20140075 Ver 1_CAMA Permit Application_20140123

A�
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Pat McCrory Braxton C. Davis John E. Skvarla, III
Governor Director Secretary
January 22, 2014
MEMORANDUM
TO:
FROM:
SUBJECT:
Applicant:
Karen Higgins, Compliance and Permitting Unit Supervisor
Division of Water Resources; Water Quality Program
Daniel Govoni
Assistant Major Permits Coordinator
CAMA Permit Application Review
Scott & Toni Blanchard
Project Location: 111 Poteskeet Trail, Southern Shores, Dare County
D
JAS 3G�T
NR
UAL 17Y
Proposed Project: Dredge /extend boat basin, bulkhead, boathouse w /lift & boardwalk
Please indicate below your agency's position or viewpoint on the proposed project and return this
form by 02/12/14 to 400 Commerce Avenue, Morehead City, NC 28557 (fax: 252- 247 - 3330).
If you have any questions regarding the proposed project, please contact Ron Renaldi 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 DATE
1367 US 17 South, Elizabeth City, NC 27909
Phone: 252 - 264 -3901 1 FAX: [phone]; Internet: www.nccoastalmanagement.net
An Equal Opportunity 1 Affirmative Action Employer

DIVISION OF COASTAL MANAGEMENT
FIELD INVESTIGATION REPORT
1 APPLICANT'S NAME Scott & Toni Blanchard
2 LOCATION OF PROJECT SITE 111 Poteskeet Trail, Southern Shores, Dare County,
adjacent to a man -made canal that leads to Jean Guite Creek
Photo Index —
2006 85 -7226 (N 14) 2000 185 -2096 (N 15) 1995 186 -1964 (W 18)
1989 146 -8 (J 8) 1984 138 -441 (W 3) 1978 Not Available
State Plane Coordinates - X 2964860 Y 876622
Lat/Long 36 11494840 -75 7328841 ° Quadrangle Kitty Hawk (UL)
3 INVESTIGATION TYPE CAMA
4 INVESTIGATIVE PROCEDURE Dates of Site Visit — 1/9/2014
Was Applicant Present - No
5 PROCESSING PROCEDURE Application Received Complete — 1/16/2014
Office - Elizabeth City
6 SITE DESCRIPTION
(A) Local Land Use Plan - Town of Southern Shores
Land Classification from LUP - The canals are classified as Conservation I
(B) Areas of Environmental Concern (AEC) Involved Public Trust Area (PTA) and
Public Trust Shoreline (PTS)
(C) Water Dependent Yes
(D) Intended Use Private
(E) Wastewater Treatment
(F) Type of Structures
Existing - Septic
Planned — N/A
Existing — Single - family dwelling, bulkheaded shoreline,
dock, boat basin, boardwalk and boatlift
Planned — Boat basin enlargement and dredging,
bulkhead, boathouse with lift and a
boardwalk around basin
(G) Estimated Annual Rate of Erosion N/A
Source - N/A
7 HABITAT DESCRIPTION [AREA, square feet (ft2)]
DREDGED EXCAVATED OTHER
(A) Shallow Bottom PTA AEC
±300 ft2
±396 ft2 shaded
(C) Public Trust Shoreline AEC
- Temporary Impacts
±96 ft2
±440 ft2 shaded
I ±2,064 ft2 disturbed
(D) Total Area Disturbed 2,900 ft2 (0 07 acres)
(E) Primary Nursery Area Yes (Designated by NC Wildlife Resources Commission)
(F) Water Classification SC Open to Shellfishing No

