55359_ANDERSON, ROBERT_20100504

C:I.MA / ❑ DREDGE & FILL
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GENERAL PERMIT �`� 4Previous permit#
❑New ❑Modification ❑Com fete Reissue ❑Partial Reissue Date previous permit issued
P P
As authorized by the State of North Carolina, Department of Environment and Natural Resources .-+7
2i
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
Applicant Name ^
ules attached.
Project Location: County_i 1 CG
Address I `i %b i d";11K L c l ` .
Street Address/ State Road/ Lot #(s)
. .
r_
City ;(✓�� eyE:IC �'�?�E state A zip
Phone # Fax #
Subdivision
Authorized Agent �S Oclkd Cl(*'I�`�I •} �1L City —' f i S ok ZIP '
Affected ElCw IJtw TA ,(DES ElPTS
Phone # ( '. .. River Basin J_ _
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
AEC(s):
Adj. Wtr. Body n, /man /unkn) 3
i
Closest Maj. Wtr. Body
ORW: yes / no PNA yes / no Crit.Hab. yes '/ no
Type of Project/ Activity L.- L' ` 4 ®r I no 3
a 1
(Scale: 0 )
Pier (dock) length_ X Q
Platform(s)
t t' I i 1
'^
E! Finger piers) _
Groin length t i
J�f
U�1 7
number —
—
Bulkhead/ Riprap length
avg distance offshore
v
4 e 0f la—
max distance offshore
j _
i
Basin, channel -— 1— -- — -- ---
—'
--- --- --+--------=---
_ _ -
cubic yards
Boat ramp
.
Boathouse/ Boatlift
Beach Bulldozing
Other { ,
Shoreline Length `` .
SAV: not sure `yes no
-
Sandbags: not sure yes--
f}
��
Moratorium: 'n/a yes no
Photos: yes nod�j
Waiver Attached: yes no
��
r 11� GK S�f -
A building permit maybe required by: Jf j' 1 �(`i t
(�y See note on back regarding River Basin rules.
Notes/ Special Conditions
' e Q ; y
(-A+ ft��� f)f'
j"
i�
Agent or Applicant Printed Name*.,
Ae—rmitOffiGPISign3ture
Signature ** Please read compliance statement on back of permit
Issuing Date• Expi tion Date
Application Fee(s) Check #
Local Planning Jurisdiction Rover File Name

Statement of Compliance and Consistency
This permit is subject to compliance with this application, site drawing and attached general and specific conditions. Any
violation of these terms may subject the permittee to a fine or criminal or civil action; and may cause the permit to become
null and void.
This permit must be on the project site and accessible to the permit officer when the project is inspected for compliance. The
applicant certifies by signing this permit that [)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 or certified mail return receipt has been obtained from the adjacent riparian
landowner(s) .
The State of North Carolina and the Division of Coastal Management, in issuing this permit under the best available
information and belief, certify that this project is consistent with the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
❑ Tar - Pamlico River Basin Buffer Rules ❑ Other:
❑ 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 Quality. Contact the Division of Water Quality at the Washington Regional Office (252-946-6481) or the Wilmington
Regional Office (910-796-7215) for more information on how to comply with these buffer rules.
Division of Coastal Management Offices
Raleigh Office
Mailing Address:
1638 Mail Service Center
Raleigh, NC 27699-1638
Location:
2728 Capital Blvd.
Raleigh, NC 27604
919-733-2293
Fax:[phone]
Morehead City Headquarters
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/ 1-888ARCOAST
Fax: [phone]
(Serves: Carteret, Craven, Onslow -above
New River Inlet- and Pamlico Counties)
Elizabeth City District
1367 U.S. 17 South
Elizabeth City, NC 27909
252-264-3901
Fax:[phone]
(Serves: Camden, Chowan, Currituck,
Dare, Gates, Pasquotank and Perquimans
Counties)
Washington District
943 Washington Square Mall
Washington, NC 27889
252-946-6481
Fax: [phone]
(Serves: Beaufort, Bertie, Hertford, Hyde,
Tyrrell and Washington Counties)
Wilmington District
127 Cardinal Drive Ext.
Wilmington, NC 28405-3845
910-796-7215
Fax: [phone]
(Serves: Brunswick, New Hanover,
Onslow -below New River Inlet- and
Pender Counties)
Revised 08/09/06

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSBOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to p1bo+ h 's
(Name of Property Owner)
property located at L4 1�5 M Concd Lo i n (.0 s DY . V Y,eAA+z,,-1 >
Cm I� (Lot, Block, Road, etc.) j�
on S14 �' I �,2 C r° , in 1 G 11 C O 1(�
.b, N.C.
(Waterbody) (Town and/or County)
He has described to me, as shown below, the development he is proposing at that location,
and, I have no objections to his proposal. I understand that a pier/mooring pilings/boatlift/boathouse
must be set back a minimum distance of fifteen feet (15') from my area of riparian access unless
waived by me.
I do not wish to waive the setback requirement.
I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development) I
i
'BooTN aNDERSoN
F3oND
Signature
Print or Type Name
Telephone Number
Date: /. '04 r J9

