20140697 Ver 1_CAMA Permit Application_20140703

20140897
xPWA
4�1M.ra
NCDENR
North Carolina Department of Environment and Natural Resources
Pat McCrory John E. Skvada, III
Governor Secretary
July 2, 2014
MEMORANDUM
TO: Karen Higgins, Compliance and Permitting Unit Supervisor
DWR - Water Quality Program
FROM: Daniel Govoni
Assistant Major Permits Coordinator
Division of Coastal Management JUL
SUBJECT: CAMA Permit Application Review
A � ounLirr.
� r Branch
Applicant: Robert Jackson
Project Location: 186 Ainsley Road, Perquimans County
Proposed Project: Construct roof over boat lifts, a finger pier, & additions to garage & deck
Please indicate below your agency's position or viewpoint on the proposed project and return this
form by 07/23/14 to 400 Commerce Avenue, Morehead City, NC 28557 (fax: 252 - 247 - 3330).
If you have any questions regarding the proposed project, please contact Will Creef at (252) 264-
3901. When appropriate, in -depth comments with supporting data are requested.
REPLY:
SIGNED
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.
DATE
1367 US 17 South, Elizabeth City, NC 27909
Phone: 252 - 264 -39011 FAX: [phone]; Internet: www.nocoastalmanagement.net
An Equal Opportunity 1 Affirmative Action Employer

DIVISION OF COASTAL MANAGEMENT
FIELD INVESTIGATION REPORT
1. APPLICANT'S NAME: Robert Jackson
2. LOCATION OF PROJECT SITE: 186 Ainsley Rd. (SR #1363) Herford,
Perquimans County, Perquimans River.
Photo Index
2006: 160 -6849 (R -16, Q -16)
2000: 160 -1759 (S -17)
1995: 160 -1648 (Q -16)
1989: 1 -18 -5 (J -15) l o-�
1984: N/A
1978: N/A
State Plane Coordinates - X: 275870 Y: 895890 Hertford UR
3. INVESTIGATION TYPE: CAMA
4. INVESTIGATIVE PROCEDURE: Dates of Site Visit — 6/20/2014
Was Applicant Present - No
5. PROCESSING PROCEDURE: Application Received Complete - 6/20/2014
Office - Elizabeth City
6. SITE DESCRIPTION:
(A) Local Land Use Plan — Perquimans County
Land Classification From LUP - Conservation
(B) AEC(s) Involved: Public Trust Area (PTA), Estuarine Waters (EW),
Estuarine Shore (ES)
(C) Water Dependent: Yes
(D) Intended Use: Private
(E) Wastewater Treatment: Existing - Septic
Planned - None
(F) Type of Structures: Existing - Single family dwelling with attached
deck, detached garage, pier/
platform, one covered boatlift, one
uncovered boatlift, and one jet ski life
mounted on pier
Planned - Roof for two existing boatlifts,
addition to the attached deck,
addition to detached garage, one
3.5'x24' finger pier.
(G) Estimated Annual Rate of Erosion: N/A
Source — N/A