Scott & Toni Blanchard
Field Investigation Report
Page 2
8 PROJECT SUMMARY The applicant proposes to dredge and extend an existing boat
basin landward, bulkhead the extended area, construct a boathouse with lift over the
basin and add a boardwalk around the basin
Project Setting
The site of the proposed development is located at 111 Poteskeet Trail, Southern Shores, Dare
County, adjacent to a man -made canal that leads to Jean Guite Creek
The property is ±27,555 ft2 in size and has an elevation that ranges from 2' to 8' above normal
water level (NWL) Man made features within the highground area include a single - family
dwelling, cement driveway and a gazebo According to the USDA's Natural Resources
Conservation Service's Web Soil Survey, the soil on the property is made up of Fripp fine sand
and is vegetated with lawn grass, loblolly pines, various deciduous trees and ornamental
bushes
The shoreline is ±206' in length and is stabilized with bulkheading A ±25'x12' wide upland
basin is located ±45' from the northern property line and is the location of a 13'x12' 4- piling
boatlift A ±20'x2 5' boardwalk is located along the southern side of the basin and on the north
side of the basin is a ±8'x8' kayak storage rack A ±17'x3' dock is located within the waters of
the canal near the southern property line extending on land creating a ±17'x10' raised platform
Existing water depths within the basin range from -3 5' near the waterward end and gradually
decrease to -2' at the inland end with an average water depth of -2 5' Connective water depths
within the canal immediately adjacent to the basin are 4 The bottom substrate within the
project area is made up of fine sands, silts and detritus with no Submerged Aquatic Vegetation
(SAV) present The waters of Jean Guite Creek and associated canal systems are classified as
SC by the Environmental Management Commission, are not open to shellfish taking and have
been designated as an Inland Primary Nursery Area (PNA) by the NC Wildlife Resources
Commission
The adjacent property to the north is bulkheaded and contains a single - family dwelling and the
adjacent property to the south is undeveloped and is vegetated with upland trees and
shrubbery Based on available information, there appears to be no archaeological sites on this
property or nearby
Permitting activity on the property includes CAMA General Permit #12913A issued on
6/30/1994 for the excavation of the basin, basin bulkheading and the installation of a boat lift
Development Proposal
In order to facilitate a larger boat (28' in length) than what the existing basin dimensions can
adequately store, the applicant is proposing to extend the basin length A 12'x8' area will be
excavated within the highground to create a total basin size of 33'x12' The average elevation
within this area is +2 5' above NWL Approximately 28' of wooden bulkhead will be constructed
along the extended basin shoreline The basin will then be mechanically dredged from the
average depth of -2 5' to a connective depth of 4, gradually decreasing in depth from the
waterward end inland Excavated materials will be taken to an offsite location for drying and
disposal
1,

Scott & Tom Blanchard
Field Investigation Report
Page 3
A new 24'x12' 4- piling boat lift will then be installed within the basin and a boat house
constructed The boathouse will have a drip -line measurement of 38'x22'(836 ft2) shading the
entire basin as well as extending 5' over land on three sides The pilings for the boathouse will
be set land due to the narrowness of the basin A 4' wide boardwalk is proposed to be
constructed around the basin immediately landward of the bulkhead
Anticipated Impacts
• The proposed lengthening of the basin will result in ±23 cubic yards of highg round material
being excavated and removed
• The proposed lengthening of the basin will result in an additional 96 ft2 of PTA AEC
• The proposed lengthening of the basin will not cause any existing impervious surfaces to
become part of the PTS AEC
• The proposed dredging within the existing basin area will result in the disturbance of ±300
ft2 of existing shallow water bottom within the PTA AEC
• The proposed dredging within the existing basin area will generate ±16 5 cubic yards of
spoil material from below NWL
• The proposed dredging will temporarily increase turbidity
• The proposed boathouse will shade ±396 ft2 of the PTA AEC
• The proposed boathouse will shade ±440 ft2 of the PTS AEC
• The proposed development will result in ±2,064 ft2 of temporary disturbance due to
construction and dredging methods
Submitted by Ron Renaldi
Date 1/17/2014

