86741A - NCDOT

fA tscwk OCAMA ElDREDGE & FILL
14 GENERAL PERMIT
[J�New ❑ Modification ❑ Complete Reissue ❑ Partial Reissue
N9 86741
Previous permit
Date previous permit issued _
A B C t I�
As authorized by the State of N rth Carolina, Department of Environmental Quality and the Coastal Resources Commission In an area of environmental concern pursuant to:
I SA NCAC o7 . f-100 ❑ Rules attached. JgGeneral Permit Rules available at the following link: Wwwdeq nc goy/CAMA ales
Applicant Name p Ke'00T
Address 1 IS - C t ogi 1L A.51 i too
City f br-NT09 State W, ZIPS
Phone # (aL% C O
Email D_ cT It�AA.xv.�CA'hL4CO✓
Authorized Agent_ W" Wi).)_tA^s
Project Location (County): p
Street Address/State Road/Lot
Subdivision
City 1S' 'jtSjblC. ZIP
Affected ❑CW E4EW ❑PTA [�?fES ❑PTS Ad]. Wtr. Body CF.o/MW 5
L0
.a-4E>t� na 'nan/unk)
AEC(s): ❑OEA ❑IHA ❑UW ❑SPIMA ❑PWS Closest Maj. Wtr. Body l.�On1 AV`tJ,�
ORW: yesA0 PNA: yes,
Type of Project/ Activity r ON49
N,IE Nv.9 4r�0L41t'jtP1J f9,_S
Shoreline Length_i0O _
Access LengthG
Pier (dock) length
Fixed Platform(s) "•�
Floating Platform(s) 40 t Y aO
Finger pier(s)
Total Platform area goo
Groin length/it
Bulkhead/ Riprdp length _
Avg distance offshore
Breakwater/Sill
Max distance/ length
Basin, channel
Cubic yards
Boat ramp
p�TE� 01 Id /o)p d-3;
(Scale: ire
Boathouse/ Boatlift
Beach Bulldozing
Other —�'Y' 6L47Mi�oNl%s%jS C�f'TI�F4 P '.3.'�` P�fa Ai &PgiDK£al�9%�Gµ�/ 1�•JDS / L
BA��E t (ractnfa _ $E PM("f-b IQ 7t EJr KT1 WAf No LB.4146r. Nff' *> 0C iiPON V�fFi111 l
SAV observed:
No'ou rzom
yes o
Moratorlum: n/a yes o o�Et l kVy(rWE}) '4 Re WRL A*tb id(,DMF A-b �U A0&4 jv�ivA P_4040�D,
Site Photos: t� /n�o
Riparian Waiver Attached: yes v
A building permit/honing permit may be required by:
Permit
❑ TAR/PAM/NEUSE/BUFFER (circle one)
❑ See note on back regarding River Basin rules
❑ See additional notes/conditions on back
I AM AWARE OF STATUTES,CRC RULES AND CONDITIONS THATAPPLY TO THIS PROJECT AND REVIEWED COMPLIANCE STATEMENT (Please Initial)
Paul w, 71 i ams &4 (, L Ais�-/
Agent or Applicat�It�P Ra1IeTg1wvffiPy: Permit Officer's PRINTED Name
Sig na ure .-Plea re a rrfBJ�tement on back of permitSignature
oo L•• wgsk 56&1 3 1 i o
Applitation Feels) Check tt/Money Order Issuing Dat Expirati n Dater

&OVO 11,hNI ❑CAMA El DREDGE & FILL
I GENERAL PERMIT
New []Modification [:]Complete Reissue ❑ Partial Reissue
N° 86741 A B C D
Previous permit
Date previous permit issued _
As authorized by the State of Nerth Carolina, Department of Environmental Quality and the Coastal Resources Commission in an area of environmental concern pursuant to
15A NCAC-)
l�� 1"'-% ❑ Rules attached.
©General Permit Rules available at the following link: www.deq.nc.gov/CAMArules
t
Applicant Name -� Ui�
Authorized Agent lAy L W 1 C 6 t A M L,
Address
�?+ jai {�. [Jk-") i )�...J 1 J ( ( U U
Project Location (County):
City 'J�Iy>`(1
State T�� ZIP (�1(j=.x �.
