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s Previous permit
GENERAL PERMIT )/,//V
�� Date pr vio s permit issued
4 ❑ Netiw ❑ Modification ❑ Complete Reissue ❑ Partial Reissue ) Ye:of
As authorized by the State of North Carolina, Department of Environmental Quality and the Coastal Resources Commission m n environmental concern pursuant to:
15A NCAC Rules attached. ❑ General Permit Rules available at the following link: www.dgq.nc.Yov/CAMArules
Applicant Name Authorized Agent t'
Address ' !` £ Project Location (County):
City'l L'({' V l �` State �' ZIP L� Street �4 dr s State toa /Lolt,�#� (,$)
Phone # (; > Z.,)'R�`f'
Email Subdivision �}
City —..,..1 f f C7 f L `/7t: ZIIPt
Ad ?+ %� NC-L natmanun
Affected ❑ CW ❑ EW ❑PTA ❑ ES ❑ PTS 1• Wtr. Body tl (//k)
AEC(s): ❑ OEA ❑ IHA ❑ uW ❑ SPIMA ❑ PWS Closest Maj. Wtr. Body
ORW: yes/no PNA: yes/no
Type of Project/ Activity Y y%
Shoreline Length � [
Access Length
Pier (dock) length
Fixed Platform(s)
Floating Platform(s)
Finger pier(s)
Total Platform area
Groin length/#
Bulkhead/ Riprap length
Avg distance offshore
Breakwater/Sill
Max distance/ length
Basin, channel l
Cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
SAV observed: yes
Moratorium: n/a yes
Site Photos: yes
Riparian Waiver Attached: yes
A building permit/zoning permit ms,
Permit Conditions
AND
Agent or Applicant PRINTED UP me Q k Q
(Scale: iR -r> I
❑ TAR/PAM/NEUSE/BUFFER (circle one)
❑ See note on back regarding River Basin rules
❑ See additional notes/conditions on back
STATEMENT. (Please Initial)
Permit Officer's PRINTED Name
Signature "Please read compliance statement on back of permit"
Application Feels) Check #/Money Order
Signature
Issuing Date
Expiration Date
Statement of Compliance and Consistency
This permit is subject to compliance with this application and permit conditions. Any violation of these terms may
subject the permittee to a fine or criminal or civil action; and may cause the permit to become null andvoid. ,
This permit must be on the project site and accessible to the permit officer when the project is inspected for
compliance. The applicant certifies by signing this permit that: 1) prior to undertaking any activities authorized by this
permit, the applicant will confer with appropriate local authorities to confirm that this project is consistent with the
local land use plan and all local ordinances, and 2) a written statement from the adjacent riparian property owner(s)
has been obtained, or proof of delivery of certified mail notification of the adjacent riparian property owner(s).
The State of North Carolina and the Division of Coastal Management, in issuing this permit under the best available
information and belief, certify that this project is consistent with the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
F� Tar - Pamlico River Basin Buffer Rules F-1 Neuse River Basin Buffer Rules
If indicated on front of permit, your project is subject to the Environmental Management Commission's Buffer Rules
for the River Basin checked above due to its location within that River Basin. These buffer rules are enforced by the
NC Division of Water Resources. If you have any questions, please contact the Division of Water Resources at the
Washington Regional Office (252-946-6481) or the Wilmington Regional Office (910-796-7215).
Notes/Additional Permit Conditions:
Please ensure all debris associated with the removal or construction of the permitted development is contained within the authorized
project area and disposed of in an appropriate upland location.
Division of Coastal Management Offices
Morehead City Headquarters
400 Commerce Ave Morehead City, NC 28557
252-808-2808/ 1-888-4RCOAST Fax: 252-247-3330
(Serves: Carteret, Craven — south of the Neuse River, Onslow
Counties)
Elizabeth City District
401 S. Griffin St. Ste. 300
Elizabeth City, NC 27909
252-264-3901
(Serves: Bertie, Camden, Chowan, Currituck, Dare, Gates, Hertford,
Pasquotank and Perquimans Counties)
Washington District
943 Washington Square Mall Washington, NC 27889
252-946-6481
Fax: 252-948-0478
(Serves: Beaufort, Craven — north of the Neuse River, Hyde, Pamlico,
Tyrrell and Washington Counties)
Wilmington District
127 Cardinal Drive Ext. Wilmington, NC 28405-3845
910-796-7215
Fax: 910-395-3964
(Serves: Brunswick, New Hanover and Pender Counties)
http://portal.ncdenr.org/web/cm/dcm-home Revised 6/01/2021
N.C. DIVISION OF .COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
CERTIFIED MAIL RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent)
Name of Property Owner: Herbert Ormond III
Address of Property, 1184 N Anderson Blvd / PID #'s 4213-70-0526-0000 & 4213-70-0428-0000
Mailing Address of Owner: 3907 Cantata Drive Greenville NC 27858
Owner's email: Normand@suddenlink.net Owner's Phone#: . (252) 71479574
Agent's Name: Southern NC Marine Agent Phone#: (910) 512-7647 .
Agent's Email: SouthemNCmarineCdlgmail.com
ADJACENT RIPARIAN. PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adiacent Property.Owner)
I hereby certify that I own property adjacent to the above referenced property. The individual applying forthis
permit has described to me, as shown on the.attached drawing, the development they are proposing. A
description or drawing, with dimensions, must be provided with this letter.