I
7. HABITAT DESCRIPTION. [AREA, square feet]
DREDGED FILLED OTHER
Public Trust Area (PTA),
Estuarine Waters (EW)
75' Estuarine 'Shoreline AEC
(D) Total Area Disturbed: 964 sq. ft (,0.022 acres)
(E) Primary Nursery Area- NO
(F) Water Classification. SC Open: NO
8 PROJECT SUMMARY:
The applicant proposes to construct a roof over two existing boat lifts, a
finger pier, an addition to the existing detached garage, and an addition to the
existing attached deck.
Project Setting
The site of the proposed development is located on the Perquimans River, in,
Perquimans County, at 1,86,Ainsley Rd. Hertford.
The property is approximately 28,275 square feet (0.64 acre) in size °and is
elevated approximately 10 feet above Normal Water Level (NWL) Existing manmade
features on the property consist of a cement driveway leading to a single family ,dwelling
with an attached deck, a maintained yard vegetated with indigenous grasses, a 24'x30'
detached garage, 1,07 feet of shoreline stabilized with wooden bulkhead, a pier leading,
to ,a 16'x24" platform, a 6'x7' platform, one het ski lift, one covered, 12'x24 boat lift, and
one uncovered 12'x24' boatlift According to the United States Department of
Agriculture's Soil Conservation Service the soils on the,property are from the conetoe
loamy, sand series
The immediate adjacent property to the, south of1he Jackson property is a
similarly developed lot with a single family dwelling and shoreline stabilized with
bulkhead. The immediate adjacent property to the north of the Jackson property is a
small portion of land with 60 feet of shoreline stabilized with riprap that is an HOA lot for
community water access. The next property to the north of the HOA community lot is
the Lane property which `is developed with a single family dwelling and shoreline
stabilized with bulkhead.
'The Division, of Environmental Management classifies the waters within this area
of the Perquimans River as SC and these waters are closed to shellfish harvest. The .
average depth of water where the development is being proposed is 3 feet with no SAV
588 sq ft
(shaded /covered)
376 sq. ft.
(disturbed /covered)
(D) Total Area Disturbed: 964 sq. ft (,0.022 acres)
(E) Primary Nursery Area- NO
(F) Water Classification. SC Open: NO
8 PROJECT SUMMARY:
The applicant proposes to construct a roof over two existing boat lifts, a
finger pier, an addition to the existing detached garage, and an addition to the
existing attached deck.
Project Setting
The site of the proposed development is located on the Perquimans River, in,
Perquimans County, at 1,86,Ainsley Rd. Hertford.
The property is approximately 28,275 square feet (0.64 acre) in size °and is
elevated approximately 10 feet above Normal Water Level (NWL) Existing manmade
features on the property consist of a cement driveway leading to a single family ,dwelling
with an attached deck, a maintained yard vegetated with indigenous grasses, a 24'x30'
detached garage, 1,07 feet of shoreline stabilized with wooden bulkhead, a pier leading,
to ,a 16'x24" platform, a 6'x7' platform, one het ski lift, one covered, 12'x24 boat lift, and
one uncovered 12'x24' boatlift According to the United States Department of
Agriculture's Soil Conservation Service the soils on the,property are from the conetoe
loamy, sand series
The immediate adjacent property to the, south of1he Jackson property is a
similarly developed lot with a single family dwelling and shoreline stabilized with
bulkhead. The immediate adjacent property to the north of the Jackson property is a
small portion of land with 60 feet of shoreline stabilized with riprap that is an HOA lot for
community water access. The next property to the north of the HOA community lot is
the Lane property which `is developed with a single family dwelling and shoreline
stabilized with bulkhead.
'The Division, of Environmental Management classifies the waters within this area
of the Perquimans River as SC and these waters are closed to shellfish harvest. The .
average depth of water where the development is being proposed is 3 feet with no SAV

T
.,
present.
Development'Proposal
The applicant proposes to remove the existing roof over the south boatlift and
construct a new 28'x37' roof system over the, two existing boat 'lifts. The applicant
proposes to construct a 3 5'x24' finger pier on the northern side of the two boatlifts; this
finger pier will be covered by the 28'x37' roof over the boat lifts. The applicant also
proposes to construct a 12'x16' addition ,to the existing garage, and a 1'0'x12' addition 'to
the existing attached deck.
Anticipated Impacts
1 The new roof system will cause an additional 588 sq. ft. of shading to EW and
PTA Tota'I shading due to platforms and covered boat lifts would be, 1,344 sq ft
with the additional `588 sq ft from the new roof system.
2 The new deck addition will cause an additional 420 sq. ft of covered area in the
75 foot AEC.
3 The new garage addition will cause an additional 256 sq ft of covered area in
the 75 foot AEC.
4. The 3.5'x24' finger pierwill be covered, by the roof system overithe existing boat
lifts and will not cause any additional shading of PTA or EW.
Submitted by- Will Creef
Date- 6/27/2014

