the date submitted:
k. Have the facilities described in Item (i) received state or local
approval?
❑Yes ❑No ®NA
If yes, attach appropriate documentation.
m. Does the proposed project include an innovative stornwater
design?
❑Yes []No ®NA
If yes, attach appropriate documentation.
RBCEWall
JUL 16 2014
252-808-28082 :: R-888.4RCOAST :: vv w.nccoaataimanaaemsnt.net
2126/06

FOrM DCWC MP-3 Upland Development, Page 2 of 2)
m. Describe proposed drinking water supply source (e.g., well, n. (1) Will water be impounded? []Yes ®No ❑NA
community, public system, etc.)
(ii) If yes, how many acres?
Public - existing
o. When was the lot(s) platted and recorded?
1986
CApplicant Signature
p. If proposed development is a subdivision, will additional utilities be
installed for this upland development?
❑Yes ®No ❑NA
JUN 18 2014
L , J also pl (6lZol2o,q))
. WY -
elf
JUN 2 0 2014
COASTM. -..`NT
252-808-2608 1-086-4RCOAST :: wnrow.nccoasWmanaFjerAent.ne4 revised: 12/26/06

Form DCM MP-4
STRUCTURES
(Construction within Public Trust Areas)
Attach this form to Joint Application for CAMA Major Permit, Form DCM MP-1. Be sure to complete all other sections of the Joint
Application that relate to this proposed project. Please include all supplemental information.
1. DOCKING FACILITY/MARINA CHARACTERISTICS
a. (i) Is the docking facility/marina:
❑Commercial ❑PubliclGovemment ®Private/Community
[]This section not applicable
b. (i) Will the facility be open to the general public?
❑Yes ONO
c. (1) Dock(s) and/or pier(s)
d. (i) Are Finger Piers included? ®Yes []No
(ii)Number 1 Existing
If yes:
(III) Length
(i) Number 1
(iv) Width
(III) Length 24'
(v) Floating ❑Yes []No
(Iv) Width 42"
(v) Floating []Yes ®No -
e. () Are Platforms included? ®Yes []No
f. (i) Are Boatlift included? ®Yes []No
If yes:
If yes:
(it) Number 2 existing
(i) Number 2
(III) Length
(III) Length 24'
(N) Width
(N) Width 12'
(v) Floating []Yes ❑No
Note: Roofed areas are calculated from dripline dimensions.
g. (!)Number of slips proposed
h. Check all the types of services to be provided.
0
❑ Full service, including travel lift and/or rail, repair or
(i) Number of slips existing
maintenance service
2
❑ Dockage, fuel, and marine supplies
❑ Dockage ('Wet slips) only, number of slips:
❑ Dry storage; number of boats:
❑ Boat ramp(s); number of boat ramps:
® Other, please describe:
Private residential
I. Check the proposed type of skiing:
❑ Land cut and access channel
❑Open water; dredging for basin and/or channel
❑Open water, no dredging required
[]Other; please describe:
NA
k. Typical boat length: 20
in. (1) Will the facility have tie pilings?
[]Yes ®No
(it) If yes number of tie pilings?
a&t t_
252-808-2808 ::
j. Describe the typical boats to be served (e.g., open runabout,
charter boats, sail boats, mixed types).
PWC. Pontoon, Center Console
I. (i) Will the facility be open to the general public?
❑Yes ONO
ri
BECE►MD
L 16 2014
:: www.nccoastaimanauement.net
12/27/06

FOrM DCM € P-4 (Structures, (page 2 of 4)
a. Check each of the following sanitary facilities that will be included in the proposed project.
❑ Office Toilets
❑ Toilets for patrons; Number: _; Location:
❑ Showers
❑ Boatholding.tank pumpout Give type and location:
J. Describe treatment type and disposal location for all sanitary wastewater.
c. Describe the disposal of solid waste, fish offal and trash.
d. How will overboard discharge of sewage from boats be controlled?
e. (i) Give the location and number of "No Sewage Discharge" signs proposed.
(ii) Give the location and number of'Pumpoul Available" signs proposed.
f. Describe the special design, if applicable, for containing industrial type pollutants, such as paint, sandblasting waste and petroleum products.
g. Where will residue from vessel maintenance be disposed of?
h. Give the number of channel markers and "No Wake" signs proposed.
i. Give the location of fuel -handling facilities, and describe the safety measures planned to protect area water quality.
j. What will be the marina policy on overnight and live -aboard dockage?
k. Describe design measures that promote boat basin flushing?
I. If this project is an expansion of an existing marina, what types of services are currently provided?
m. Is the marina/docking facility proposed within a primary or secondary nursery area?
❑Yes ❑No';P.
252-808-2806 :: 1-688-4RCOAST :: wwwr.nccoastalmanamemont.not revised: 12/27/06

Form DCM MP-4 (Structures, Page 3 of 4) ( JUN 18 2014
n. Is the marina/docking facility proposed within or adjacent to any shellfish harvesting areal --
[]Yes ❑No !
o. Is the marina/docking facility proposed within or adjacent to coastal wetlandstmarsh (CW), submerged aquatic vegetation (SAV), shell bottom
(SB), or other wetlands (WL)? If any boxes are checked, provide the number of square feet affected.
❑CW ❑SAV ❑SB
OWL ❑None
p. Is the proposed marina/docking facility located within or within close proximity to any shellfish leases? []Yes []No
If yes, give the name and address of the leaseholder(s), and give the proximity to the lease.
3. BOATHOUSE (including covered lifts) [I This section not applicable
a. (i) Is the boathouse structure(s):
❑Commercial ❑Public/Government ®Private/Community
(ii) Number 1
(iip Length 28'
(iv) Width 37'
Note: Roofed areas are calculated from ddpline dimensions.
4. GROIN (e.g., wood, sheetpile, etc. If a rock groin, use MP-2, Excavation and Fill.) ®This section not applicable.:
a. (i) Number
(ii) Length
(iii) Width
5. BREAKWATER (e.g., wood, sheetpile, etc.) ®This section not applicable
a. Length b. Average distance from NHW, NWL, or wetlands
c. Maximum distance beyond NHW, NWL or wetlands
6. MOORING PILINGS and BUOYS ®This section not applicable
a. Is the structure(s):
❑Commercial ❑PublictGovernment ❑Private/Community
a Distance to be placed beyond shoreline _
Note: This should be measured from marsh edge, if present.
e. Arc of the swing _
7. GENERAL
b. Number
d. Description of buoy (color, inscription, size, anchor, etc.)
RECEIVEDI.
JUL 16 2014
DC:M-hIHD C"
252-808-2808 ::
:: www.nccoastalmanaaement.net
revised: 12127/06

Form DCM MP-4 (Structures, Page 4 of 4)
a. Proximity of structures) to adjacent riparian property lines
5' and 50'
Note: For buoy or mooring piling, use arc of swing including length
ofvessel.
c. Width of water body
3/4 mile
e. (1) Will navigational aids be required as a result of the project?
❑Yes ®No ❑NA
(ii) If yes, explain what type and how they will be implemented.
a. Give complete description:
see attached,narrative
b. Proximity of structure(s) to adjacent docking facilities.
150'
d. Water depth at waterward end of structure at NLW or NWL
3'
252-808-2808 :e 1-888-4RCOASi :: vuwrw.necoastalmnnaPoment.nat revised: 92/27/06

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ROBERT L. JACKSON
AND WIFE.
DIANA L. JACKSON
LOT NO. 8 • CHESTERFIELD HEIGHTS
PARKVILLE TOWNSHIP
PEROUIMANS COUNTY. NORTH CAROLINA
SCALE: r. 50' AUGUST of 2001
0 25 30 100 150 200
1 1 REFERENCES,: PLAT CABINET 2, SLIDE $MAP l2
DEED BOOK 123, PAGE 799
2 1 AREA = 28,275SOUARE FEET 10.649 ACRE)
3 1 THIS TRACT L/ES WITHIN FEMA. FLOOD ZONE'A-5"
Y BASE FLOOD ELEVATION 7.0' M.5.L.1
SEE FIRM 370316 0120 B,
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V7CINITY SKETCH

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Perquimans County, NC
PIN Number..
7859-85-7732
Parcel Number.
5-DO51-0008-CH
OwnerName:
JACKSON, ROBERT L. & DIANA L.
��,acrs
PROPERTY MAP
Owner Address:
186AINSLEYROAD
a 2�.
Owner Address 2:
HERTFORD, NC 27944 -
�+e
Drstlaimer
Owner Address 3:
-
Theaaw Pmi vmaPreparea lm Neimem Ireai
myo wopany rmmaw;mm
Owner Account
C.M.mama
rddatm.rsmrmy, mcmnnre.9�mumkam mraeayshouaeoar,a„aemmmaeucrecma: Description:
#8527700
CH
#B CHESTERFIELD HGHT
enaaaa.maamh.Pm Mmrmmcnai µ,vmn only n 1,iaeanveuesuwme
Taavv
brawe4ac scats,, PmpetlY vppaaalsurveY, or formn�nprmifiuiaen.
Deed Book:
1m____
120
—
Plat Map: 12
Plat Slide: 3
Record Date:
Sold Date:
Deed Acres: N Tax Value: 458,900
Use Value:
Township: PARKVILLE One Inch = 60 Feet