PP
Street Address/State Road/Lot#(s) 0(, Vr4 (fAs kJA-A:
). 0(k%
Phone# `
6,!i�.�- �G F...p
ti '':' L - �,
Email
i
-
Subdivision
I
City LA�w, }�&LoK ZIP o•c.nt-:f.
Affected ❑CW 11EW ❑PTA dES ❑PTS
AEC(s): ❑OEA ❑IHA ❑UW SPIMA ❑PWS
�
ORW: yes49D PNA: yes/,fib,
Type of Project/ Activity C< :•ts* C ,.-f 'j [ rA fi<:;:AF , .t s I N(, L r 46
!"C,E?16.IPJ�--IL,III"il6-�JIK6_.fR.fa`I-. PeoJf(-TA, l
Shoreline Lsneth /"iUn,
Adj. Wtr. Body CE-)ATA\3 %"JJT%i'✓ (nat1man/unk)
fll �!
Closest Maj. Wtr. Body C-F-DAI z�fJ--UwjL;
G ji'2i.Ae,As -IFF.J
(Scale:
A[s A
Access Length
Pier (dock) length �IYGT
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r
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-
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1' �`?
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Fixed Platform(s)
i
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!ft
_
-_
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_
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j
-�
Floating Platforms) t'Ib K )0
Finger pier(s)
....�
Total Platform area ifzn
Groinlength/fJ
)
-
-
)
-
_
Bulkhead/ Riprap length
-7-
i
---
—
-_-
—
4
Av distance offshore
g
Breakwater/Sill
Max distance/ length
Basin, channel
�-
-"-
—`—
-�-
j-
j—
r
Cubic yards
Boat ramp
I
i
I
j
Boathouse/ eoatlik
;
Beach Bulldozingr-
Other {
L
(,.j�jh
o
tffttil
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-7
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f
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SAV observed: yes noL,
Moratorium: n/a yes no
a...;V
f�.;�:'
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L-
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.
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('L
/•.7 i�"a.�
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[�'!�}7-'�
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Site Photos: yes no
-
- I
----
-
-
--
''
--
Riparian Waiver Attached: yes no
A building permit/zoning permit may be required by:
Permit Conditions
❑ TAR/PAM/NEUSE/BUFFER (circle one)
❑ See note on back regarding River Basin rules
❑ See additional notes/conditions on back
I AM AWARE OF STATUTES, CRC RULES AND CONDITIONS THAT APPLY TO THIS PROJECT AND REVIEWED COMPLIANCE STATEMENT. (Please
Agent or Applicant PRINTED Name
Permit Officer's PRINTED Name
Signature "Please read compliance statement on back of permit•* _
k
Application Fee(s) Check M/Money Order
Signature i
f_Ili
r
Issuing Data Expiratidn Date

RECEIVED
/ surr
✓(
� r � MAY 0 02023
STATE OF NORTH CAROLINA ®CM®EC
DEPARTMENT OF TRANSPORTATION
Roy COOPER J. ERIC BOYETTE
GOVERNOR SECRETARY
May 9, 2023
Greg Daisy
NC Division of Coastal Management
401 S. Griffin Street, Suite 300
Elizabeth City, NC 27909
Subject: Request for a CAMA General Permit for a loading ramp/barge for
the Bridge #9 Preservation Project in Dare County. WBS # 50346.3.1
TIP HB-0017 Project
Dear Mr. Daisey,
The North Carolina Department of Transportation (NCDOT) requests the issuance of a
CAMA General Permit .1200 for the installation of a loading ramp and barge in Manns Harbor,
Dare County. NCDOT will soon start a Bridge Preservation Project on Bridge 9 (Manns Harbor
Bridge), and the contractor has proposed using a loading ramp and barge to facilitate the loading
of material and equipment to small boats for use on the project. The location is an undeveloped
portion of the NCWRC Boat Ramp and Commercial Fishing Docks in Manus Harbor on US 64.