To CAMA, L ynk nn- F
Fr Robert L Jackson
1'86 Ainsley Rd JUN $ 2014
Hertford, NC 27944
757 618 -7569, robdibrenP- --mail com (-OAST J =:,T
Subs CAMA,Major Permit Application F -
Encl,('1) DCM MP -1 flA tj 'D • -0'CL 111e-kE't>
Encl (2) DCM MP -3 u
i KEL
Encl (3) DCM MP -4 �� SSF Z
Encl (4) Existing configuration
Encl (5) Proposed configuration
Encl (6) Boat `House front elevation
Eric[ (7) Boat House side elevation
Encl (8) Lot Survey
Encl (9) Site survey /sketch
Encl (10) Current Aerial View
Encl (11) CAMA 33759
Encl (12) CAMA 39502
Eric[ (13) CAMA 57221
Encl (14) Riparian Letter 174 Ainsley
Encl (15) Riparian Letter 192 Ainsley
'Encl (16) Riparian Letter HOA Lot
Encl (17) Aerial View HOA,Lot
Encl (18) Cover sheet of Deed of Trust
1 Respectively submitting request to accomplish modifications and additions to existing waterfront
structures as delineated below, and shown on Enclosures 4 thru 9
2 Discussions of specific additions and changes, and rationale provided
a Request permission to remove existing gable roof system over one boat lift, as
authorized in Encl 12 Request authorization to build a 24 foot by 33 foot gable roof with
2 foot overhang5sover both existing boat lift Second boat lift authorized via Encl, 13
b Request permission to construct 3 foot finger pier on outboard side of,second boat lift, 2
feet of which will be covered by new roof system
c Request permission to build 20 foot by 16 foot extension to existing_ garage that extends
to within 68 feet of waterline
d Request permission to build 12 foot by 10 foot extension to existing deck that extends to
within 68 feet of waterline
3_ These variances are requested to provide protection from the elements to watercraft already docked
on approved structures
4 Your considerations of these requests are greatly appreciated and please contact me for any
additional information needed for evaluation In addition to signatures on the riparian letters, I have

asked the adjoining neighbors to sign this document as well, to ensurelthey-a-re-jglly aware -of -a
changes requested "
i
v/R 18 2014
Robert Jackson
I have read and understand the changes /addMo6s Mr Jackson,is requesting a6d,have,nordbjections
Alva Renshaw 192 Ansley Rd G� wG� 2:21 ��— Date -3 — l 7 y
G A Lane 174 Annsley Rd ✓� ".� Date
--Jit+N /d'1 rc 6fez- WAl -rcuw (WV '+ 107
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0
ph"re I

gem OF-I
NPLICATION for
Maler6erdoament
(last revised 12/27/06)
No
JUN 18 2014
,arolifii DIVISION OF COASTALMANAGEMENT
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6 ) 252-808-2808 : 1-888-4,RC,GAST — wwvv. nccoa stailimana gem ent.,net
Business Name
NA
Project,Name (if applicable)
Na
Last Name
NA
Applicant 1 First Name
Last Name
MI
Last Name
Robert
State
L.
Jackson
Applicant 2 First Name
Phone No 2
MI
Last Name
NA
ext
NA
NA
If additional applicants,, please attach an additional page(s) with names listed
Mailing Address
FAX No
PO Box
City
'State
186,Ainsley Rd
ZIP
Email
Hertford
NG
ZIP
Country
Phone No
FAX No
27,944
USA
757 - 618 - 7569 ext
NA- -
Street Address (if different�hrcim above)
City'
State
ZIP
NA
Email
robdibren@gmail com
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6 ) 252-808-2808 : 1-888-4,RC,GAST — wwvv. nccoa stailimana gem ent.,net
Business Name
NA
Agent/ Contractor 1 First Name
MI,
Last Name
Agent/ Contractor 2 First Name
ml
Last Name
Mailing Address
PO Box
City
State
ZIP
Phone No 1
Phone No 2
ext
ext
FAX No
Contractor #
Street,Address (if different from above)
City
State
ZIP
Email
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6 ) 252-808-2808 : 1-888-4,RC,GAST — wwvv. nccoa stailimana gem ent.,net