GENIb L ERaCJtl�
-/.
x i
tl t15"9Fl
Ke'w' ❑Modiflcation ❑Complete Reissue
OPartial Reissue
Previous permit #
Date revious permit issued
P
As,authorized by the State of North Carolina, Department of Environment
and Natural Resources
and the Coastal'Resources Commission in an area of environmental concern pursuant to 15A NCAC
- Rules attached '
Applcant"tJame n"�� Q �kC (�CS���
_
r}4 prolecr.Locatlon
County ReQcicf+ trd us Cnoctiu
Address' arl�t3'' �DR�� ?E�f7a�itf�t #�y1vF
t
Street Address/State'Road/Lot#(s) �D'f' f�
clty�'t�esao�akP Statel�+'r ZIP�=J72►
Ar�S�ey
d�+Civ�
Subdivision
Authgnzed Agents
f� i c iC
City pE�criaraa v 6' �rluc %l� ZIP .
Affected ❑CW EIFN PTA A'g]Es ❑PYS
Phone# (_)
River Basin
❑OF,A D.ON 0USA ❑N/A
AEC(s);
Ad) Wtr. Body
�7 o '-
I G1GGr °atv5, (nat /man /unknl
ORW: yes / Co PAPA yes / 0 Crit. Hab.
yes / Lftp Closest Mal. Wtr.'Body P�'Iy ff<r: u spa s / the +e - .
-a, If <
Type of Project/ Activity
Pier (dock) length .__.._.
Platfonn(s) 1 I -%U
Finger pier
(s)
Groin length
number —'-"
Bulkhead/ Ripmp length
avg distance offshore!
max distance offshore
Basin, channel
cubic yards
i
Boat ramp L'- iSF;INS-
Boathouse/ Boadift
—i �..efF_TieYSfF
Beach Bulldozing
Other P-6+ 2lu5
ANI 1 8 2014
'-
(Scale:�,)i5 )
iSantlbrags not sure lst 9Ye5-�'d-dk� � � ... - - �.'�G)tSc. /C� - �•- i �-- l i r�[;;, t:kllv[..:�
Moratonum n a
I n li
f { -
rWa,verAttachedf,.r yes �i
A building p"er' mit may be required by: fn_04 A+ ❑ See note on back regarding River Basin rules.
idotes/Special Conditions '% H. /j 0 Z)
�NG L `/ /

' ? CARAA / -- DREDGE & FILL
iLGENERAPERMIT
❑New uModification 'complete Re sue is elssue
As authorized by the State of North Carolina, Departure t of Environment
and the Coastal Resources Commission in an area off"envi{onmej'tal cQ4l
Applicant Name RV6/tek I L, 13MLIN$DgJ
Address ' 8 (p A I,N S! Cy I\ 040 ' -.
City 4164+g0m State 0 C- ZIP a194q
Phone # (ZYA) 33-3 I fYY Fax #
Authorized Agent
Affected --CW w '<PTA ES PTs
C OEA HHF IH USA N/A
AEC(s):
PWS: FC:
ORW: yes / dp PNA yes / 4V Crit. Hab. yes /
;�T" A 0
Previous permit #
Date previous permit Issued
eso ces
ISA CAC a�
- �RUles aE�tasched. l
at ation Countyi 1pM4;J (..Ottslr"�Y
Address/ State Road/ Lot #(s) 19'4 40S /ey
Subdivision_�yews. f}c,2e;_
City_---- ---------- ZIP_
Phone # (_ ) River Basin RIV&D 44PU 1-
Adj. Wtr. Body°- NMfo;s /�"/v6,t�anunkn)
Closest Maj. Wtr. Body,41A'eW 'Vd•
Type of Project/ Activity AlP—W pI�A , ld/A-1-4404 1— 60A4A10otSE-
Pier dock length /49
Platform(s)-29—t kAA2J�_--_ `�l_Ieftll t[Nt1t} $ /L
Finger pier(s) RIUEro� Au TH0kl ZCd
Groin length Nw P/E'e *-
number_ _ Pk4-rp=uQm w.
Bulkhead! Nprap length_- ($�RYnomS 2
avg distance offshore_
max distance offshore130y
Basin, channel _ I 1 4 1 R
cubic yards
Boat ramp _ I_
Boathouse/ Boadlf:A�w
Beach Bulldozing_ -
Other
Shoreline Length _. /'9 L /
SAV: not sure yes V
k-
Sandbags: not sure yes ® Z t c k si v&7
Moratorium: ® yes no
Photos: 0> no -
Waiver Attached: yes no �..
A building permit may be required by: QeA 44/N*AAS C'QNIV7y
� v I
Notes/ Special Conditions
�tj,�Agent or Applicant Printed Name
Signature -1
Please read compliance statement on back of permit
JIL-2 °
Application Fee/s) CA/CL �2� Check,#
r P/L 1,+9W,�i'
RECENED
6 rbt`o$Q$4k regarding River Basin rules.
DCMMfI c"
Permit Officer's Signatu e
Issuing ate E piianon Zteo
P;Xtq�.ucF•:.
Local PIa/71�'ingJunsdiccion Rovei Fde Name

o 'VICAMA /,q DREDGE & FILL
(GENERAL PERMOT
XNew ElModification Ocomplete Reis!
As authorized by the State of North Carolina, Department
and the Coastal Resources Commission in an area of envirc
Affected --­ N- -- I-- I- --
AEC(s): 0 OEA 0 HHF D IH DUBA DN/A
50WS.� 211
ORW: yes yes Crit.Ha�. ye
Iro -) to�
U
Previous permit #
Date previous permit issued
' I �
�t&tXcl&eW gfiiV Road/
cad/ Lot #
ot#
(s).
ON7
Subdivision -,
C ty.
ZIP-i,:
Phone # '&'er Basin Lak"
qkdj. W,tr. Body �9-rc, na an ./Unkn)'
2`1
ClosesttMaj.-f.W.tr.$od,Y`, I W 'iV
Type of I Project/ Activity. O-D n stnul
Q,-
3 'A j
a ' +nc,
�-r (1i cr rLYL-cL
-fnr
bna+
I ITT
'(Scale: +6
3-ci,
Cidd pil'incS
Pier (dock) length_
Platform(s) - —.-1 - -
-7 ---
--T
Finger r
P
Gr
L . . . . . . .
7
number
r
7
7
BU he'll R'i'prap length_ I
avg distance offshore
LA .....
max distance offshore
Basin, channel
--r -
-L—
—J
cubic yards r
—T-
Z-
A
-1
-
Boat ramp
Boathouse/ Boatlift 1T)e-L0
Beach Bulldozing
Other
iv Wi-
!7!!
,Shoreline Length
sSAYg-Y, o�
.moratorium,,
i
T
I
tJ
rrr,
4 --4
fS
�PhoFP7 y
W
yes no
kT r.
..... ;l,
Waiver A "h'd .. ....
A building permit may be required by
See no(e on back regarding River Basin
rules.
Notes/ Special Condition
ko-lrc
e&cl, U?

t
' r 7
rv�
a
ors:
. m•
r L
� {� r i�Y ♦n
1 Y
Perquimans County, NC PIN Number. 7959-85-6864
Parcel Number: 5-DO51-0000-CH
Owner Name: WINSLOW, JOHN MICHAEL S
ins PROPERTY MAP Owner Address: DILLARD MARK
Omer Address 2: 222 AINSLEY RD
Discerner Owner Address 3: HERTFORD, NC 27944
m°3 ,neaam Owner Account: 052720
�. np plpaeaon Nism are c,mpareab, the laved pets,
.andofauna Wicln
ve,e�maaacaoary, t✓c ee1pen-1aeeo-aw,e' lt..aeem, and ame, puera,ewa Description: WATER ACCESS LOT -CH
he ms. mR eelaamnma, ales iwmaaex awry ae mewa anne aabsumee Deed Book: 126
he atrue 4tle aearcn. pioveM apwarsal, survey, ar lw xanNO venfPLbrt —__1 f,____ „ems,
m
V
Plat Cab.
2
Plat Map:
12
V
Plat Slide:
Record Date:
3
0
Sold Date:
Deed Acres:
Tax Value:
10000
Use Value:
Township:
PARKVILLE
One Inch = 50 Feet

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Resources
Pat McCrory
Governor
July 14, 2014
MEMORANDUM:
To: Daniel Govoni
Assistant Major Permits Coordinator
Coastal Management Division
400 Commerce Avenue
Morehead City, NC 28557
From: Dyk Luben, P.E., Acting Regional Engineer, PWSSNVaRO
Subject: CAMA Application Review
Applicant: Robert Jackson
Project Location: 164 Hertford Beach Road, SR #1353, Perquimans County.
John E. Skvarla, III
Secretary
Proposed Project: Reconfigure existing moorings, adding 2 new moorings for a total of 20 moorings
for jet skis & small motor boats, & construct 3 finger piers.
REPLY: This office has no objection to the project as proposed.
X This office has no comment on the proposed project.
This office approves of the project only if the recommended changes are
incorporated. See attached.
This office objects to the project for reasons described in the attached
comments.
SIGNED 4/
Public Water Supply Section
Washington Regional Office
943 Washington Square Mall, Washington, North Carolina 27889
Phone: [phone] \ FAX: [phone] \ Internet: www.ncwater.org/pws)
An Equal Oppotlunity \ Affirmative Action Employer
DATE
RBMRW
JUL 16 2014
TDO&M Cn'y

DIVISION OF COASTAL MANAGEMENT
FIELD INVESTIGATION REPORT
APPLICANT'S NAME: Ernestine Strickland - Strick's Family Campground
2. LOCATION OF PROJECT SITE: 164 Hertford Beach Road (SR #1353), adjacent to the Perquimans River,
in Perquimans County, North Carolina.
Photo Index: 2006: 236-6803 K12 & K13 2000: 236-1.780 M13 1995:153-1626 M15 1989:117-14 07 & 08
1986: 115-780 K6
State Plane Coordinates: X: 3200 2763445.764ftUSE Y: 884055.074ftUSN
3. INVESTIGATION TYPE: CAMA
4. INVESTIGATIVE PROCEDURE: Dates of Site Visit: June 10"h, June 24th and June 26, 2014
Was Applicant Present: Yes
5. PROCESSING PROCEDURE: Application Received Complete: Accepted on June 27, 2014
Office: Elizabeth City
6. SITE DESCRIPTION:
(A) Local Land Use Plan: Perquimans County
LUP Land Classification: RA — Residential Agricultural
(B) AEC(s) Involved: EW and PTW
(C) Water Dependent: Yes
(D) Intended Use: Commercial - an amenity for visiting campers to dock small power boats and personal
water craft
(E) Wastewater Treatment: Existing: None
Planned: No change
(F) Type of Structures: Existing: Existing 100' pier with two platforms, 29 tie pilings for 18 PWC's
or powerboats, boat ramp w/ courtesy dock and a small pavilion.
Planned: Three 2' x 14' finger piers, reconfiguration of 6 existing pilings
and the addition of 23 pilings to expand dockage from 18 to 20
for small watercrafts/powerboats. I ceplacement
piling lost in a previous storm.
(G) Estimated Annual Rate of Erosion: N/A JUL 16 2014
HABITAT DESCRIPTION: [AREA]
DREDGED FILL DC*KI%91TY
(A) Vegetated Wetlands:
(B) Non -Vegetated Wetlands:
(Open Water) ------------ — --- — -
--------------- ----------
----- ----------- ---- ------ >
New Finger Piers: 84sf
(Shallow Bottom) --------------
------------------------->
New Pilings: 6sf
(C) Other:
(D) Total Area Disturbed: Within an AEC = 90sf (.0002 acres)
(E) Primary Nursery Area: No
(F) Water Classification: SB Open: No
8. PROJECT SUMMARY: The project includes a three small finger piers (2' x 14'), 24 new tie pilings and removal of
6 existing pilings. The applicant proposes to reconfigure existing moorings and add two new moorings for a total
of twenty moorings for jet skis and small motorboats. Currently there are moorings for 18 small watercraft.