JEFFREY H. HASKETT HOMES, INC. il JA N 1 6 2014 f �
GENERAL CONTRACTOR �
4711 LINDBERG AVE.
KITTY HAWK, NC 27949 - - -- - - _ -- - -- -- - -
252- 261 -8016
PROJECT NARRATIVE
The Blanchards (Homeowners) have purchased a new and larger boat that will not fit in the
existing boat basin. Therefore, they would like to modify the existing basin to accommodate the
new boat. The following would be included in the project-
Excavate existing basin to lengthen it by 8' and to bring it to a new depth of 4'. This would also
require adding some new bulkhead tied into existing bulkhead
Replace existing boat lift with new lift to accommodate new and larger boat.
Build a 4' ground deck/courtesy deck on the three landward sides of the boat basin for complete
access to boat.
Build a roof (boat house) over all of the above to protect new boat from the elements

DCM MP4
APPLICATION for
16 M
JA N 2014
Major Development Permit
past revised 12/27106) -
North CaroliPra DIVISION OF COASTAL MANAGEMENT
1. Primary Applicant/ Landowner Information -
Business Name
Project Name (if applicable)
Applicant 1 First Name
MI
C-
Last Name
1914 NC- Gt /ZW
Applicant 2 First Name
MI
Last Name
If additional applicants, please attach an additional page(s) with names listed
Mailing Address
PO Box
City
SGk ores
State
ZIP G� s�
Country
Phone No
FAX No
Street Address (if different from above)
City
State
ZIP
Email
?. 'Agent/COntraCtor Information
Business Name
J- a-Q;dC 14.44 e-H do/w"e L.JL
Agent/ Contractor 1 First Name
MI
Last Name
Agent/ Contractor 2 First Name
MI
Last Name
Mailing Address
PO Box
City
State
47/1 1-r' d (sere 6 ✓-,
%i :�f h� K
A/C
ZIP
Phone No 1
Phone No 2
:2-71P7 -y
S2 - eel
- 86/4 ext
ZS -2- Zb7 /- 777ext
FAX No
Contractor #
252- - 20 -033(,.
718
Street Address (if different from above)
City
State
ZIP
Email
<Form continues on back>
252 - 803 -2808 1- 888 -4RCOAST . wxiw.nc:c0ast81m2nageinent.net

Form DCM MP-1 (Page 2 of 4) r- 3 ' —_� APPLICATION for
i
Mato Development Permit
JAN 1 5 2014 �
3. - Project,Location
a Total length of shoreline on the tract (ft )
b Size of entire tract (sq ft )
County (can be multiple)
Street Address
-
�'�7r 'r'T
`-
=
Stat� Rd #
(If many lot srces, please attach additional page with a list)
Q f
❑NHW oroNWL S
-
l - - --
Subdivision Name
City
State
Zip
To A/ — SiN7 iW_ VG4 " /I
772 5 - V4_C 4&4 A-0 -f–
h How does local government zone the tract?
r Is the proposed project consistent with the applicable zoning?
Phone No
Lot No (s) (if many, attach additional page with list)
- - ext
I W
a In which NC river basin is the protect located?
b Name of body of water nearest to proposed protect
1054 s -A J
C�.eelc'
c Is the water body identified in (b) above, natural or manmade?
❑NaturalvManmade ❑Unknown
d Name the closest major water body to the proposed protect site
6 ' �Lle-- C_ N
e Is proposed work within city limits or planning jurisdiction?
f If applicable, list the planning jurisdiction or city limit the proposed
-AYes [I No
work falls within
So . S I'L(DKe S
4. Site Description
a Total length of shoreline on the tract (ft )
b Size of entire tract (sq ft )
�7y87�
�7sss
c Size of individual lot(s)
275'6's 64 .9+-
d Approximate elevation of tract above NHW (normal high water) or
NWL (normal water level)
(If many lot srces, please attach additional page with a list)
Q f
❑NHW oroNWL S
e Vegetation on tract
so D /�1445;4;
f Man -made features and uses now on tract
`Jr'►9 /e A+-U ; 1 h v'm 't' 1 1-1 u
et y ;& V "? /00A' f L.'I +- K^ y j jL S �o Ee+t e eA C.�_-
g Identify and describe the existing land uses adjacent to the proposed protect site
To A/ — SiN7 iW_ VG4 " /I
772 5 - V4_C 4&4 A-0 -f–
h How does local government zone the tract?
r Is the proposed project consistent with the applicable zoning?
(Attach zoning compliance certificate, if applicable)
�es ❑No []NA
Lai
j Is the proposed activity part of an urban waterfront redevelopment proposal? ❑Yes 1W(No
k Has a professional archaeological assessment been done for the tract? If yes, attach a copy ❑Yes IZNo ❑NA
If yes, by whom?
I Is the proposed project located in a National Registered Historic District or does it involve a ❑Yes No ❑NA
National Register listed or eligible property?
<Form continues on next page>
262 - 808 -2808 , 1- 888- 4RCOAS wr�nre�u,axcco�sY�9vro�rBa es �r�s,..rg