Starting at the NCWRC gravel parking lot of the commercial fisherman, matting would
be placed across a spoil bank near the shoreline. The 7.5' X 36.5' steel ramp would be placed on
the matting and attached to the 20' X 40' barge. The barge would be spudded down for stability.
The average draft of the barge is 1.9'. Temporary fencing would be placed between the matting
and the gravel parking area for security.
The material and equipment will be stored within a fenced laydown yard on the other side
of US 64. The contractor would use telehandlers and other equipment to transport material from
the laydown yard to the barge to be loaded onto small boats. The project would not result in any
permanent impacts to the adjacent 404 wetlands, open water, or the shoreline. The ramp, mats,
and barge would be in place for approximately 3 years. When the structure is no longer needed
for the project, everything would be entirely removed.
Included with this letter are the adjacent landowner notifications, MP-1, MP-4, location
map, and permit drawing. If you have questions, please contact me at [e-mail] or
[phone]. The permit fee can be charged to WBS # 50346.3.1.
Sincerely,
Clemmon W. "Win" Bridgers, Jr., PE
Division One Engineer
�jDocu3igne by:
Paul Williams c7g 11D2941F47E...
Division One Environmental Officer
Mailing Address: Telephone: [phone] Location:
NC DEPARTMENT OF TRANSPORTATION Fax: [phone] AIRPORT DRIVE, SUITE 100
DIVISION ONE Customer Service: 1-877-368-4968 EDENTON, NC 27932
113 AIRPORT DRIVE, SUITE 100
EDENTON, NC 27932 Website:w .ncdot.gov

HB-0017 Bridge Preservation Project N
William B. Umstead Bridge
US 64 over Croatan Sound
Dare County Quad: Manns Harbor & Manteo
EG-ElVED
MAY 0 9 2023
�E DCM—EC
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"•N-DOT GIS'Unit, Copyright:©2013 National Geographic
Mt,ar er;�s --�--Society, i-cubed
0 0.5 1 2 Miles
Date:6/7/2022 1 i i t 1 i i t 1
Author: Paul Williams

IN MP-1
APPLICATION for
Major Dovolopmont Pormh
(last revised 12/27/06)
North Carolina DIVISION OF COASTAL MANAGEMENT
1. Primary Applicant/ Landowner Information
Business Name
N.C. Department Of Transportation
Project Name (if applicable)
Dare Bridge 9 - Manns Harbor Bridge Preservation Project
Applicant 1: First Name
Paul
MI
C
Last Name
Williams
Applicant 2: First Name
MI
Last Name
If additional applicants, please attach an additional page(s) with names listed.
Mailing Address
113 Airport Road, Suite 100
PO Box
City
Edenton
State
NC
ZIP
27932
Country
Phone No.
252-482-1861 ext.
FAX No.
252-482-8722
Street Address (if different from above)
City
State
ZIP
Email
[e-mail]
2. Agent/Contractor Information
Business Name
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
-
- ext.
Phone No. 2
- - ext.
FAX No.
Contractor #
Street Address (if different from above)
City
State
ZIP
Email
<Form continues on back> RECEIVED
MAY 0 9 2023
DCM-EC
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Form DCM MP-1 (Page 2 of 5)
APPLICATION for
Major Development Permit
3, Project Location
County (can be multiple)
Street Address
State Rd. #
Dare
NCWRC Boat Ramp and Docks near Manna Harbor Bridge
US 64
Subdivision Name
City
State
Zip
Manus Harbor
NC
27953 -
Phone No.
No.(a) (if many, attach additional page with list)
ext.a.
In whichNC river basin is the project located?
Emanmade?ame
ame of body of water nearest to proposed project
T
Pasquotank
Croatan Sound
c. Is the water body identifed in (b) abovenatrl or
the closest major water body to the proposed project site.
❑Natural []Manmade ®Unknown
Croatan Sound
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.
Dare
4. Site Description
a.
Total length of shoreline on the tract (ft.)
b. Size of entire tract (sq.ft.)
400'
40,000
c.