Strick's Family Campground
Field Investigation Report
Page 2
Protect Setting
The project site is located at an established local family owned campground that has been in business for over twenty
years. Strick's Family Campground is located adjacent to the Perquimans River at the end of SR#1353, Hertford Beach
Road, in Perquimans County, North Carolina. The address for the project site is 164 Hertford Beach Road. Adjacent
land uses include a mix of small residences and seasonal vacation homes. The property is bounded on the north by the
Perquimans River, to the west and south by a road and to the east by a seasonal vacation home.
The property has approximately .82 acres, with 306' fronting along the Perquimans River. Existing structures at the
project site include a concrete boat ramp with a small 3' x 14' (42sf) courtesy dock paralleling the shoreline on the
southeast side of the ramp, a 100' pier with two platforms totaling 377sf with 29 tie pilings used for 18 small water craft
and power boats. Located on high ground approximately 54' landward of normal water level is a large gazebo used for
grilling and for periodic Sunday Services.
Vegetation on the property is limited to domestic grasses and a mimosa tree (Albizia julibrissin). There are no unusual
geologic formations on the property, and no identified archeological or historical sites on the property. Average elevation
of the property is 7' above normal water level. Approximately one third of the adjacent associated property is located
within a designated flood zone. Existing shoreline stabilization consists of wooden bulkheads in front and adjacent to
the subject property. Water depths average 1.5' at a distance of 14' watenvard of the bulkhead and 2' at 35' waterward
of the bulkhead. The property is located adjacent to "Joint Waters" which are classified as Estuarine Waters, and are an
Area of Environmental Concern (AEC). No submerged aquatic vegetation was found within the project area.
Development Proposal
The applicant, Ernestine Strickland, owner of Strick's Family Campground has applied for a CAMA Major Permit to
remove six existing tie pilings and replace them with 23 new pilings and (3) 2' x 14' finger piers. The reconfiguration and
addition of pilings and piers will expand and existing waterfront recreational area from 18 formal moorings (using two tie
pilings) to 14 two pile moorings and (6)12' x 35' boat slips for visitors pontoon boats for a total of 20 mooring facilities.
i
Open`Wafers (3) 2' x 14' finger piers = 3 x 28sf = 84sf
51�a)low$offo `: 24 6"' x 6" pilings 24 x .25 = 65f
Anticipated Impacts
1) Shading of 84sf of water bottom from finger piers.
2) Increased boating traffic will result in increased wave action along adjacent shorelines.
3) Jetting pilings for the marina will result in temporally suspending sediments in the water.
4) Along the shallow waters of the proposed boat slips, prop wash may cause resuspension of sediments within
the water column.
5) Vessels fueling at the site will run a risk of discharging fuel into the surrounding water body.
6) Mooring of vessels always increases the possibility of fuel and oil being introduced into the surrounding waters.
7) A secondary impact will include debris from boaters.
Submitted by: Lynn W. Mathis
Date: July 1, 2014

Boat ramp, boat slips, and dock's are for use of Strick's Family Camp Ground only.
There 8 tie ups for Jet Ski's and 12 tie ups for run -about boats. These are recreational
vessels owned and operated by the campers. The finger piers are for easy and safe access
to their respective boats. This is a convenience for the campers and provides easy access
to the Perquinums River.
ritECE1VE19 : �:
JUL 16 2014
ncM-Man crry

Bowl
APPLICATION for
Major Development
(last revised 12127/06)
i J
JUN 1 9 2014
cnnsTr,i - ;�
No afi C—rolinba-MVISIONOF-COASTAL MANAGEMENT
1. Primary Applicant/ Landowner Information
Business Name
Project Name (if applicable)
,3 Y' .S - ro
Applicant t: First Name
MI
Last Name
efr
J r) �an
Applicant 2: First Name
MI
Last Name
If additional applicants, please attach an additional pages) with names listed.
Mailing Address
PO Box
Cfly
state
l
HerfoYd
ZIP
Country
Phone No.
FAX No.
9
r
#
Street Address (d different from a )
City
State
ZIP
J�f He orc� each
er�ovo)
Email
r` in
Ak
RECCENtNED
2. Agent/ContractorInformation
JUL 16 2014
Business Name
pruximptTy
Agent/ Contractor t: First Name
MI
Last Name
e b
A
L
�a nci fir.
Agent/ Contractor 2: First Name
MI
Last Name
Mailing Address
PO Box
Clty
Slate
ZIP
Phone No. 1
l6hone No.
2
d 7 N
s�t 3/
3V-/ 5'ext.
Writ.
FAX No.
Contractor tt
Streel Address (ffddferent Dom above) J
City
State
ZIP
l �� llerfor� ec7ci/I d
14e f d
C
o27q`
Email
.Styr G S l
<Form continues on back>
282-808.2808 .. 1-888.4RCOAST :: www.nccoastaimanagement. net

Form DCM MP-1 (Page 2 of 4)
APPLICATION for
Major Development Permit
3Pru�ecf Gocafron� `
i
County (can be multiple)
Street Address
State Rd. #
qJ
hi.3
J1'ffPe_rtP'0rJ3e0e'k
Subdiv' ' n Name
City
State
Zip
N R
l er-r'O ✓d '
Af&
Phone No.
Lot No.(s) (if many, attach additional page with list)
s s�� 7 9da ex".I
I I ,
a. In which NC river basin Is the project located?
b. Name of body of water nearest to proposed project
S_._5VU,Q
?erJtt;rn25n,5Tiber
c. Is th&4ater body identified in (b) above, natural or manmade?
d. Name Irie closest major water body to the proposed project site.
EKNatural ❑Manmade ❑Unknown
R i b Ao d
e. rn 3 rl e n
e. Is proposed work within city limits or planning jurisdiction?
f. If applicable, list the planning jurisdiction or city limit the proposed
[]Yes RNo
work falls within.
a. Total length of shoreline on the tract (ft.)
b. Size of entire tract (sq.ft.)
g
.J
.44,4:-©�d5
c. Size of individual lot(s)
d. Approximate elevation of Act above NHW (normal high water) or
�/�
NWL (normal waterlevel)
(if manylot sizes, please attach additional page with a list)
�,(
/ ❑NHW or 172NWL
e. vegetation on tract
Yard gYd'SS: .`.
I
f. Man-made features and uses now on tract
t�a2(LI�Of $ul i Y195r �t�"fj ����/1$ry pi �o� t %l e- U/05
I
g. Identify and describe the existing land uses ad'acen to the proposed project site.
'/ieeti!eafon IaYr'-rY
h. How does local government zone the tract?
I. Is the proposed project consistent with the applicable zoning?
C'a m m e,r i 0_a/
(Attach zoning compliance certificate, If applicable)
DQYes ❑No ❑NA
j. Is the proposed activity part of an urban waterfront redevelopment proposal? ❑Yes CRNo
k. Has a professional archaeological assessment been done for the tract? If yes, attach a copy. []Yes KNo ❑NA
If yes, by whom?
I. Is the proposed project Iodated In a National Registered Historic District or does It involve a []Yes EoNo ❑NA
National Register listed or eligible property?
<Form continues on next page>
2S2.808.2808 :: 7-888-4RCOAST :: www.nccoastaimanagement.net

Form DCM MP-1 (Page 3 of 4)
APPLICATION for
Major Development Permit
2014
m. (i) Are there wetlands on the site?
Oyes Wdo
(ii) Are there coastal wetlands on the site? ,. - '7
Oyes W60
(iii) If yes to either (i) or (ti) above, has a delinea6ton-5Wn—conduclsd?
❑Yes ONO
(Attach documentation, if available)
n. Describe existing wastewater treatment facilities.
/v //,
o. Describe existing drinking water supply source.
p. Descri existing storm water management or treatment systems.
AYR
5. Activities and Impacts
a. Will the project be for commercial, public, or private use?
ommercial ❑Public/Government
❑Private/Community,
b. Give a brief description of purpose, use, and daily operations of the project when complete.
Doo-k -Boars
Tr- vvido- ,sofa aacesd 71 boat
e. Describe the proposed construction methodology, types of construction equipment to be used during construction, the number of each type
of equipment and where it is to be stored. ,
prr Ve pi fini95 }ocl�"�j(Y �i'D p�1iN�s .✓�i-h. 3�� X?"be I'ts
�cftu�ASdd.ybty rd5 to
SXSI,jr)re iV."Tie"Ppft s. /Pil¢Oriver�nll,Ski115a
Y�/y'ruTrenehes
J`�Oraci p 5jie.
d. List all development activities you propose.
IVIA
e. Are the proposed activities maintenance of an existing project, new work, or both?
f. What Is the approximate total disturbed land area resulting from the proposed project?
❑Sq.Ft or [:]AcresIVV
Ale
g. Will the proposed project encroach on any public easement, public accessway or other area
❑Yes ®No ❑NA
that the public has established use of?
h. Describe location and type of existing and proposed discharges to waters of the state..j� La
/V/9
i. Will wastewater or stormwater be discharged into a wetland?
❑Yes ❑No NA
If yes, will this discharged water be of the same salinity as the receiving water?
❑Yes []No ❑NA
j. Is there any mitigation proposed?
❑Yes ❑No ;RNA
If yes, attach a mitigation proposal.
<Form continues on back>
ttr
JUL 16 2014
252-808.2808 .. 1.888.4RCOAST .. www.necoastalma •ment.not