I DO NOT have objections to this proposal. I DO have objections to.this proposal...
If you have .objections to what is being proposed, you must notify the N.C. Division of Coastal
Management (DCM) in writing within 10 days of mceipt .of this notice.. Correspondence should be
mailed to 127 Cardinal Drive Ext, I Mimington, NC 28406-3845. DCM. representatives can also be
contacted at (910) 796-7215 .No response Is considered the same as no objectionif you have been
notified by Certified Mail.
WAIVER SECTION
I understand that any proposed pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or
groin must be set back a minimum distance of 15' from my area of riparian access unless waived by me.
(this does.not apply to bulkheads or riprap. revetments). (If you wish to waive the setback, you must sign
the appropriate blank below.) .
I DO wish .to waive some/all of the 15' setback /j/ �Lc�cd/ .
Signature of Adjacent Ripa 'an Property Owner
-OR-
1 do not wish to waive the 15' setback requirement (initial the blank)
Signature;of Adjacent:Riparian Property Owner. _r!/ f7lP,cllLd/
Typed/Printed name of ARPO:. Vickie Lewis
Mailing Address of-ARPO: 1188 N Anderson Blvd Topsail Beach NC
ARPO's email: Vwlewis2Cd_igmail.com ARPO's Phone#: (910) 214-9567
Date:*waiver is valid for up to one year -from ARPO's Signature"
Revised May 2021
AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: Herbert Ormond III
Mailing Address: 3907 Cantata Drive Greenville NC 27858
Phone Number:
Email Address:
I certify that I have authorized
(252) 714-9574
Hormond@suddenlink.net
Southern NC Marine
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:
Shift Floating Dock and replace Boat Lift
at my property located at 1184 N Anderson Blvd Topsail Beach NC
in - ^Pender County.
1 furthermore certify that 1 am authorized to grant, and do in fact grant permission to
Division of Coastal Management staff, the Local Permit Officer and their agents to enter
on the aforementioned lands in connection with evaluating information related to this
permit application.
Property Owner Information:
Signature
Herbert Ormond III
Print or Type Name
Owner
Title
07 01 2022
Date
This certification is valid through 12 / 31 / 2022
N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERY .
(Top portion to be completed by owner or .their agent)
Name of Property Owner.. Herbert Ormond III
Address of Property: 1184 N Anderson Blvd / PID #'s 4213-70-0526-0000 & 4213-70-0428 0060 .
Mailing Address of Owner. 3907 Cantata Drive -Greenville NC 27858
Owner's email: Hormond@suddenlink.net Owner's Phone#: (252) 71479574
Agent's Name:- Southern NC Marine Agent Phone#: (910) 512-7647
Agent's Email: SouthemNCmarineCaaamail:com
ADJACENT RIPARIAN PROPERTY OWNER'S.CERTIFICATION
(Bottom portion to be completed by the Adlacent Property Owner)
I hereby certify that I own property adjacent to the above referenced property. The individual applying forthis
permit has described to me, as shown on the attached drawing, the developnient'they are proposing. A
description'or drawing. with dimensions, must be provided with this letter.
90-6—I DO NOT have objections to this proposal. 1 DO have objections to this proposal.
If you have objections to what is being proposed, you must notify the N.C. Division of Coastal
Management (DCM) in writing within 10 days of receipt of this notice. Correspondence should be
malted to 127 Cardinal Drive Ext., ,1Mrmington, NC 28406-3845. DCM representatives can also be
contacted at (910) 796-7215. No response is considered the same as no objection N you have been
notff/ed by certiried mail.
WAIVER SECTION
understand that any proposed pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or
groin must be set back a minimum distance of 15' from my area of riparian access unless waived by me
(this does not apply to bulkheads or riprap revetments). (If you wish to waive the setback, you must sign
the appropriate blank below.) .
I DO wish to waive somelall of the 16 setback
d
Signature oo(djaciAt Riparian Property Owner
-OR-
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner:
Typed/Printed name of ARPOO Judith Brock
Mailing Address of ARPO: 1182 B N Anderson Blvd Topsail :Beach NC
ARPO's email:- dy kr'a rod 4,e't. a ARPO's Phone#:
Date: Z2 ^ `waiver is valid for up to one year from ARPO's Signature*
Revised May 2021
AM,:
Date Received
Date Dmaaltod
Check From (Name)
Name of Permit Holder
Vender
Check number
Check
amount
Permit NumberlComment5
Receipt or Re7und7Reallncated
Columnl
Ce1umn2
Column3
Co1umn4
Column5
Column6
Cc1umn7
ColumnB
'Co1umn9
10152022
RG Manna Conlracthq LLC
Bullard
Barik or Amedn
1135
200.OD
GP k87440D
8H rct. 1T720
10/511022
South— NC Marine LLC
Ormond III
Fuet Bank
1551
200.00
GP 087482D
JD rcl. 17697
10152022
' hll—e Marine C=Ie ction Ix
Peterem
Coastal Baas aM Trod
43BS
$ 200.00
GP k87800D
JD rct. W691
101512 2
Daniel Ross Woos
same
USAA Federal S ' s Banc
3022
S 200.00
GP k87445D
KB mt. 1D365
101512022
H5Canatmclion
MCGan
Tmis
10266
200.OD
GPO.L7 10
PA rct 17737