Form DCM MP -1 (Page 3 of 4)
I',' -
APPLICATION for
Major Development_Permit
I � ,
m (i) Are there wetlands on the site? ❑Yes K4 '
(u) Are there coastal wetlands on the site? ❑Yes &Nol �
( JAN 7 6
:i
(w) If yes to either (Q or (u) above, has a delineation been conducted? ❑Yes KNo'I (
(Attach documentation, if available)
n Describe existing wastewater treatment facilities _
C-
* Describe existing drinking water supply source
G 4J�
p Describe existing storm water management or treatment systems
/V
5. Activities and ,Impacts
a Will the project be for commercial, public, or private use? ❑Commercial ❑Public /Govemment
❑Pnvate /Community
b Give a brief description of purpose, use, and daily operations of the project when complete
&44 lie w/ �o+. L.. --iC 4
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
qL k ti s�bcGw�Sf4 AJA'%,s.A L00O4 1C+- 4---C- r o.J � A&C -
t Q aN 10e-dpeJe�1 -1
d List all development activities you propose
E.x.'Fe-^)d etc '(.4 ?-J? 604-+ i34 s. `,V � ' � A baiN 9 \Ie� bK l k AL e4d �o
gvv"V& Old 6044 L.r`iCf +4b Aje-.j bo*4 L,- -,c4 -, 4 b C-oetei�esy
?u f JeO&f' o u'M 62 L. 44 -t- '6 oc.A::N / 1 w Pd S / "U5
e Are the proposed activities maintenance of an existing project, new work, or both? /J A41
f What is the approximate total disturbed land area resulting from the proposed project? ✓Jq / b Sq Ft or ❑Acres
g Will the proposed project encroach on any public easement, public accessway or other area / T ❑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
5�4A-'q c pe 0-�4
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 XNo ❑NA
If yes, attach a mitigation proposal
<Form continues on back>
252 - 808 -2808 . 1- 888- 4RCOAST . www.nccomstaqmanmgelment.net
2074
;r

Form DCM MP-1 (Page 4 of 4) C APPLICATION for
I 4or Development Permit
1
JAN 7 5 2614 i I
A',- A'ddidonallnformation
r� nx' ^' 7, a, �.'r "e'.r dl�
�In adddron to this completed apphcahoh,form, (MP-,I) the foilowing`rtemsbelow Irfj`apphcable, must "�ub»htted rn or "der, for'the applicahon , I
'package to be cpmplete Items (a) -, (f) are always apphcable to any `n dyo� development'apphcahon'RaP/ease consu/t`the apjFl cehon� `
ins uchori booklet on how to properly prepare the required items below -TT y
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 mad 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
, Mame ` in �k; �e $ W i e� y� , °, Phone No'
Address 'i c�'�'. Ma,l k e 2e �PKu► 0�4g,�1° e,` Y,�vc,k. �� _ 320-7 3-
Name Y, 4 +t^ � e -0- fJ QAy� ^4;N !" Phone No
Address ` I� i rJ�C NVtCiR r lr�`� �V� D N i X M 1` > 2-1 l 3
- ;Name` „ 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
LAPAA CP41Vi1IA is&y,c 08.0119'14 'FO Ke.w,CA►. I13US►,VC, t f�' [)! �J�X14, baa�.ti �n
-4, I °' d� 1 ra 14 t3oGil,�t [lnci bo I K/lfuC with ., Elu bks-rti
h Signed consultant or agent authorization form, if applicable
i 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
7.;Certification dnd P, erinission to E'nte`r dbland
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 /Z• -go, / 3 Print Name -Je4�C +4AL ke*
Signature 2,4 4 A'"
Please indicate application attachments pertaining to your proposed project
.ZDCM MP -2 Excavation and Fill Information ❑DCM MP -5 Bridges and Culverts
❑DCM MP -3 Upland Development
4DCM MP-4 Structures Information
252 - 808 -2808 -- 1- 888 -ARCO AST . vvvvw.nccoastallrna nag es3 ent.ne