Form DCM MP-1 (Page 4 of 4) - APPLICATION for
Major Development Permit
♦� .gddl�lOOa�IR%ORflBflOtl � n .; rr "-r r * • < '� t i ^ c
J y U
In ad�dion to ihrs completed epplfcatron form, (MP 1) the following items below rf applicable must be submitted in o derforthe a plicabon s
package to be complete fterns'(a) (fJ er'eslways appGcatite ro anymaJor developmenfappltcatlon-PleasQ cons`uttihe appfip6on
msWcbon bookle(on hot4 to projiedy prepare the requirod Items below > tC r +
a. A project narrative.
b. An accurate, dated work plat (including plan view and cross -sectional drawings) drawn to scale. Please give the present status of the
proposed project. Is any portion already complete? If previously authorized work, clearly indicate on maps, plats, drawings to distinguish
between work completed and proposed.
c. A site or location map that is sufficiently detailed to guide agency personnel unfamiliar with the area to the site.
d. A copy of the deed (with state application only) or other Instrument under which the applicant claims tills to the affected properties.
e. The appropriate application fee. Check or money order made payable to DENR.
I. A list of the names and complete addresses of the adjacent waterfront (riparian) landowners and signed return receipts as proof that such
owners have received a copy of the application and plats by certified mail. Such landowners must be advised that they have 30 days In
which to submit comments on the proposed project to the Division of Coastal Management
Name �h'2 v'f 2s T %)grrelj4 r.x PhoneNo r
Aaarose/01'in� f�iiewr 5`f; 7�r)fa`rdt,✓ea'79'�" Asa 33'9 ,�9G1/ +
Name L,O n n i d- R Bbf.✓ e— 11 Phone No.
Address/3 9-frte.A'S �.an�,H�r'�ta✓riille- g 71 s,2-•s� � /�'/l
t°IJamer �a°� e �' -_ 'r �, n'.',1 J rLh e a t , Pbone NO ' r
3'
?Add ..
g. A list of previous state or federal permits issued for work on the project tract. Include permit numbers, permiltee, and Issuing dales.
��P# SclO/(c h�E/id a — �t+tYsi7n/c S'1Wi'-ie49 V'3
eaa,A20,9 i - 4YA F;Wjeei nnr�
h. Signed consultant or agent authorization form, If applicable.
I. Weiland delineation, if necessary. k( A
J. A signed AEC hazard notice for projects in oceanfront and inlet areas. (Must be signed by property owner)
k. A statement of compliance with the N.C. Environmental Policy Act (N.C.G.S. 113A 1-10). if necessary. If the project involves expenditure
of public funds or use of public lands, attach a statement documenting compliance with the North Carolina Environmental Policy Act.
I understand that any permit issued in response to this application will allow only the development described in the application.
The project will be subject to the conditions and restrictions contained in the permit.
I certify that I am authorized to grant, and do in fact grant permission to representatives of state and federal review agencies to
enter on the aforementioned lands in connection with evaluating Information related to this permit application and follow-up
monitoring of the project.
I further certify that the information provided in this application is truthful to the best of my knowledge.
Date PdntName 45rnes7%:ie T.i%�✓i�kl�t//xL
Signature
Please indicate application attachments pertaining to your proposed project.
❑DCM MP-2 Excavation and Fill Information ❑DCM MP-5 Bridges a d Cul sits
❑DCM MP-3 upland Development JUN 19 2014
?CM MP-4 Structures Information
252.808-2808 :: 1.888-4RCOASY :: www.ncecastaimanagement.net

N
Form DCM MP-4
STRUCTURES
(Construction within Public Trust Areas)
JUN 19 2014
Attach this form to Joint Application for CAMA Major Permit, Form DCM 4P=1-Besure 40 e
Application that relate to this proposed project. Please include all supplemental information.
the Joint
1. DOCKING FACILITYLMARINA CHARACTERISTICS❑This section not applicable
Is the ducking facility/marina: b. (i) Will the facility be open to the general public?
[Commercial ❑Public/Government ❑Private/Community []Yes tKNo
c. (i) Dock(s) and/or pier(s)
d. (i) Are Finger Piers included? ZYes
(ii) Number fj+44 C
If yes:
�e
(iii) Length 1i% �
(ii) Number
(iv) Width .� r
(III) Length
(v) Floating []Yes [jNo
(iv) Width
(v) Floating []Yes No
e. (i) Are Platforms included? []Yes l!RNo
f. (1) Are Boatlifts included? ❑Yes (&No
If yes:
If yes:
(ii) Number
(ii) Number
(III) Length
(III) Length
(iv) Width
(iv) Width _
(v) Floating []Yes []No
Note: Roofed areas are calculated from dripline dimensions.
g. _ (i) Number of slips proposed PhD'Zc, VA C
h. Check all the types of services to be provided.
'A Sl_t i
❑ Full service, including travel lift and/or rail, repair or
(ii) Number of slips existing
maintenance service
g
❑ Dockage, fuel, and marine supplies
® Dockage ("wet slips") only, number of slips: aD
❑ Dry storage; number of boats:
® Boat ramp(s); number of boat ramps:
❑ Other, please describe:
I. Check the proposed type of siting:
❑ Land cut and access channel
[]Open water; dredging for basin and/or channel
INOpen water; no dredging required
❑Other; please describe:
k. Typical boat length: J & —'+ *I .&Asb J NT S Kr(s)
j. Describe the typical boats to be served (e.g.. open runabout,
charter boats, sail boats, mixed types).
D�.,r runabout"
I. (i) Will the facility be open to the general public?
❑Yes RNo
m. (1) Will the facility have tie pilings? Rumm
®Yes ❑No
(ii) If es number of tie pilings? py Aj`G A nnC-fL rDCU-MM
L 16 2014
�D CR Y
252-808.2808 :: 1-888-4RCOAST :: www.nccoastaimananement.net revised: 12/27/06

�V.. 1 %V.. CJ, r VV L VI Yf
a. Check each of the following sanitary facilities that will be included in the proposed project.
❑ Office Toilets
❑ Toilets for patrons; Number: _; Location: MR
❑ Showers -
❑ Boatholding tank pumpout; Give type and location:
b. Describe treatment type and disposal location for all sanitary wastewater.
c. Describe the disposal of solid waste, fish offal and trash.
d. How will overboard discharge of sewage from boats be controlled?
e. (i) Give the location and number of "No Sewage Discharge" signs proposed.
(ii) Give the location and number of "Pumpout Available" signs proposed.
f. Describe the special design, if applicable, for containing industrial type pollutants, such as paint, sandblasting waste and petroleum products.
g. Where will residue from vessel maintenance be disposed of?
h. Give the number of channel markers and "No Wake" signs proposed. Tin
I. Give the location of fuel -handling facilities, and describe the safety measures planned to protect area water quality.
j. What will be the marina policy on overnight and live -aboard dockage?
k. Describe design measures that promote boat basin gushing?
vlg
I. If this project is an expansion of an existing marina, what types of services are currently provided?
' I i
252-808.2808 n 1-888-4RCOAST :: www.necoastalmanaaement.net revised: 12127106

I
r
m. Is the marina/docking facility proposed within a primary or secondary nursery area?
[]Yes [SNo
n. Is the marinatdocking facility proposed within or adjacent to any shellfish harvesting area?
❑Yes ($No
o. is me manna/dociung tactuty proposed within or adjacent to coastal wet ands/marsh (CW), submerged aquatic vegetation (SAV), shell bottom
(SB), or other wetlands (WL)? If any boxes are checked, pmvide the number of square feet affected.
❑CW ❑SAV ❑SB
❑WL ®None
p. Is the proposed marina/docking facility located within or within close proximity to any shellfish leases? []Yes D(No
If yes, give the name and address of the leaseholder(s), and give the proximity to the lease.
3. BOATHOUSE (including covered lifts)
a. (i) Is the boathouse structure(s):
❑Commercial ❑Public/Govemment ❑Private/Community
III) Number
(III) Length
(iv) Width
Note: Roofed areas are calculated from dripline dimensions.
i
I F L JUN 19 2014
not applica
L4. GROIN (e.g., wood, sheetpile, etc If a rock groin, use MP-2, Excavation and Fill.) I,KThis section not applicable]
a. (i) Number
(ii) Length
(III) Width
5. BREAKWATER (e.g., wood, sheetpile, etc.) This section not applicable
a. Length
c. Maximum distance beyond NHW. NWL or wetlands
QOR/NG PILINGS and BUOYS
a. Is the structure(s):
ERCommercial ❑Public/Govemment ❑Private/Community
a Distance to be placed beyond shoreline .Sy
Note: This should be measured from marsh edge, if present.
e. Am of the swing
b. Average d istance from N HW, NWL or wetlands
❑This section not applicable
I?. Number
d. Description of buoy (color, inscription, size, anchor, etc.)
JUL 16 2014
252.808.2808 :: 1-888-4RCOAST :: w .nccoastalmanagement.net
DCM40DIC" revised:12/27/06