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIERIMOORING PILINGSBOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to PL CJ '4 ►''I ►"lIX -iV'sc h 's
(Name of Property Owner)
property located at �C 5 W f�ocd LJ i nds Dy. V r IeAA4?l 1 ,
(Lot, Block, Road, etc.)
on 5 Y) J�j,, l � 1 X e e k , in 'FG I r C t7 CO , N.C.
(Waterbody) (Town and/or County)
He has described to me, as shown below, the development he is proposing at that location,
and, I have no objections to his proposal. I understand that a pier/mooring pilings/boatliftlboathouse
must be set back a minimum distance of fifteen feet (15') from my area of riparian access unless
waived by me.
I do not wish to waive the setback requirement.
I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development) I
PC 4
10 if
> I5 ' ---�— 30 ' —}— > 15,
BooTR "IrNDERSoN 'i F3©No
Sigfiad/i / "
Print or Type Name
33(Q--11o�-I�tZIU
Telephone Number
Date: '� ., S — Z-D I p

North Carolina Depal ment of Environment anti Natl_lral Resources
Division of Coastal Management
iyUct.ad F. Gasie f. Lo%mor Charles S. ,;ones, Director IiVilliam .;. Ross .. S2Cret;'.rr
Date
Applicant NamL
� n
Mailing Address �C �C) _ A ��Z—\�-
Me 0 1:�" %3W-s V , % `1 �4. a3ly b.
I certify that I have authorized (agent) &0" C9eAL QbosT b--OC-to act on my
behalf, for the purpose of applying for and obtaining all CAIV1A Permits necessary to
install or construct (activity)
at (location) L6"T*S _ ��� �Ol'�����1n1d�s �R ���e ►�Q� i.�C
a%ll �
This cereifi�ation is `ali(Mru (date) S 4e o, ,
Signature
400 Commerce Avenue, Morehead City, North Carolina 28557
Phone: [phone] FAX: [phone] Internet: www.ncrroastalmanagement.net
An Equal Opportu*j 1 Arfimadve Actior. Employer — 50% Recycled l 10% Post Consumer Paper

NC Division of Coastal Mgt. Habitat Impact Computer Sheet
Applicant: Robert Anderson
Date: May 4, 2010
General Permit #: 55359C
Describe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
found in your Habitat code sheet.
TOTAL Sq. Ft.
FINAL Sq. Ft.
TOTAL Feet
FINAL Feet
(Applied for.
(Anticipated final
(Applied for.
(Anticipated final
DISTURB TYPE
Disturbance total
disturbance.
Disturbance
disturbance.
Habitat Name
Choose One
includes any
Excludes any
total includes
Excludes any
anticipated
restoration
any anticipated
restoration and/or
restoration or
and/or temp
restoration or
temp impact
temp impacts)
im act amount)
temp impacts)
amount
ow
Dredge ❑ Fill ❑ Both ❑ Other ❑O
470
470
LM
Dredge ❑ Fill ❑ Both ❑ Other ❑X
50
50
HG
Dredge ❑ Fill ❑ Both ❑ Other ❑x
50
50
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
252-808-2808 :: 1-888-4RCOAST :: www.nccoastaimanagement.net revised:02/03/10

A riparian buffer authorization is required for pier and docking facilities access ways through the Tar -Pamlico &
Neuse River Riparian buffer per Division of Water Quality (DWQ) regulations 15A NCAC 0213.0233 & .0259.
The Division of Coastal Management (DCM), through a Memorandum of Understanding with the Division of
Water Quality (DWQ) has reviewed your project proposal, determined that the project as proposed complies
with the aforementioned regulations, and made a "no practical alternatives" determination per those
regulations.
Those activities covered by your Coastal Area Management Act (CAMA) permit have received Buffer
Authorization as long as the project is constructed in a manner that continues to meet all of the conditions
listed below. Failure to comply with this Buffer Authorization shall subject the property owner & the party
(contractor) performing the construction Wor land clearing to a civil penalty of up to $25,000 per day per
violation.
1. Crossing is Perpendicular: Pier and docking facility access way must cross the 50 ft. riparian buffer
perpendicularly (which is defined as between 75 and 105 degrees) unless otherwise approved by DCM.
The alignment shall minimize the removal of woody vegetation to the greatest extent practicable.
2. Pervious Materials: All reasonable measures shall be taken to ensure the access way is made of
pervious materials like open -slatted wood or composite, mulch, or grass to meet the intent of the rules
to the maximum extent practicable.
3. Access Width: The width of the pier or docking facility access way shall be limited to six (6) feet.
4. Project Drawing: The drawing on the CAMA General Permit is considered the project drawing of your
property indicating the relative location of the pier or docking facility and any requested access way.
This drawing will be used to aid in compliance and monitoring efforts.
By your signature below you agree to be held responsible for meeting all of the conditions listed above and
verify that all information provided is complete and accurate.
A a hem " I/J
Agent r Applicant Printed Name
/1 07
Agen or Applicant Signature
CAMA GENERAL PERMIT #:
Washington Office
943 Washington Square Mall
Washington, NC 27889
Phone [phone]
Morehead City Office
400 Commerce Avenue
Morehead City, NC 28557
Phone [phone]
Version 5, 09/2009
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BROAD CREEK CONTRACTING INC
PO BOX 88
MERRITT, NORTH CAROLINA 28556
[phone]
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GRANTSBORO, NC 28529-ggg7
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