Form DCM MP -2
� j JAN i 6 2014
EXCAVATION and FILL = --
(Except for bridges and culverts) �-
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
Describe below the purpose of proposed excavation and /or fill activities. All values should be given in feet
1. EXCAVATION OThis section not applicable
a Amount of material to be excavated from below NHW or NWL in b Type of material to be excavated
cubic yards
c (i) Does the area to be excavated include 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 gNone
(n) Describe the purpose of the excavation in these areas
/2
d High- ground excavation in cubic yards
23
2. DISPOSAL OF EXCAVATED MATERIAL [I This section not applicable
a Location of disposal area b Dimensions of disposal area
o(:ZF s; k -e. -
c (Q Do you claim title to disposal area?
❑Yes ❑No >�NA
(n) If no, attach a letter granting permission from the owner
e (Q Does the disposal area include any 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
(n) Describe the purpose of disposal in these areas
(i) Will a disposal area be available for future maintenance?
❑Yes []No %1NA
(n) If yes, where?
f (i) Does the disposal include any area in the water?
❑Yes ❑No XNA
(n) If yes, how much water area is affected?
252 -808 -2863 _s 1- 888.4RCOAST - v�ivirvv .nccoesta0manamement.net revised: 12/26/06
Access
Other
Channel
(NLW or
Canal
Boat Basin
Boat Ramp
Rock Groin
Rock
Breakwater
(excluding
shoreline
NWL )
stabilization
Length
Width
Avg. Existing
Depth
Z , j
NA
NA
Final Project
Depth
�.
NA
NA
1. EXCAVATION OThis section not applicable
a Amount of material to be excavated from below NHW or NWL in b Type of material to be excavated
cubic yards
c (i) Does the area to be excavated include 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 gNone
(n) Describe the purpose of the excavation in these areas
/2
d High- ground excavation in cubic yards
23
2. DISPOSAL OF EXCAVATED MATERIAL [I This section not applicable
a Location of disposal area b Dimensions of disposal area
o(:ZF s; k -e. -
c (Q Do you claim title to disposal area?
❑Yes ❑No >�NA
(n) If no, attach a letter granting permission from the owner
e (Q Does the disposal area include any 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
(n) Describe the purpose of disposal in these areas
(i) Will a disposal area be available for future maintenance?
❑Yes []No %1NA
(n) If yes, where?
f (i) Does the disposal include any area in the water?
❑Yes ❑No XNA
(n) If yes, how much water area is affected?
252 -808 -2863 _s 1- 888.4RCOAST - v�ivirvv .nccoesta0manamement.net revised: 12/26/06