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'"r�"`t"�^�3*z=�� v. ;�`?�.:, ' '� t'n's�.✓ �r �aS s. -1 -,� w� ry .mzs+msy$ r�"�"l'F"9' r"�.A.�� 3 Y
:.° 3 r•t^7r�`1 f«���. �:: r`A'�„�Rfti°-.�.z)„'.aK"rise�k'«:1���.�.`��,3�sr" '.rr' '. ���,. �+.+.,s-,"r �F �t.�''�`a.k'..`:u�rxr�'.�t`Krs��a
a. Proximity of structure(s) to adjacent riparian property lines., b. Proximity ofstructure(s) to adjacent docking facilities.
911-/iB,GI
Note: For buoy ormooring piling, use arc of swing including length
of vessel.
c. Width of water body
/mile,
e. (i) Will navigational aids be required as a result of the project?
❑Yes DkNo ❑NA
(ii) If yes, explain what type and how they will be implemented.
a. Give complete description:
Yec✓eis7l.vr,�1 Vesbels.
d. Water depth at water ward end of structure at NLW or NWL
�3 I
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North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
July,2, 2014
MEMORANDUM
TO:
Ken Pace, PE; Environmental Operations & Rest Area
Department of Transportation
FROM: Daniel Govoni
Assistant Major Permits Coordinator
Division of Coastal Management
SUBJECT: LAMA Permit Application Review
John E. Skvarla, III
Secretary
Applicant: Robert Jackson
Project Location: 186 Ainsley Road, Perquimans County
Proposed Project: Construct roof over boat lifts, a finger pier, & additions to garage & deck
Please indicate below your agency's position or viewpoint on the proposed project and return this
form by 07/23/14 to 400 Commerce Avenue Morehead City, NC 28557 fax: [phone] .
If you have any questions regarding the proposed project, please contact Will Creef at (252) 264-
3901. When appropriate, in-depth comments with supporting data are requested.
REPLY: 4— This office has no objection to the project as proposed.
This office has no comment on the proposed project.
This office approves of the project only if the recommended changes are
incorporated. See attached.
This office objects to the project for reasons described in the attached
SIGNET) �IU Id_t DATE
1367 US 17 South, Elizabeth City, NC 27909
Phone: [phone] FAX [phone] ; Internet: www,noccastalmanagamentnet
An Equal opportunity 1 Affirmallve Action Employer
E0/T0 39Vd 1000N 6ELPTEEZSZ 9E:L0 VT02',/TT/L0

�4-.
NCDENR
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
July 2, 2014
MEMORANDUM
TO:
13 ;ZlM) �
SUBJECT:
Applicant:
Project Location:
Proposed Project:
Lee Padrick
Division of Community Assistance
Daniel Govoni
Assistant Major Permits Coordinator
Division of Coastal Management
CAMA Permit Application Review
Robert Jackson
186 Ainsley Road, Perquimans County
John E. SkvO& III
Secretary
RBp�
JUL 10 2n14
"CM-MFMCITp
Construct roof over boat lifts, a finger pier, & additions to garage & deck
Please indicate below your agency's position or viewpoint on the proposed project and return this
form by 07/23/14 to 400 Commerce Avenue, Morehead City. NC 28557 (fax: [phone]).
If you have any questions regarding the proposed project, please contact Will Creef at (252) 264-
3901. When appropriate, in-depth comments with supporting data are requested.
REPLY: This agency has no objection to the project as proposed.
L/This agency has no comment on the proposed project.
This agency approves of the project only if the recommended changes are
incorporated. See attached.
This agency objects to the project for reasons described in the attached
comments.
SIGNED�DATE %— %—/�
1367 US 17 South, Elizabeth City, NC 27909
Phone: [phone] FAX: [phone] ; Internet: wwa.nccoastalmanagement.net
An Equal Opportunity 1 Affirmative Action Employer

4
NCDENR
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
July 2, 2014
MEMORANDUM
TO:
Charlan Owens, District Planner
Division of Coastal Management
FROM: Daniel Govoni
Assistant Major Permits Coordinator
Division of Coastal Management
SUBJECT: CAMA Permit Application Review
Applicant: Robert Jackson
Project Location: 186 Ainsley Road, Perquimans County
John E. Skvada, III
Secretary
Proposed Project: Construct roof over boat lifts, a finger pier, & additions to garage & deck
Please indicate below your agency's position or viewpoint on the proposed project and return this
form by 07/23/14 to 400 Commerce Avenue, Morehead City, NC 28557 (fax: [phone]).
If you have any questions regarding the proposed project, please contact Will Creef at (252) 264-
3901. When appropriate, in-depth comments with supporting data are requested.
REPLY: This office has no objection to the project as proposed.
This office has no comment on the proposed project.
This office approves of the project only if the recommended changes are
incorporated. See attached.
This office objects to the project for reasons described in the attached
comments.
SIGNS DATE 7 - t o - I + UCEIVBD
1367 US 17 South, Elizabeth City, NC 27909 JUL 14 2014
Phone: [phone] \ FAX: [phone] ; Internet: www.ncoosstalmanagement.net
An Equal opportunity \ Affirmative Action Employer DCM MAD CITY

NCDENR
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
d4i421111111111i
TO: Daniel Govoni, DCM Assistant Major Permits Coordinator
Division of Coastal Management
FROM: Charlan Owen AICP, DCM NE District Planner
Division of Coastal Management
John E. Skvarla, III
Secretary
SUBJECT: Major Permit Request by Robert Jackson to install a 28 foot by 37 foot roof system
and a 3.5 foot by 24 foot finger pier over the Perquimans River and construct a 12
foot by 16 foot garage addition and 10 foot by 12 foot deck addition on land within
75 feet of the shoreline, at 186 Ainsley Road, in the Matthews Acres subdivision,
Perquimans County.
DATE: July 10, 2014
Consistency Determination: The request is consistent with/not in conflict with the 1998
Perquimans County Land Use Plan certified by the CRC on
October 24, 2002.
Overview: The subject property consists of a .64 acre lot with 107 linear feet of shoreline along
the Perquimans River. The lot is elevated approximately 10 feet above Normal Water Level
(NWL). The shoreline of the property is within the AE Floodzone, with the remainder being
Shaded X and not within a Floodzone.
Existing site improvements consist of a single family house with attached deck, a 24 foot by 30
foot detached garage, and a driveway. A portion of the house and attached deck is located
within 75 feet of the shoreline. The corner of the garage is located 75 feet from the shoreline.
Existing shoreline improvements consist of wooden bulkhead along the entire shoreline and a
pier with a 16 foot by 24 foot platform, a 6 foot by 7 foot platform, a jet ski lift, a roof covered 12
foot by 24 foot boat lift and an uncovered 12 foot by 24 foot boat lift.
Installation of a 28 foot by 37 foot roof system and a 3.5 foot by 24 foot finger pier over water
and construction of a 12 foot by 16 foot garage addition and 10 foot by 12 foot deck addition on
land within 75 feet of the shoreline are proposed. The roof system will cover the two (2) existing
boat lifts and the finger pier. The existing boatlift roof will be removed.
The waters of the Perquimans River are classified SC in this area and are closed to shellfish
harvesting. Water depths average 3 feet at a distance of 130 feet offshore. Submerged Aquatic
Vegetation (SAV) is not present at this location. A review of historic and archagwooliab
resources was not provided.
JUL 14 2014
1367 US 17 South, Elizabeth City, NC 27909 DCM MHp CITY
Phone: [phone] FAX: [phone] ; Internet: www.nocoastalmanagement.net
An Equal Opportunity 1 Afirmalive Action Employer— Made in part by recycled paper

North Carolina Department of Environment and Natural Resources
Division of Coastal Management
MEMORANDUM
Page 2 of 3
Anticipated Impacts resulting from this project are expected to include: the shading of 588 sq. ft.
of Public Trust Area/Estuarine Waters Areas of Environmental Concern (AEC) and the
disturbance of 376 sq. ft. of Estuarine Shoreline AEC.
Basis for Determination:
The Perquimans County Land Classification Map identifies the site area as "Rural'. As noted on
Page 49 of the Land Use Plan (LUP), all areas within an AEC also qualify for the designation of
"Conservation". The following are LUP policies that may be applicable to this request:
Areas of Environmental Concern (AEC) and Appropriate Land Uses in AECs:
Policy #1, Page vi.
"Perquimans County will continue to support and enforce, through its CAMA Minor
Permitting capacity the State policies and permitted uses in Areas of Environmental
Concern. Such uses shall be in accord with the general use standards for coastal
wetlands, estuarine waters, estuarine shorelines, and public trust areas as stated in
Chapter 15A, Subchapter 7H of the North Carolina General Statutes."
Note: The implementation statement for this policy indicates that the County will refer
applicants to the State CAMA office for major permits.
Constraint to Development Including Soil Limitations Flood Prone Areas. Hazardous and
Fragile Land Areas:
Policy #2, Page vi.
"The County will continue to rely on existing Regional, State and Federal regulatory
programs to monitor and determine the appropriateness of future development in the
fragile lands areas, flood prone areas and soils with limitations to development."
Stormwater Run-off Residential Development:
Policy #7, Page viii.
"It shall be the policy of Perquimans County to regulate existing residential
subdivisions so as to prevent the overburdening of existing waterways and drainage
systems by excessive run-off, with particular attention to fragile areas of the County."
RECEIVER
JUL 14 2014
DCM-MHiDCnY
1367 US 17 South, Elizabeth City, NC 27909
Phone: [phone] \ FAX: 252-264,3723 ; Internet: www.nccoastalmanagement.net
An Equal opportunity 1 Affirmative Action Employer— Made in pan by recycled paper

North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Commercial and Recreational Fishing:
Policy #12, Page ix.
"The County encourages commercial and recreational fishing in its waters and will
cooperate with other local governments, State and federal agencies to control
pollution of these waters to allow commercial and recreational fishing to increase."
Storm Hazard Mitigation:
Policy #23, Page xii.
"It will be the policy of Perquimans County to enforce all controls and regulations it
deems necessary to mitigate the risk of severe storms and hurricanes to life and
property..."
Note: The implementation statement concerning Wave Action and Shoreline Erosion
for this policy indicates that the County continues to support CAMA permitting
procedures concerning the estuarine shoreline.
MEMORANDUM
Page 3 of 3
3RECEIVED
JUL 14 2014
DCM-MMCffy
1367 US 17 South, Elizabeth City, NC 27909
Phone: [phone] PAX: 252-264-3723 ; Internet: www.nccoastalmanagement.net
An Equal opportunity 1 Aifirmadve Action Employer- Made in part by recycled paper