IJ
Form DCM MP-1 (Page 2 of 4) APPLICATION for
Major Development, Permit
JUN 18 2014
on Rq'V
ist1h
b Size of entire tract (sq ft) `_r rr
c Size of mdividual'lot(s)"
d Approximate elevatiornof tracbabove NHW (normal high water) or
28,275 SF,
NWL (normal water level)
County (can'be multiple)
Street Address
-State Rd #
Perquimans
186 Ainsley Rd
SR 1416
Subdivision Name
City
State
Zip
Chesterfield Hts
Hertford
NC
27944 -
Phone No L
Lot No (s) (if many,,attach additionalpage with list)
757 - 618 - 7569 ext
8,
a In which NC river basin is the project located? -
b Name of body of water nearest to proposed project
Perquimans
Perquimans'River
c Is the water body'identified in (b) above, natural of manmade?
d Name the closest,major water'body to the proposed project site
ONatural ❑Manmade ❑Uriknown
Perquimans River
e Is proposed work within city limits or planning jUrisdiction?
f If applicable, list the planning jurisdiction or city limit the proposed
OYes ❑No
work falls within
Perquimans County
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252- 508 -2808 -.. 1-8,88-4RCOAST :: www.ncdoastaimano,geme,nt.net
I
I
a Total lengtfi of shoreline on the tract (ft)
b Size of entire tract (sq ft) `_r rr
c Size of mdividual'lot(s)"
d Approximate elevatiornof tracbabove NHW (normal high water) or
28,275 SF,
NWL (normal water level)
(If many lot sizes, please attach additional page with a list)
loft ❑NHW or OlNiWL
e Vegetation on'tract
Domestic and ornamental grasses
f Man-made features and uses,now on tract
Residential House, Garage, Drive Way, Septic, Pier
g Identify and describe the,existing land uses adiacent to the proposed,project site
Residential
h How does local government!zone the tract?
i Is the proposed project consistent with, the, applicable zoning?
RA 25
(Attach zoning,comoliance certificate, if'applicable)
OYes ❑No ❑NA
j Is the proposed activity part of an urban waterfront fedevelopment proposal? ❑Yes ONo
k Hasa professional archaeological assessment been done for the tract? If yes, attach acopy ❑Yes [DNjo ❑NA
If yes, by Whom?
I Is the proposed project' located in a National Registered Historic District or does it involve a ZYes ❑No ❑NA
National'Register listed or eligible property?
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252- 508 -2808 -.. 1-8,88-4RCOAST :: www.ncdoastaimano,geme,nt.net
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I

Form DCM MP -1 (Page 3 of 4) `_k APPLICATION for
Major Development Permit
JUN 1 8 2014
m (i) Are there wetlands on the site? Yes ®No
(u) Are there coastal wetlands on the,site? ' ❑Yes ®No
(m) If yes to either (i) or (u)�above, has a delineation been conducted? ❑Yes ❑No
(Attach documentation, if available)
n Describe existing wastewater treatment facilities
Gravityflow Septic System
o Describe existing drinking water supply source
County Water
p Describe existing,storm water management or treatment systems
Existing swale4ong front of property draining to a vegetated drainage ditch that extends to the river
a Will the protect be for commercial; public, or pnvate�use? ❑Commercial ❑Public/Government
®Private /Community
b Give a brief description of purpose, use, and daily operations of the protect when complete
Request removal' of existing roof, request.new gable roof,system over existing boat lifts,per attached drawing One roof
system over both existing lift of approximately 28' by 37' Add 42 !" finger pier outboard on second boat'lift Request
permission to add to ^existing garage, per drawing, within the 75" AEC buffert Request permission to add to existing deck,
per drawing, within the 75" AEC buffer
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,b&stored
Wood construction No equiprimerit other tlian hand tools Concrete footers for garage extension wdl' be delivered to site by
wheel barrows
d List all development activities you propose
One new roof system•over existing boat lifts One 42" by 24' finger pier Extension to existing garage, 12' by 16', to encroach
within the 75' AEC buffer Extension,to existing deck, 10' by'12', to encroach °within the 75 AEC'buffer
e Are,the proposed activities maintenance of an existing project, new work, or both? Both
f What is the approximate'total,dlsturbed land area resulting from the,proposed projects 600 ®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 oflexisting and proposed discharges'to waters of the state
Surface runoff, no changes
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
I Is there any mitigation proposed? ❑Yes ®No ❑NA
If yes, attach a mitigation proposal
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Form DCM MP -1 (Page 4=of<4)
a F
I Itlni 1 R 2014
APPLICATION for
, Major Development Permit
- r - y7''-nvi iF'_ -•-i• .„= t.- i-€-,
_6 Addifionallnformatton_�,,r _,4 Ya `� =
-�
_'�'
In addrhon -to this =con feted a Ircahon form, MP- t
_1)t�hesfo/lo ng,tesbeliiapsJicab�evs' subm ed rnorderforthe ^applicahon
package o be �compl tte= altems (a)__ (f)_are ay §'applicable?t any mayor development appl gat }o'n� P %ase consultthe - app %cation
rnstruc6on book/ehon how to properly prepare thesrequrred�item4sLbelow=
a A project narrative
b An accurate„ dated work plat (including plan view and cross - sectional drawings) drawn to scale Please gnre'the present,status of the
proposed,project, Is any portion already complete? If previously authorized work, clearly indicate onlmaps, plats, drawrngs.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 apphcant claims title to the affected properties
e The appropriate application fee Check or money order made payable toaDENR
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
ens n
Name�Alva= Rha'w:��` Phone_No-= 252.862 =' '6327-
±�
L,-- G�.x- == a'^ ==�Ti �=E*.: •• _�_._ �.���-h -' _ _ rr -'�.s: �` r r� ' �-: �'t"2- s�',j��'x -.,=�' av*��_�sJ "a'�y`-p2�.�+
��-�i �t�a� j,_ :�'�iw.�_ a. -ice = `-�..,� ,�-�- ..'= �-�.='�:.z � �ac.:E;`.3 ±� �._ -1`'�"- - ,— vim=' ,__a �a��.= " =�c3� __:= Y+,:�`'",.� • •- �� �_F`�- `r':..r�': rw.. � �_.=.. �r
Name G A Lane Phone, No 252 426 -5505
Address 174 Ansley Rd
Name�John= Michaela�dMark ;Vl/inslow;Phone3No 252337.4163 Address222Alrisleys — �= *.� -�-_ ���-= ,.a,= � >���,�--- ��.---- =;r�>� -�-� � '�.z��-•�,s=._�_,�� <�z..r�,y�=� �=-�- ���,
g A list of previous,state or federal,perm its issued for work on the project tract Include permit numbers, permittee, and issuing, dates
Copies Attached
h 'Signed,consultant or agent authorization form, ;if applicable
i Wetland delineation, if necessary
I A signed AEC hazard notice for projects in`oceanfront and inlet areas (Must be signed by property owner)
k A statement of compliancemith 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 of1public,la-nds, attach a statement documenting compliance with the North Carolina Environmental Policy Act
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 certlfy'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 "ln this application is truthful to the best of my knowledge
Date _14 April 2014
Print Name bert L ,Jackso
Signature
Please indicate application attachments pertaining to your proposed project
❑DCM MP -2 Excavation and Fillinformation ❑DCM MP -5 Bridges and Culverts
®DCM MP -3 Upland Development
®DCM MP -4 Structures Information
E�C- I-( /) 252- 808 -28013 :. 1I- 88'8- 4RCOAST www,nccoastvilmanagement.net
*2