Form ®CM P °2 (Excavation and Fill, Page? 2 of 2)
3. -'SHORELINE'STABILIZATION Thrs sect�on'not appl�cab /e I
Ode' elopment is a wood groin, use MP -4 — Structures '1 -6--2014
a Type of shoreline stabilization b Length_ j
Bulkhead ❑Riprap ❑Breakwater /Sill ❑Other
Width
c Average distance waterward of NHW or NWL d Maximum distance waterward of, NHW or NWL
e Type of stabilization material f (i) Has there been shoreline erosion during preceding 12
months?
❑Yes -]No XNA
(u) If yes, state amount of erosion and source of erosion amount
information
g Number of square feet of fill to be placed below water level h Type of fill material
Bulkhead backfill Riprap
(�,-1 eAJ d -r
Breakwater /Sill Other
I Source of fill material
4. OTHER FILL ACTIVITIES This section not applicable
(Excluding Shoreline Stabilization)
a (i) Will fill material be brought to the site? ❑Yes []No ❑NA b (i) Will fill material be placed in coastal wetlands /marsh (CW).
If yes,
(u) Amount of matenal to be placed in the water
(iii) Dimensions of fill area
(ro) Purpose of fill
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
(u) Describe the purpose of the fill in these areas
5. GENERAL
a How will excavated or fill material be kept on site and erosion b What type of construction equipment will be used (e g , draglme,
controlled? backhoe, or hydraulic dredge)?
C-
c (Q Will navigational ai s be required as a result of the protect? d
❑Yes ❑No MA
(u) If yes, explain what type and how they will be implemented
t - ,
Date
Protect Name
1314
(i) Will wetlands be crossed in transporting equipment to protect
site? ❑Yes ❑No )&
(n) If yes, explain steps that will be taken to avoid or minimize
environmental impacts
Applicant Name
.Ie -Ff
Apphcant`Signature
252 - 808 -2803 — 1- 889- 4RCOAST " ww'w.yiccoastalimanagementz.net revised: 12/26106

Form ®CM MP -4
STRUCTURES
(Construction within Public Trust Areas)
JA N 16 2014 f I
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 ❑ Public /Government Private /Community
c (i) Dock(s) and /or pier(s)
(u) Number
(iii) Length
(iv) Width
(v) Floating [--]Yes ❑No
e (i) Are Platforms included? ❑Yes KNo
If yes
(ii) Number
(m) Length
(iv) Width
(v) Floating []Yes ❑No
Note Roofed areas are calculated from dnpline dimensions
g (i) Number of slips proposed
(n) Number of slips existing
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 08
m (i) Will the facility have tie pilings?
❑Yes XNo
(n) If yes number of tie pilings?
This section not applicable
b (i) Will the facility be open to the general public?
[--]Yes XNo
d (i) Are Finger Piers included? ❑Yes 00
If yes
(ii) Number
(in) Length
(iv) Width
(v) Floating []Yes ❑No
f (i) Are Boatlifts included? Yes ❑No
If yes
(ii) Number
(iii) Length —�
(iv) Width
h Check all the types of services to be provided
❑ Full service, including travel lift and /or rail, repair or
maintenance service
❑ 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
Describe the typical boats to be served (e g(--.pen , runabout,
charter boats, sail boats, mixed types)
I (i) Will the faculty be open to the general public?
❑Yes 4No
252- 808 -28 08 ,. 1- 838- 4RCOAST ao iAnir .nccoastalmanagemennt "net revised 12/27/106

Form DCM MP-4 (Strra4ctaemes, Page 2 of 4)
I j
I I A r
2. DOCKING FACILITY /MARINA OPERATIONS XThis section not applicable '
a Check each of the following sanitary facilities that will be included in the proposed project l - - -- -- - - -- — — i '
❑ Office Toilets I
❑ 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
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
r
j What will be the manna 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?
252 -808 -2808 :: 2- 888- 4RCOA.S`B :: vvvvvv .nccoasta1m2napern9nt.rnet revised- 112127d11:)

m Is the manna/docking facility proposed within a primary or secondary nursery area?
[]Yes []No JAIL 1 6 2014
n Is the madna/dodang facility proposed within or adjacent to shellfi h I _
j any s harvesting area
❑Yes []No
o Is the manna/docking facility proposed within or adjacent to coastal wettands/marsh (CW), submerged aquatic vegetation (SAV), shg11- 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 dose pro)amdy to any shellfish leases? ❑Yes []NO
If yes, give the name and address of the leaseholder(s), and give the proximdy to the lease
3. BOATHOUSt (including covered kits) []This section not applicable
a (i) Is the boathouse structure(s)
❑Commercial ❑Public/Govemment Private /Community
(ii) Number
(m) Length
(w) Width _ .y
Note Roofed areas are calculated from dnphne dimensions
4. GROIN (e.g., wood, sheetprle, etc. If a rock groin, use MP -2, Excavation and Fill) This section not applicable
a (I) Number
(i) Length
(w) Width
5. BREAKWATER (e.g., wood, sheetpile, etc.) }1�fThrs section not applicable
a Length b. Average distance from NHW, NWL, or wetlands
c Maramum distance beyond NHW, NWL or wetlands
6. MOORING PILINGS and BUOYS This section not applicable
a Is the structure(s):
❑Commercial ❑Public/Govemment ❑PrivatelCommundy
c Distance to be placed beyond shoreline
Note. This should be measured from marsh edge, if present.
e Arc of the swing
b- Number
d Description of buoy (color, inscription, size, anchor, etc.)