ALTA
NCDENR
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
MEMORANDUM
TO: Daniel Govoni, Assistant Major Permits Coordinator
THROUGH: Frank Jennings, District Manager 4*1
FROM: Will Creef W&
DATE: 7/8/2014
SUBJECT: Robert Jackson Major Permit Recommendations.
John E. Skvarla, III
Secretary
The applicant proposes to construct a roof over two existing boat lifts, a finger pier, an addition to the
existing detached garage, and an addition to the existing attached deck at 186 Ainsley Rd. Hertford in
Perquimans County, on the Perquimans River.
I have reviewed the rules as they pertain to piers, docking facilities, and development within the 75' Area of
Environmental Concern (AEC) and would like to offer the following:
15 NCAC 07H .0208 Use Standards
(b)Special Use Standards
(6) Piers and Docking Facilities:
(A) Piers shall not exceed six feet in width. Piers greater than six feet in width shall be permitted
only if the greater width is necessary for safe use, to improve public access, or to support a
water dependent use that cannot otherwise occur;
Consistent: The proposed development is consistent with the intent of this rule.
(B) The total square footage of shaded impact for docks and mooring facilities (excluding the pier)
allowed shall be eight square feet per linear foot of shoreline with a maximum of 2,000 square
feet. In calculating the shaded impact, uncovered open water slips shall not be counted in the
total. Projects requiring dimensions greater than those stated in this Rule shall be permitted
only if the greater dimensions are necessary for safe use, to improve public access, or to
support a water dependent use that cannot otherwise occur. Size restrictions shall not apply to
marinas;
Consistent: The proposed development is consistent with the intent of this rule.
(C) Piers and docking facilities over coastal wetlands shall be no wider than six feet and shall be
elevated at least three feet above any coastal wetland substrate as measured from the bottom
of the decking;
Consistent: The proposed development is consistent with the intent of this n0e. RECMM
(D) A boathouse shall not exceed 400 square feet except to accommodate a documentefte4 fpr2014
1367 US 17 South, Elizabeth City, NC 27909 D�f MHD PITS'
Phone: [phone] FAX: [phone]InterneC www.nocoastaimanagement.net
An Equal Opportunity 1 Affirmative Action Employer

a larger boathouse and shall have sides extending no farther than one-half the height of the
walls and covering only the top half of the walls. Measurements of square footage shall be
taken of the greatest exterior dimensions. Boathouses shall not be allowed on lots with less
than 75 linear feet of shoreline. Size restrictions do not apply to marinas;
Consistent: The proposed development is consistent with the intent of this rule.
(E) Ttie'total area enclosed by an individual boatlift shall not exceed 400 square feet except to
accommodate a documented need for a larger boat lift;
Consistent: The proposed development is consistent with the intent of this rule.
(F) Piers and docking facilities shall be single story. They may be roofed but`shall not be designed
to allow second story use;
Consistent: The proposed development is consistent with the intent of this rule.
(G) Pier and "docking facility length shall be limited by: -
(1) not extending beyond the established pier or docking facility length along the same
shoreline for similar use; (This restriction does not apply to piers 100 feet or less in
length unless necessary to avoid unreasonable interference with navigation or other
uses of the waters by the public);
(i) not extending into the channel portion of the water body; and,
(iii) not extending more than one-fourth the width of a natural water body, or humanmade
canal or basin. Measurements to determine widths of the water body, canals or basins
shall be made from the waterward edge of any coastal wetland vegetation that borders the
water body. The one-fourth length limitation does not apply in areas where the U.S. Army
Corps of Engineers, or a local government in consultation with the Corps of Engineers, has
established an official pier -head line. The one-fourth length limitation shall not apply when
the proposed pier is located between longer piers or docking facilities within 200 feet of the
applicant's property. However, the proposed pier or docking facility shall not be longer than
the pier head line established by the adjacent piers or docking facilities, nor longer than
one-third the width of the water body.
Consistent: The proposed development is consistent with the intent of this rule.
(H) Piers or docking facilities longer than 400 feet shall be permitted only if the proposed length
gives access to deeper water at a rate of at least 1 foot each 100 foot increment of length
longer than 400 feet, or, if the additional length is necessary to span some obstruction to
navigation.
Consistent: The proposed development is consistent with the intent of this rule.
(1) Piers and docking facilities shall not interfere with the access to any riparian property and shall
have a minimum setback of 15 feet between any part of the pier or docking facility and the
adjacent property owner's areas of riparian access.
Consistent: The proposed development is consistent with the intent of this rule.

(J) Applicants for authorization to construct a pier or docking facility shall provide notice of the
permit application to the owner of any part of a shellfish franchise or lease over which the
proposed dock or pier would extend. The applicant shall allow the lease holder the opportunity
to mark a navigation route from the pier to the edge of the lease.
Consistent: The proposed development is consistent with the intent of this rule.
15A NCAC 071-1.0209 COASTAL SHORELINES
(d) Use Standards. Acceptable uses shall be those consistent with the management objectives in
Paragraph (c) of this Rule. These uses shall be limited to those types of development activities
that will not be detrimental to the public trust rights and the biological and physical functions of
the estuarine and ocean system. Every effort shall be made by the permit applicant to avoid,
mitigate or reduce adverse impacts of development to estuarine and coastal systems through
the planning and design of the development project. In every instance, the particular location,
use, and design characteristics shall comply with the general use and specific use standards
for coastal shorelines, and where applicable, the general use and specific use standards for
coastal wetlands, estuarine waters, and public trust areas described in Rule .0208 of this
Section. Development shall be compatible with the following standards:
Consistent: The proposed development is consistent with the intent of this rule.
(1) All development projects, proposals, and designs shall preserve and not weaken or eliminate
natural barriers to erosion including peat marshland, resistant clay shorelines, and cypress -
gum protective fringe areas adjacent to vulnerable shorelines.
Consistent: The proposed development is consistent with the intent of this rule.
(2) All development projects, proposals, and designs shall limit the construction of impervious
surfaces and areas not allowing natural drainage to only so much as is necessary to
adequately service the major purpose or use for which the lot is to be developed. Impervious
surfaces shall not exceed 30 percent of the AEC area of the lot, unless the applicant can
effectively demonstrate, through innovative design, that the protection provided by the design
would be equal to or exceed the protection by the 30 percent limitation. Redevelopment of
areas exceeding the 30 percent impervious surface limitation may be permitted if impervious
areas are not increased and the applicant designs the project to comply with the intent of the
rule to the maximum extent feasible.
Consistent: The proposed development is consistent with the intent of this rule. .
(3) All development projects, proposals, and designs shall comply with the following mandatN4L 14 2014
standards of the North Carolina Sedimentation Pollution Control Act of 1973:
(A) All development projects, proposals, and designs shall provide for a buffer zone along th&M-MM,
margin of the estuarine water which is sufficient to confine visible siltation within 25 percent
of the buffer zone nearest the land disturbing development.
(B) No development project proposal or design shall permit an angle for graded slopes or fill
which is greater than an angle which can be retained by vegetative cover or other
erosion -control devices or structures.

(C) All development projects, proposals, and designs which involve uncovering more than one
acre of land shall plant a ground cover sufficient to restrain erosion within 30 working days of
completion of the grading; provided that this shall not apply to clearing land for the purpose
of forming a reservoir later to be inundated.
Consistent: The proposed development is consistent with the intent of this rule.
(4) Development shall not have a significant adverse impact on estuarine and ocean resources.
Significant adverse impacts include development that would directly or indirectly impair water
quality standards, increase shoreline erosion, alter coastal wetlands or Submerged Aquatic
Vegetation (SAV), deposit spoils waterward of normal water level or normal high water, or
cause degradation of shellfish beds.
Consistent: The proposed development is consistent with the intent of this rule.
(5) Development shall not interfere with existing public rights of access to, or use of, navigable
waters or public resources.
Consistent: The proposed development is consistent with the intent of this rule.
(6) No public facility shall be permitted if such a facility is likely to require public expenditures for
maintenance and continued use, unless it can be shown that the public purpose served by the
facility outweighs the required public expenditures for construction, maintenance, and
continued use. For the purpose of this standard, "public facility" means a project that is paid for
in any part by public funds.
Consistent: The proposed development is consistent with the intent of this rule.
(7) Development shall not cause irreversible damage to valuable, historic architectural or
archaeological resources as documented by the local historic commission or the North
Carolina Department of Cultural Resources.
Consistent: The proposed development is consistent with the intent of this rule.
(8) Established common-law and statutory public rights of access to the public trust lands and
waters in estuarine areas shall not be eliminated or restricted. Development shall not encroach
upon public accessways nor shall it limit the intended use of the accessways.
Consistent: The proposed development is consistent with the intent of this rule.
(9) Within the AECs for shorelines contiguous to waters classified as Outstanding Resource
Waters by the EMC, no CAMA permit shall be approved for any project which would be
inconsistent with applicable use standards adopted by the CRC, EMC or MFC for estuarine
waters, public trust areas, or coastal wetlands. For development activities not covered by
specific use standards, no permit shall be issued if the activity would, based on site -specific
information, degrade the water quality or outstanding resource values.
Consistent: The proposed development is consistent with the intent of this rule.