Form ®Cif MP-3
_ f
(Construction and /or land disturbing activities)
'r . 1-k - -
I
JtlN 1 8 2014
Attach,this form to -Joint Application for CAMA Mayor 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
——�i'` x°'= ^.€." -.,
3 ru' _ t� _,,`�'_— 'a;,', "tnz,'. ",-
GEiVERA'L�UPL.4flID DEVELDPME111T s 4 �
,� — -'_r _
'i ,` $"c''J
". _,...�'n,—.'t,
a Type and number of buildings, facilities, units or structures b Number -of lots or parcels
proposed 1
Addition to existing garage, 14' by 17' includes overhangs
(drip line) Actual size 12' by 16 Addition to existing deck,
10" x 12
c Density (give the number of residential units and the unitvper d Size of area tobe graded, filled, or disturbed including roads,
acre) ditches, etc
NA 600 scl ft, mcludes,footer and,disturbed adjacent land
e If the proposed project will disturb more than one,acre of land, the
Division of Land Resources must receive an erosion and
sedimentation control plan at least 30 days before land- disturbing
activity begins
(i) If applicable, has,a sedimentation and erosion control plan been
submitted to the Division of Land Resources?
❑Yes U ❑No ❑NA
(ii) If yes, list the date submitted NA
f List the,matenals (such as, marl, paver stone, asphalt; or concrete)
,to be used for impervious surfaces
Concrete for footer of garage
g Give the percentage,of the tract within the coastal shoreline AEC to h Protects that require a CAMA Major, Development Permit may also
be.covered by impervious'and /or built -upon surfaces, such as require a Stormwater Certification
pavement, building; rooftops, or to be�used for vehicular driveways (i) Has ,a site development plan been submitted to the Division of
or parking Water Quality for review?
Less than 5% ❑Yes ❑Nb ®NA
i Give the percentage of the entire,tract to be covered by impervious
and /or built -upon surfaces, such as pavement, building, rooftops,
or to be used'for vehicuiar`dnveways�or parking
19%
t Describe proposed method of sewage disposal
NA
(ii) If yes, list the date submitted
k Have the facilities descnbed'in Item (i) received state�or local
approval?
❑Y,es ❑No ®NA
If yes, attachappropriate documentation
I Describe location. and type of proposed discharges to waters of the m Does the proposed protect include,an innovative stormwater
state (e g , surface runoff, sanitary wastewater, industrial/ design?
commercial,effluent, "wash down" and residential discharges) ❑Yes ❑No [DNA
No Changes If yes, attach appropriate documentation
252 - 808 -28082 1 -€ 68- 4RCOAST revised- 12126/06