7. GENERAL
a. Proxundy of structure(s) to adl nt riparian property lines
(Vote For buoy or mooring piling, use arc of swing including length
Of vessel
c Width of water body
e () Will navigational aids be required as a result of the project?
❑Yes ❑No *A
(i) If yes, explain what type and how they will be implemented
t
JA ki i G 2-034
I
Proximity of structure(s) to adjacent ` dodang facilities
d_ Water depth at water ward end of structure at NLW or NWL
S71
8. OTHER - - y❑ This section not applicable I
Date
Give complete description
��r EGT % llltl wUes J.° X. p� Nil ��/J9 C� /Yi2As/1J�74! �%r^t�9 ew)��tILVJ 6o, 44 4b4S r Al iNclade.
e�w►otJ�N9 P.tci x4, nlai lop& F 4Y'4 , Ajd <'A15411 t 4 AJe .] y" 1-4ItrqrbL L.rVO
'(;t`c t 1,4A-+C ZAgl C K. 6"4 U744 64511,A) bJ 1 If 4t fr u r r-r, ii%W /-;U / k- kUA
/n1hYAL� Pa��C��`�Gt Gii'�rDeJ D•�' 1.+4N� 6 c... DN �srC+GL St�clei dF �,ttc %�J
R40kh dy. .4cLa4S -/-o 411 AK alocrle 4 lx Ca,-t:AVJ
Inm&"a-
1,2.3o -/3
Project Name
r3/4Ak-
Applicant Name - -
�.1 e- C- F�9sKe7�
Applicant Signatures_ f
2 3 -2"-,7 .. I -P- ni" ?" _- -1' - Ifm0 - 1, -- CQS�ia S as! Em- ar?a =-- -v- E-,0.___ `12,12; /GS

A r4 16 2014 � I
-- - - - -- -- - _ - • C:arml . - •. %•. -!... sae no Os,: ac tai _ t
-Ge 8.811
_ _� 'NY102'SH'IR'.'.•• ••fiZ'S7'� 8
wooden Buwn ' •: •: •..•m4 i fi K
••tote f° �2 'R •T `� i� vee 0. cKr _ — —3d' GAt
�Y
ZLI
O- '•~ - m o j m�
ara•• _ Lai 475
6$tM3'� V�IGXmGr�
Lot 473 , Ham* oniamdat ea •„ -_ = ;-
P ,❑ t -
t8 2z'S7° E ' - • e„ -••®• I W5 2 0' 9 36.131
S Lx.36 - f7d9a, fink
RP1O26B9. (te!- �t,�*./w1'. `L • �'y • _
Ealntap Nommmt
% comeref
LoR C�roga r 6.286 •` 9('1 Si I nl— �l rl © n S
e.r./27.666 at (fatal erne) ' + J
22.72, in aaeordoncs with `�� �.• �
SouWe►n Shpm inning a Efl&n a`hard
• - - 4f
L.Gf _,4741 Chlczhat* 5ubdrvis@ort
and,
A Portion of the Laetd Dasarbad in OB 551, PO 141
�" =QC) ' Shut