<,
Based on this rule review I would like to recommend that the request be approved
subject to the standard conditions.
RECEIVED
JUL 14 2014
DCM-M MCffY

Y�
NCDENR
North Carolina Department of Environment and Natural Resources
Pat McCrory
Govemor
July 2, 2014
MEMORANDUM
TO:
SUBJECT:
Applicant:
Project Location:
Proposed Project:
rT
RECEIVEDL 2 3 2014
CM-MifA(7rr
Tim Walton, Manager
State Property Office
Daniel Govoni
Assistant Major Permits Coordinator
Division of Coastal Management
CAMA Permit Application Review
Robert Jackson
186 Ainsley Road, Perquimans County
John E. Skvarla, III
Secretary
RECEIVED
JUL 0 3 2014
DOA
STATE PROPERTY
OFFICE
Construct roof over boat lifts, a finger pier, & additions to garage & deck
Please indicate below your agency's position or viewpoint on the proposed project and return this
form by 07/23/14 to 400 Commerce Avenue, Morehead City. NC 28557 (fax: [phone]).
If you have any questions regarding the proposed project, please contact Will Creef at (252) 264-
3901. When appropriate, in-depth comments with supporting data are requested.
REPLY:
iae�T� a i
60A P,e
(AAA
SIGNED
This office has no objection to the project as proposed.
s office has no comment on the proposed project.
This office approves of the project only if the recommended changes are
incorporated. See attached.
This office objects to the project for reasons described in the attached
comments.
DATE -. — '1 — 1
1367 US'IZ Soul Elizabeth City, NC 27909
41 FAX: 25 4- 723 ; Internet: www.ncooastalmanagement.net
An Equal Opportunity 1 Affirmative Action Employer

A�)
��
NCDENR
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
EMAIL MEMORANDUM
TO: The Daily Advance
Legal Advertisement Section
[e-mail]
FROM: Yvonne Carver for Will Creef
DATE: July 1, 2014
SUBJECT: Public Notice — Robert Jackson
ACCOUNT: #2119219, NCDENR/Stadiem
John E. Skvarla, III
Secretary
Please publish the attached Notice in the Wednesday, July 9, 2014 issue of The
Perquimans Weekly.
The State Office of Budget and Management requires an original Affidavit of Publication
prior to payment for newspaper advertising. Please send the affidavit, an original
copy of the published notice, and an original invoice to Melissa Sebastian, NC
Division of Coastal Management, 400 Commerce Avenue, Morehead City, NC
28557, (Telephone [phone]).
Thank you for your assistance in this matter. If you should have any questions, please
contact me at our Elizabeth City office [phone].
Attachment
cc: Daniel Govoni, Assistant Major Permits Coordinator, DCM',. MQrghead City
Michele Walker, PIO, DCM, Raleigh
Melissa Sebastian, Accounts Payable, DCM, Morehead City
File
YiBOt'd M
r' JUL 0 7 2014
1367 US 17 South, Elizabeth City, NC 27909
Phone: [phone] FAX: [phone]; Internet: www.nocoastalmanagement.net
DC3".-MHDCffY
An Equal Opportunity \ Affirmative Action Employer

NOTICE OF FILING OF
APPLICATION FOR CAMA MAJOR
DEVELOPMENT PERMIT
NCDENR hereby gives public notice as required by NCGS 113A-119(b) that
application for a development permit in an AEC as designated under'the CAMA was
received on 06/20/14. Robert Jackson proposes to construct a roof over 2 boat lifts, a
finger pier, & additions to a garage & deck, located at 186 Ainsley Road in Perquimans
County.
A copy of the entire application may be reviewed at the office of the Division of
Coastal Management, located at 1367 US 17 South, Elizabeth City, NC, 252-264-3901
during normal business hours. Comments mailed to Braxton Davis, Director, DCM, 400
Commerce Avenue, Morehead City, NC 28557, prior to 07/29/14, will be considered in
making the permit decision. Later comments will be considered up to the time of permit
decision. Project modification may occur based on review and comment by the public,
state & federal agencies. Notice of the permit decision in this matter will be provided
upon written request.
PLEASE PUBLISH ON: Wednesday, July 9, 2014
"r

A�i�
NCDETIR
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
July 1, 2014
Mr. Robert L. Jackson
186 Ainsley Road
Hertford, NC 27944
Dear Mr. Jackson:
John E. Skvarla, III
Secretary
The NC Division of Coastal Management hereby acknowledges receipt of your
application for State approval for development of your property located in Perquimans
County. It was received complete on June 20, 2014, and appears to be adequate for
processing at this time. The projected deadline for making a decision is September 3,
2014. An additional 75-day review period is provided by law when such time is
necessary to complete the review. If you have not been notified of a final action by the
initial deadline stated above, you should consider the review period extended. Under
those circumstances, this letter will serve as your notice of an extended review.
However, an additional letter will be provided on or about the 75th day.
If this agency does not render a permit decision within 70 days from June 20, 2014, you
may request a meeting with the Director of the Division of Coastal Management and
permit staff to discuss the status of your project. Such a meeting will be held within five
working days from the receipt of your written request and shall include the property
owner, developer, and project designer/consultant.
NCGS 113A-119(b) requires that Notice of an application be posted at the location of
the proposed development. Enclosed you will find a "Notice of Permit Filing" postcard
which must be posted at the property of your proposed development. You should post
this notice at a conspicuous point along your property where it can be observed from a
public road. Some examples would be: Nailing the notice card to a telephone pole or
tree along the road right-of-way fronting your property, or at a point along the road right-
of-way where a private road would lead one into your property. Failure to post this
notice could result in an incomplete application.
> REOVED
JUL 0 7 2014
1367 US 17 South, Elizabeth City, NC 27909
Phone: [phone] FAX: [phone] ; Internet: hap://oortal.ncdenr.oralweblcmldcm-home
An Equal Opportunity I Affirmative Action Employer

July 1, 2014
Page 2
An onsite inspection will be made, and if additional information is required, you will be
contacted by the appropriate State or Federal agency. Please contact Will Creef, Field
Representative, if you have any questions and or if you wish to receive a copy of his
field report.
Sincerely,
��q�s
Frank Jennings
District Manager, Northeastern District
NC Division of Coastal Management
FJ/yc
Enclosure
cc: Daniel Govoni, Assistant Major Permits Coordinator, DCM, Morehead City, NC
Will Creef, Field Representative, DCM, Elizabeth City, NC

\Tt1'1'I(01*1:
CAMA PERMIT
APPLIED FOR
"
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O
COMMENTS ACCEPTED THROUGH Z:) i A %I b y
APPLICANT:
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7;7-/
FOR MORE DETAILS CONTACT
THE LOCAL PERMIT OFFICER BELOW:
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113 1�0 �1 qj YW Y 17 z .
AF4 i z A METR e iTy-
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Name of Adja ent Property,
�
O er
Addre s
City, State Zip '
To Whom It May Concern:
MAJUA—
This correspondence is to notify you as a riparian property owner that I am applying for a CAMA Miner permit
to E?cp,1,O a,,,. f S7trnf � eovrrt Acc E'�(1nn G /fir LioCr` ,� xp �
vv iW+
on my property at �� /� tijL E'�' %ZQ/ in
4& Chu tM A-tiJ County, which is adjacent to your property. A copy of the application and project
drawing is attached/enclosed for your review.
If you have no objections to the proposed activity, please mark the appropriate statement below and return to
me as soon as possible. If no comments are received within 10 days of receipt of this notice, it will be
considered that you have no comments or objections regarding this project.
If you have objections or comments, please mark the appropriate statement below and send your
correspondence to the NC Division of Coastal Management at 1367 US 17 South, Elizabeth City, NC 27909.
If you have any questions about the project, please do not hesitate to contact me at my address/number listed
below, or the Division of Coastal Management at 252-264-3901.
Sincerely,
1 _
Property Own 's Name
2S2 (26 3 9 y
Telephone Number
Address city State rp
li I have no objection to the project described in this correspondence.
I have objec 'on(s) to the project described in this correspondence. JUL U 7 2014
Adjacent Riparian Signature Date
CA- Lg VV'e— ZSZ IFI Z.-c�gSS
Print or Type Name Telephone Number
Address City State Zip
�N�L-C�

Name of Adjacent Property Owner
/97 A(Arlty Ad
Ad(1 �
/ I�YLTvrbr,✓I /1/C Z ?"Y/V
City, State Zip
To Whom It May Concern:
MRJOX
This correspondence is to notify you as a riparian property owner that I am applying for a CAMA Minef permit
to
b
Avo eX1K0
on my property at / J,6 iN-rare/ k- ' in
A u /K � J County, which is adjacent to your property. A copy of the application and projeet
drawing is attached/enclosed for your review.
If you have no objections to the proposed activity, please mark the appropriate statement below and return to
me as soon as possible. If no comments are received within 10 days of receipt of this notice, it will be
considered that you have no comments or objections regarding this project.
If you have objections or comments, please mark the appropriate statement below and send your
correspondence to the NC Division of Coastal Management at 1367 US 17 South, Elizabeth City, NC 27909.
If you have any questions about the project, please do not hesitate to contact me at my address/number listed
below, or the Division of Coastal Management at 252-264-3901.
Sincerel
Property er's Name
W2 Y2j 3 9 s9
Telephone Number
Address city State ip
REMMW
I have no objection to the project described in this correspondence.
I have
objection(s) to the project described in this correspondence. JUL 0 7 2014
> 3 — /7— DCM-1YIH crry
Adjacent Ril�anan Signature Date
&/Wd TAIVZ
Print or Type Name
Z,5" Z - k6 Z - G ..r.2 7
Telephone Number
Address ulty State Zip

DATE:
NAME: JD�� MtC(�A L d �lA2l� LU�.t�Sc-uv j
ADDRESS: Z27- /Y t&ixk y/Ld
CITY: ST/\(C ZIP 2�4SQf
RE:
To Whom It May Concern: /�/
This correspondence is to notify you as a riparian property owner that L ti�E12� C �/'M' is applying for
{insert property owner name or company)
a CAMA Major permit to eK7M-p �ycrl7tn6
✓2- ;E rT 6
Vao Ll 4�a t,Ut Tt-F /� 2 ` �C 37 G,9-/3c.E' RorY4 EJ4 fj,,—rkrla-t
on property located at ( Oc 114iti SLED 9Z
(insert property address i county)
which is adjacent to your property. A copy of the application and project drawing(s) is enclosed for your review. If you have no
objections to the proposed activity, please mark the appropriate statement below and return to:
as soon as possible.
{insert name of responsible party)
If no comments are received within 30 days of receipt of this notice, it will be considered that you have no comments regarding this
project. If you have objections or comments, please mark the appropriate statement below and send your correspondence to the NC
Division of Coastal Management at 1367 US HWY 17 S., Elizabeth City, NC 27909. If you have questions about the project, please do
not hesitate to contact me at 7 S2 f6 9P {insert phone number) or the Division of Coastal Management at 252-264-3901.
Sincerely,
INSERT NAME
1 have no objection to the project as described.
RECEIVED
rJUL 0 7 2014
DCM-MRDCITv
I have objection(s) to the project as described.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, or lift 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.)
I do wish to waive tp
lilt4^t MtC+f>�i Wr.Vl�
Print Name Signature of Adjacent Property Owner
� 21 A ,s Ley /2'1 144L r ,ao, /(/C 2 ) 9
Mailing Address and/or Email Address
I do not wis to w i e the 15' setback requirement.
S %
Date
zS2 337 f/63
Phone Number
eiVCL c4>