Size of individual lot(s)
d. Approximate elevation of tract above NHW (normal high water) or
NWL (normal water level)
(If many lot sizes, please attach additional page with a list)
3 ®NHW or ❑NWL
e.
Vegetation on tract
Various roadside grasses on the maintained road shoulder, adjacent wetlands predominantly phragmites
f.
Man-made features and uses now on tract
RECEIVED -
Gravel Parking lot and commercial fishing docks
MAY o 9 2023
g.
Identify and describe the existing land uses adlacent to the proposed project site.
Marsh DC Vi— C
h.
How does local government zone the tract?
i. Is the proposed project consistent with the applicable zoning?
Public, Commercial
(Attach zoning compliance certificate, if applicable)
❑Yes []No ®NA
j.
Is the proposed activity part of an urban waterfront redevelopment proposal? ❑Yes NNo
k.
Has a professional archaeological assessment been done for the tract? If yes, attach a copy. NYes ❑No ❑NA
If yes, by whom? NCDOT - Cultural Resources
I.
Is the proposed project located in a National Registered Historic District or does it involve a ❑Yes NNo ❑NA
National Register listed or eligible property?
<Form continues on next oaae>
M. (i) Are there wetlands on
(ii) Are there coastal wetlands on the site?
❑Yes NNo
(iii) If yes to either (i) or (ii) above, has a delineation been conducted? NYes []No
(Attach documentation, if available)
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Form DCM MP-1 (Page 3 of 5)
APPLICATION for
n. Describe existing wastewater treatment
None
Major Development Permit
o. Describe existing drinking water supply source.
None
p. Describe existing storm water management or treatment systems. _ C C
NIA C lJ
5. Activities and Impacts
a. Will the project be for commercial, public, or private use? ❑Commercial ®Public/Government
❑Private/Community
b. Give a brief description of purpose, use, and daily operations of the project when complete.
NCDOT will be conducting a Bridge Preservation Project on the Manns Harbor Bridge (Dare #9) under contract (Coastal
Gunite). The contractor has proposed to use an undeveloped shoreline on the NCWRC property in Manns Harbor for a ramp
and barge to load material to boats for the project. The structure will be in place for approximately 3 years and function as a
temporary pier/dock. The project will not result in any permanent wetland, open water, or shoreline impacts.
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.
Tele-handlers, skidsteers, and other material handling equipment will be used to transport material and equipment to the
barge to load onto small boats to transport to the bridge. Material and equipment will be stored across US 64 within a fenced
in upland area within the NCDOT ROW.
d. List all development activities you propose.
Matting will be placed across a spoil bank near the shoreline. The 7.5' X 36.5' steel ramp will be placed on the matting and
attached to the 20' X 40' barge. The barge will be spudded down for stability. The average draft of the barge is 1.9'.
Temporary fencing will be placed between the matting and the gravel parking area for security.
e. Are the proposed activities maintenance of an existing project, new work, or both? New work
f. What is the approximate total disturbed land area resulting from the proposed project? 224 ®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.
No discharges to open waters.
i. Will wastewater or stonmwater 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>
6. Additionallnformation
In addition to this completed application form, (MP-1) the following items below, if applicable, must be submitted in order for the application
package to be complete. Items (a) — (0 are always applicable to any major development application. Please consult the application
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.
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Form DCM MP-1 (Page 4 of 5)
APPLICATION for
Major Development Permit
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.
Name NC Wildlife Resources Commission Attn: William Ridgeway
Phone No. 252426-2255
Address 1133 Don Juan Rd., Hertford, NC 27944
Name William A. Phillips and Kathryn B. Phillips RECCIVED
Phone No. 252-706-0064
MAY 0 9 1013
Address 3656 Fort Landing Rd., Columbia, NC 27925
Name DC ` EC
Phone No.
Address
g. A list of previous state or federal permits issued for work on the project tract. Include permit numbers, permittee, and issuing dates.
h. Signed consultant oragent authorization form, if applicable.
i. Welland 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.