f A N i 6 2014
, I
- ad�il�i • �'• :•:• s� 09551. PG 141 I
Serno531,PC14 • - ••- • -•..• ••N2 °57'�'w -
_ 113'x'•'• -- ,.s
\Veodan 9YINh - • '� r 1�
o■° 'r' °' ; K e� e Kjtl° K `e U i s e
- , Prai7O b� Ptbvt _ - -3c-' C ArAA
-
_
tOf�S
�
pis }.rrbGnLa
r-. 98.1 -
■ D
O I o i m
s 3rz. a o
Lot 475
Lot 47 1 - , iaaaa�ien .r :,� _ :: -:_ .
WGXm�i
CP
S i x9 E F�n _ E�9e anL
�� � � F.�linp Monomer!
` im, cvnaref
Nor - 4b6�� •- - •,
LotCoVWe9@ a.3b8 �_. $ f fo �.SC' D'- ve-lopnv"p- -
a,f•M.666a-4 (tatai area) -
V-n to aeeordonee with T" S,. f4�
Sauthem Sham zorfirq - Sqdtt c. EEif chard
ardt++on�• 44
!Lott -,474, Chicahauk SUbdivislan
A Porthn of the Land Des0ti gad in DE3 551, pa 141
rOt9 1°Ct SbE1rA3^' 1 G - rEiWF6 t b__'3aM lv—+Ilod ! IGUOa
J�

� ' 1
JAN 7 6 20,114
t
�
I
ca
, -
'2
�
�
S
�
R �

3
2
i
1 �
1
f �
! 1
!
!
i
I �
! M
f � v
f �
R
zo
\n
�
I
N
i
�
d
�
i 7
i=
I
(
3
2
i
1 �
1
f �
! 1
!
!
i
I �
! M
f � v
f �
R
zo
\n
�
I
N
i
i
fi
i 7
I
(
/my 13A ra
N� �
!
M
t !
o�
rj 1
vi
z
7
!
f
i
I
i
17-
� w
—► f , ve VI
a
�
I
i
i
i 7
vi
z
7
!
f
i
I
i
17-
� w
—► f , ve VI
a

- J
- 3 �
S
� o
v
--------- - - - - -- r
a-
i I.
5 c�
f
L �
E' 1
i r
-x
X �2.
1 -7—
J
1� I
co
X
a
I
x
7
0
�D
J
c� 3
7
0
�D
J
s
/
d
d
�

1 1101 I cE
k IC
I
JAN 1 6 2014
'� � ��se �•-� In,cw�5 -e
%c
A,KQA
CD (Xvt1'Ls J pwc,rtwa1r,
/ � a
F
c

F'T �y�d ,,����"" }�1•� TVF2�'�1t '�'�.
aoy
�3h.J "� t _rim -,F �k, y an - •.,� y�, ` �.
�� ''"+� .. F.h` '• ) Y' t^ t' s� 5 1J Z' 3 .'�k+ . 'i �! � � 2 Y �'A� `v .
F 4
way
Up
01.
-.ga
021 Wo
-W R
✓` . #" x 3 "t'+`' •� cy gyp •..� < - - ',,.IS•ENE i � � 110
�: 3MI
=5 �2h S iy- a"Y' I +y. ,� - 4M• ,r..t-y. J�iF�
-
_ _ � 3a� ♦ �F
1 �� �fx fir. dv g�th r nyF 3
M t "a
�. 3 . .. ..nom_ .._ SH

If
4
a
1
v4T4� "IN-54a wmlsimm : y +rvn }
1 kk'
P
i
I
1
v4T4� "IN-54a wmlsimm : y +rvn }
1 kk'
P

MAJOR PERMIT FEE MATRIX
Applicant: Ton;
Selection
Development Type
Fee
DCM %
DWQ %
(14300 1601 435100093 1625 6253)
(24300 1602 435100095 2341)
I Private, non - commercial
E]
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
$400
100%($400)
0%($0)
involve the filling or
excavation of any wetlands
or open water areas
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
$400
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
1
concurrence is needed
because of concerns
related to water quality or
aquatic life
III(D) If General Water
Quality Certification No
$400
60%($240)
40%($160)
3490 (see attached) cannot
be applied
IV For development that
involves the filling and /or
$475
60%($285)
40%($190)
excavation of more than
one acre of wetlands and /or
open water areas