MAJOR PERMIT FEE MATRIX
Applicant: � b D 6—K 7— TA C{fS ".� d
Selection
Development Type
Fee
DCM %
DWQ %
(14300 1601 435100093 1625 6253)
(24300 1602 435100095 2341)
I. Private, non-commercial
development that does not
$250
100% ($250)
0% ($0)
involve the filling or
excavation of any wetlands
or open water areas:
II. Public or commercial
development that does not
100% ($400)
0% ($0)
involve the filling or
excavation of any wetlands
or open water areas:
I
Major Modification to a
100% ($250)
0% ($0)
CAMA Major ermit
III. For development that
involves the filling and/or
excavation of up to 1 acre
of wetlands and/or open
water areas, determine if A,
B, C, or D below applies:
III(A). Private, non-
'
commercial development, if
$250
100% ($250)
0% ($0)
General Water Quality
Certification No. 3490 (See
attached can be applied:
III(B). Public or commercial
development, if General
$4 00
100% ($400)
0% ($0)
Water Quality Certification
No. 3490 (See attached)
can be applied:
III(C). If General Water
Quality Certification No.
$400
60% ($240)
40% ($160)
3490 (see attached) could
be applied, but DCM staff
determined that additional
review and written DWQ
JUL U 7 201
concurrence is needed
because of concerns
related to water quality or
DCkf YM
life:
III(D). If General Water
Quality Certification No.
$400
60% ($240)
40% ($160)
Paquatic
3490 (see attached) cannot
be a lied:
IV. For development that
FEI
involves the filling and/or
$475
60% ($285)
40% ($190)
excavation of more than
one acre of wetlands and/or
open water areas:
Ch&ck '0 341Z9 = 425a kt- cei%lk-d Crro, — R,(«fi —J clGla.�

r,
l
JUN
FILED In PEROOInANs Countyy, NC `` 8 2014
on tar 31 2003 st 01.51:05 PH ' l!
by: DEBORAH S. REED
REGISTER OF DEEDS
BOOK 243 PAGE 249 ------
Return To: JChn V. bbtth> ,S, 3r., At3 37W at Law, P.O. Bx 516, Baud, w zm4
Prepared By: Jdat V. %tb- s, Jr., AbnjiEy at L3v, Hatttxd, NC 27944
,ace Above This Line For Recording Data
DEED OF TRUST
/
NUN 100159966117263318
✓
DEFINITIONS
Words used in multiple sections of this document are defined below and other words are defined in Sections
3, 11, 13, 18, 20 and 21. Certain rules regarding the usage of words used in this document are also provided
in Section 16.
(A) "Security Instrument" means this document, which is dated March 31, 2003
together with all Riders to this document
(B) "Borrower" is Robert Lynn Jackson, Diana Lynn Jackson (husband & wife)
Also known as Robert L. Jackson and Diana L. Jackson (husband
& wife)
".- MEMO
Borrower is the trustor under this Security Instrument JUL 0 7 2014
(C) "Lender" is Branch Banking and Trust Company
DC!N-h!I{rj�,
Lender is a Corporation
organized and existing under the laws of North Carolina
DOC #:523821 APPL #:7000290789 LOAN #:6611726331
NORTH CAROLINA-Single Family -Fannie Mae/Freddie Mac UNIFORM INSTRUMENT WITH MERE
-6A(NC) (ano) Form 30 1 1
umse ona y�p�
Page 1 of 15 I0111a1s UNty/'/
VMP MORTGAGE FORMS - (80 1.729

F
u
-r4
'
lionon
?
r".

rl
e ***This is a word processing form to be completed in Microsoft Word—
WC Division of Coastal Management
Major Permit Application Computer Sheet
(111012012)
Applicant: Robert Jackson Date: July 1,2014
Project Site County: Perquimans
Staff- Will Creel District. ®Elizabeth City Washington
❑Morehead City El Wilmington
Project Name: Roof for boat lifts, Deck and garage additions Rover File:
Date of imhal applicetion submittal (D( 1/8t2007); 6/182014 �
Date application "received as complete" in the Field office (EX 1/&2007): 62MO14 JUL O i 2nm
SITE DESCRIPTION/PERMIT INFORMATION
PNA: ❑Yes ®NopSure
Photos Taken: Yes® No❑
Setback Required (riparian): Yes ®No
Critical Habitat: Ye15
foot waiver obtained: []Yes ®o
Hazard Notification Returned. -
[]Yes ®No [ty/p
SAV. Yes No ❑Shell
Bottom: Yes No ® Not Sure
Temporary Impacts: Yes No
Sandbags: Yes
Did the land use classification come from
county LUP:®Yes ❑No
Mitigation Required (optional):
El Yes ®No
Moratorium Conditions: []Yes []No
®NA
Environmental Assessment Done:
El Yes ®No ❑NA
SECONDARY WATER CLASSIFICATION - OPTIONAL (choose MAX of 4)
Future Water Supply (FWS)
0 Nutrient Sensitive Waters (NSIM
Swamp Waters (SW)
❑ High Quality Waters (HQW)
0 Outstanding Resource Waters (ORM
WETLANDS IMPACTED
El (404) Corp. of Engineers (Jurisdictional
(LS) Sea lavender (Limonium sp.)
(SS) Glasswort(Salicomia sp.)
wetlands)
• (CJ) Saw grass (Cladium jamaicense)
0 (SA) Salt marsh cotdgrass (Spartina
C3 (Sr Salt reed grass (Spartina
altemftlors)
cynosuroides)
• (DS) Salt or spike grass (Disfichlis
0 (SC) Bullrush or three square (Scirpus
0 (TV) Cattail (Typha sp.)
spicats)
SO
❑ (JR) Black needlerush (Juncus
❑ (SP) SaWneadow grass (Spartina
roemerianus)
patens)
APPLICATION FEE
El No fee required - $0.00
El III(A) Private w/D&F up to 1 acre; 3490
III(D) Priv. public or comm w/D&F to 1
can be applied - $250
acre, 3490 cant be applied - $400
Minor Modification to a CAMA Major
El Major Modification to a CAMA Major
El IV Any development involving D&F of
permit - $100
permit - $250
more than 1 acre - $475
Permit Transfer- $100
El III(B) Public or commercial w/D&F to 1
El Express Permit - $2000
acre; 3490 can be applied - $400
Major development extension request -
11. Public or commerciaUno dredge
$100
and/or fill - $400
01. Private no dredge and/or fill - $250
El III(C) Pmpublic or Comm w /D&F to 1
acre; 3490 can be applied; DCM needs
DWQ agreement - $400
252-808.2808 :: 1-888-4RCOAST :: www.nccoastaimanagement net
revised: Nov. 2012

'ision of Coastal Mgt. Application Computer Sheet, Page 2 of 3) '
�nt: Jackson
/ate: July 1, 2014
Describe below the ACTIVITIES that have been applied for. Alt values should match the dimension order, and units of
measurement found in your Activities code sheet.
TYPE
REPLACE
Activity Name
Number
Choose
Choose
Dimension 1
Dimension 2
Dimension 3
Dimension 4
One
One
Roof over. : „
1
New Work ®
Replace
588 sq. ft
boatli is
Maint ❑
❑ Y ® N
Garage
I
New Work ®
Replace
256 sq. ft.
Addition
S
Maint ❑
❑ Y ® N
Deck Addition
I
New work ®
Replace
120 sq. ft.
..
Maint ❑
❑ Y ® N
New Work❑
Replace
,
Maint ❑
❑ Y ❑ N
New Work ❑
Replace
Maint ❑
❑ Y ❑ N
I
New Work ❑
Replace
Maint ❑
❑ Y ❑ N
_
New Work ❑
Replace
Maint ❑
❑ Y ❑ N
New Work
Replace
Maint ❑
❑ Y ❑ N
New Work ❑
Replace
Maint El
❑Y❑N
New Work ❑
Replace
Maint ❑
❑ Y ❑ N
New Work ❑
Replace
Maint ❑
❑ Y ❑ N
New Work
Replace
Maint ❑
❑ Y ❑ N
New Work
Replace
Maint ❑
❑ Y ❑ N
New Work ❑
Replace
Maint ❑
❑ Y ❑ N
New Work❑
Replace
Maint ❑
❑ Y ❑ N
.'
New Work El
Replace
Maint ❑
❑ Y ❑ N
New Work❑
Replace
Maint ❑
❑ Y ❑ N
New Work El
Replace
Maint ❑
❑ Y ❑ N
New Work ❑
Replace
Maint El
❑Y❑N
New Wodr❑
Replace
Maint ❑
❑ Y ❑ N
New Work
Replace
Maint ❑
❑ Y ❑ N
New Work Ll
Replace
Maint ❑
❑ Y ❑ N
revised Nov. 2012

/ision of Coastal Mgt. Application Computer Sheet, Page 3 of 3)
,,plicant
Date: June 23, 2014
Describe below the HABITAT disturbances forthe application. All values should match the name, and units of measurement
found in your Habitat code sheet.
Habitat Name
DISTURB TYPE
Choose One
TOTAL Sq. Ft.
(Applied for.
Disturbance total
includes any
anticipated
restoration or
temp Im ads
FINAL Sq. Ft.
(Anticipated Anal
disturbance.
Excludes any
restoration
end/orrtemp
impact amount
TOTAL Feet
(Applied for
Disturbance
total includes
any anticipated
restoration or
tOMP im acts)
FINAL Feet
(Anticipated final
disturbance.
Excludes any
restoration andror
temp impact
amount
Open Water
Dredge [I Fill ❑ Both [I Other
588
588
75' AEC
Dredge ❑ Fill ❑ Both ❑ Other ®
376
376
Dredge ❑ Fill ❑ Both ❑ Other ❑
,
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
-
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
JUL 0 7 20%
�a,,�certi'
252-808.2808 :: 1-886411COAST :: w .nccoastalmanaaement.net revised: Nov. 2012