1 7. Certification and Permission to Enter on Land 1
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 05/09/2023 Print Name Paul Williams, NCDOT Division One Environmental Officer
Dmuegne by:
Signature LD r��s
1C79130029MF47E...
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
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RECEIVED
Form DCM MP-4
STRUCTURES
(Construction within Public Trust Areas)
MAY 0 9 2023
DCM-EC
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 ®PublidGovernment ❑Private/Community
❑This section not applicable
b. (1) Will the facility be open to the general public?
❑Yes ®No
c. (1) Dock(s) and/or pier(s)
d. (1) Are Finger Piers included? []Yes ®No
(it) Number 1
If yes:
(iii) Length 76.5
(it) Number _
(iv) Width 20
(iii) Length
(v) Floating ®Yes []No
(iv) Width
(v) Floating ❑Yes []No
e. (i) Are Platforms included? ❑Yes ®No
f. (i) 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
h. Check all the types of services to be provided.
n/a - boats will be tied to the barge
❑ Full service, including travel lift and/or rail, repair or
(ii) Number of slips existing
maintenance service
n/a
❑ 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:
Material loading for bridge Preservation oroiect
i. Check the proposed type of siting:
❑ Land cut and access channel
❑Open water; dredging for basin and/or channel
®Open water; no dredging required
❑Other; please describe:
k. Typical boat length: variable, but small craft
m. (!)Will the facility have tie pilings?
❑Yes ®No
(ii) If yes number of tie pilings?
i. Describe the typical boats to be served (e.g., open runabout,
charter boats, sail boats, mixed types).
open runabout, small craft
I. (i) Will the facility be open to the general public?
❑Yes ®No
252-808-2808:: 1-88B-4RCOAST :: www_nccoastaimanagement_net revised: 12/27/06

Form DCM MP-4 (Structures, Page 2 of cl)
2. DOCKWG FACILITY/MARINA OPERATIONS ❑This section not epplicab
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:
b. Describe treatment type and disposal location for all sanitary wastewater.
c. Describe the disposal of solid waste, fish offal and trash.
Rb".."'E I VE
MAY U 9
d. How will overboard discharge of sewage from boats be controlled? ((��'��] �{
®�lt —EC
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 offuel-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
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Form DCM MP-4 (Structures, Page 3 of 4)
n. Is the marina/docking facility proposed within or adjacent to any shellfish harvesting area?
❑Yes ®No
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
EWL 0 erm. []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) ®This section not applicable
a. (i) Is the boathouse structure(s):
❑Commercial ❑PubliGGovernment ❑Private/Community
(ii) Number
(iii) Length
(iv) Width
Note: Roofed areas are calculated from dripline dimensions.
14. 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
15. BREAKWATER (e.g., wood, sheetpile, etc.) ®This section not applicable I
a. Length
c. Maximum distance beyond NHW, NWL or wetlands
b. Average distance from NHW, NWL, or wetlands
6. MOORING PILINGS and BUOYS ®This section not applicable
a. Is the structure(s):
❑Commercial ❑PubliGGovernment ❑Private/Community
C. Distance to be placed beyond shoreline
Note: This should be measured from marsh edge, if present.
b. Number
d. Description of buoy (color, inscription, size, anchor, etc.)
e. Arc of the swing
IVE: D
MAY 0 9 2023
7. GENERAL
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Form DCM MP-4 (Structures, Page 4 of 4)
a. Proximity of structure(s) to adjacent riparian property lines
80,
of vessel.
c. Width of water body
400'
e. (i) 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.
b. Proximity of structure(s) to adjacent docking facilities.
Commercial Fishing Docks -130' to NE
Private pier-100'to S
d. Water depth at waterward end of structure at NLW or NWL
10' -14'
8. OTHER ❑This section not applicable
a. Give complete description:
This structure will be temporarily in place for approximately 3 years for the Bridge Preservation Project on the Manns Harbor
Bridge.
05/09/2023
Date
Dare Bridge 9 - Manns Harbor Bridge Preservation Project
Project Name
Paul Williams
Applicant Name
ooeusynea ny:
Applicant Signature C7G791301 11FVE...
