NCDOT 106-12 B-2500 Phase I Navigation Application 9/3/2016

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DEPARTMENT OF HOMELAND SECURITY OMB Approval: 1625-0011
U.S. Coast Guard Expiration Date: 12/31/2017
PRIVATE AIDS TO NAVIGATION APPLICATION
(See attached instructions and copy of Code of Federal Regulations, Title 33, Chap. 1, Part 66)
• NO PRIVATE AID TO NAVIGATION MAY BE AUTHORIZED UNLESS A COMPLETED APPLICATON FORM HAS BEEN RECEIVED(14 U.S.C. 83; 33 CFR. 66. 01-5).
1 ACTION REQUESTED FOR ❑x A. ESTABLISH AND MAINTAIN ❑ B. DISCONTINUE ❑ C. CHANGE 0 D. TRANSFER OWNERSHIP 2. DATE ACTION TO START:09/26/2016
PRIVATE AIDS TO NAVIGATION:
3. AIDS WILL BE OPERATED: x❑ A. YEAR-ROUND 0 B. TEMPORARILY UNTIL C.SEASONAL FROM TO
4 NECESSITY FOR AID (Continue in Block 8) 5 GENERAL LOCALITY AUTHORIZING PERMIT FOR THIS STRUCTURE OR BUOY
ACE PERMIT AND/ PERMIT (Valid Permit Number)
Establishment of Wave Break for SAV Mitigation I - 2 mi W of Oregon inlet ❑ OR STATE
FOR DISTRICT COMMANDERS ONLY 1 7. APPLICANT WILL FILL IN APPLICABLE REMAINING COLUMNS
NO LIGHT - DEPTH FOCAL STRUCTURE REMARKS
LIGHT LIST NAME OF AID 00 FLASH FLASH COLOR POSITION OF CANDELA PLANE TYPE,COLOR.AND HEIGHT (See instructions)
ra NUMBER I PERIOD LENGTH (7e) WATER (7g) HEIGHT
(7a} (7b) (7c) (7d) (7f) (7h) ABOVE GROUND (7i) (7j)
Old House Channel 3S°45' 17.305'N 2 -Danger' diamond
Warn ing Light A 2 . 59 0.5s White 75°35' I3.696'W 3 , 9 ' single pile on dayboard. white
structure
regulatory
Old House Channel 35°45' 17.852'N
Warning Light 2. 53 0.5s White 75°35' 10.741'W: single pile on 2' 'Danger- diamond
3 9 ' dayboacd. white
structure
regulatory
O+d House Channel 35°45' 17 129-N
:%arning Light 2 .5s 0 5s White 775°35 7 839-w` single pile on 2 Danner diamond
C 3' 9 ' dayboard. white
structure
regulatory
-
8. ADDITIONAL COMMENTS
Ilk I
AME AND ADDRESS OF PERSON IN DIRECT CHARGE 10a_ NAME AND ADDRESS OF PERSON OR CORPORATION 10b. THE APPLICANT AGREES TO SAVE THE COAST GUARD HARMLESS
OF THE AID(S) AT WHOSE EXPENSE THE AID(S)WILL HE MAINTAINED WITH RESPECT TO ANY CLAIM OR CLAIMS THAT MAY RESULT ARISING
Pablo Hernandez . NCDOT Res. Eng. North Carolina Dept . of Transpor t a t ion FROM THE ALLEGED NEGLIGENCE OF THE MAINTENANCE OR OPERATION
p 349 Water Plant Rd . Unit B Man teo NC 1 South Wilmington St OF THE APPROVED AID(S).
9b. ELEPHONE NO. Raleigh NC 27699 loc. DATE 10d. SIGNAT E AN .TITLE OF,OjFICIA IGNING
-473-3637 ,,��
ft. E-MAIL ADDRESS v�`'tl 1(o d'i/v "Pk . lip S, i-letyvisi , P. L.. . I
piernandeztEncdot gov NCDOT Natural Environment Sect . Head
FOR USE BY DISTRICT COMMANDER RECO DATE APPROVED MATURE (By direction)
raviSERIAL NO. CLASSIFICATION OF AIDS(S) CHARTljxpll0 —Th LNM
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