RC9
MAY 0 9 ZOZ3
Dag .1 1
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252-308.2808 a 1-888-4RCOAST :: p v vv,nccoastalmanagement.net revised; 12127i06

RECE L
N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONNVAIVER FORM
MAY 0 9 2023 CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERY
DCM-EC (Top portion to be completed by owner or their agent)
Name of Property Owner: State of NC - Manns Harbor Boat Access (Loading Ramp/Barge for Bridge Preservation Project)
Address of Proparty:
Mailing Address of Owner: 1 13 Airpnrt T)r Edenton NC 27932,
Owner's email:
Agent's Name: Paul Williams - NCDOT
Agent's Email:
Owner's Phone#:
Agent Phone#: [phone]
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom Portion to be completed by the Adjacent Property Owner)
I herebycertify that 1 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
descriptiorwr drawina. with dimancinna mnel hn n.n,d J ...:al _
I DO NOT have objections to this proposal. I DO have objections to this proposal.
IT you have objections to what is being proposed, you must notify the N.C. Div)sion of Coastal Management (DCM) in writing within 10 days of receipt of this notice. Correspondence should be
mailed to 401 S. Griffin St., Ste. 300, Elizabeth City, NC, 27909. DCM representatives can also be
contacted at [phone]. No response is considered the same as no objection if you have been
notified by Certified Mail.
WAIVER SECTION (Choose only one)
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 riprao 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' setbackOl/
-OR-
Signature of Adjacent R" rian Pr party Owner
I DO NOT wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner:
Typed/Printed name of ARPO:
Mailing Address of ARPO: 1133 Don Juan Rd., Hertford, North Carolina 27944
ARPO's email' [e-mail] 252-426-2255
ARPO's Phone#:
Date: S l *waiver is valid for up to one year from ARPO's Signature*
Revised August 2022

p`� N.C. DIVISION OF COASTAL MANAGEMENT
ECE iVENCERTEFIED MAIL - RET RNERECEIIPTRTY N EQUEST DER AorIHHA DADELIIVEERRM
MAY 0 9 2023 (Top portion to be completed by owner or their agent)
r N roperty Owner: State of NC - Manns Harbor Boat Access (Loading Ramp/Barge for Bridge Preservation Project)
CI A_
Address of Property: NCWRC Boat Ramps & Docks - 5227 US-64, Manns Harbor- NC 27953
Mailing Address of Owner: 1 I I Airnnrt Dr , Edenton, NC 27912
Owner's email:
Owner's Phone#:
Agent's Name: Paul Williams - NCDOT Agent Phone#: [phone]
Agent's Email: [e-mail]
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adjacent Property Owner)
I hereby certify that I own property adjacent to the above referenced property. The individual applying forthis
permit has scribed to me, as shown on the attached drawing, the development they are proposing. A
I DO NOT have objections to this proposal. I DO have objections to this proposal.
If you have objections to what is being proposed, you must notify the N.C. Division of Coastal
Management (DCM) in writing within 10 days of receipt of this notice. Correspondence should be
mailed to 401 S. Griffin St., Ste. 300, Elizabeth City, NC, 27909. DCM representatives can also be
contacted at [phone]. No response is considered the same as no objection if you have been
notified by Certified Mail.
WAIVER SECTION (Choose only one)
I understand that any proposed pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or
groin must be set back a minimum distance of 15' from my area of riparian access unless waived by me
(this does not apply to bulkheads or riprap revetments). (If you wish to waive the setback, you must sign
the appropriate blank below.)
I DO wish to waive some/all of the 15' setback
Signature of Adjacent Riparian Property Owner
-OR-
I DO NOT wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner:
Typed/Printed name of ARPO:
Mailing Address of ARPO:
ARPO's email:
3656 FT L
NC 27925
Phone#: 9� ?U b :Vj�
Date:
*waiver is valid for up to one year from ARPO's Signature`
Revised August 2022

MANNS HARB(
LOADING RAAA
TING
EMSTiNG GROUND
BRIDGE PRESRVATION P.
ACCESS
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