C;
��rlffl DCIVI MP -3 (uplan'd, (upland, Devegopmentf Pa #e 2 of 2) r
m Describe proposed'drmking water supply source (e g , well, n (Q Will water be impounded? E]Yes ®No ❑NA
community, ;public system, etc )
(n) If yes, how many acres
Public - existing
o When was the lot(s) platted and recorded?
1986
l
p If proposed development is a�subdivision, will additional utilities be
installed for this upland development?
E]Yes ®No E] IA
h
r
J U N 18 2014
�
. J a` '�So'l �
JUN 2 0 20111T
rl,f �lr�'I r
252 -808- 2868 -- 9- 888- 4RCOAST .e revised- 12126/06

Forums ®CKAP4 (� JUN i `8 2014
I_
(Construction within Public Trust Areas) - - -- — - - -- -- - - , -- - -, --
Attach this,,form to JointApplication for CAMA Major Permit, Form PCM MP -1 Be•sure to complete all other sections of the Joint
Application that relate to this proposed project Please 'include all supplemental information
a (i) Is the docking facility /marina
❑Commercial ❑Public /Government ®Prvate /Community
c (Q Dock(s) and /or pier(s)
(n) Number 1 Existing
(iii) Length
(iv) Width
(v) Floating ❑Yes ❑No
e (i) Are Platforms included? ®Yes ❑No
If yes
(n) Number 2 existing
(m) Length
(iv) Width
(v)-Floating []Yes ❑No` t
Note Roofed areas are, calculated from dnphne dimensions
g () Number of slips _proposed
0
(n) Number of slips existing
2
i Check the proposed type of siting
❑ Land`cut and access,chanriel
❑Open water, dredging for basin and /or channel
❑Open water, no dredging required
❑Other,,please describe
NA
k Typical boat length 20
m (i) Will the facility have tie pilings?
[]yes, ®No
(n) If yes number of tie pilings?
b (Q Will the facility be open to the general public?
❑Yes ®No
d (Q Are Finger Piers included? ®Yes ❑No
If yes
(n) Number 1'
(m) Length 24'
(iv) Width 42"
(v) Floating ❑Yes ®No
f (i) Are Boatlifts included? ®Yes []No
If yes
(n) Number 2
(m) Length 24'
(iv) Width 12'
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.manne supplies
❑ Dockage (`wet slips ") only, number of slips
❑ Dry storage, number of boats '
❑ Boat ramp(s), number of boat ramps
® Other; please describe
Private residential
I Describe the °typical boats -to be served (e g , open runabout,
charter'boats; sail boats, mixed types)
PWC, Pontoon, Center Console
I (i) Will the facility be open to the general public?
❑Yes ®No
252 - 808 -2808 :. i- 888 -4RCOAST :' wwwAiccoastaimanaggernont.not rev6s4* /2/27106

Corm ®C V -4 (Structures, Page 2 of 4)
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 treatmentAype 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
(u) Give the location and number of " Pumpout Available" signs proposed
JUN i 8 2014 -I
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 facdities,aand describe the safety measures planned to protect area water quality
t - What wdl'be the marina policy on overmght'and live - aboard, dockage?
e
k Describe design measures that promote boat basin flushing?
I If this�protect is an expansion of =an, existing,marina „what types of seances are currently provided?
'm Is the,manna/dockmg facility proposed'within•a primary or secondary nursery area?
❑Yes ❑No
2552 -808 -2808 -- 1- 888- 4RCOAST s: www.necoastm4eananagement.net revised. 12/27/06

Form &ACM P -4 (St ctures, Page 3 of 4) I JUN 18 20 14
n Is the marina/docking facility proposed within or adjacent to any shellfish harvesting areas
' ❑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)9 If any boxes are checked, provide the number of square feet affected
❑CW ❑SAV ❑SS
OWL, ❑None+
p Is the proposed mahna/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
a (i) Is4he boathouse structure(s)
❑Commercial ❑Public/Government ® Private/Comm unity
(u) Number 1
(m) Length 28'
(iv) Width 37'
Note Roofed areasrare ca/culated,from dnpline,dimensions
�4 ,.GROIAI- +(e=gg wood; sheetpde;�; etc =elf, a' �rock�gro_ m; �use�NlP�2 ;�- Excavation,andaFill�) _�� -��-} -���� = � ®Th►sssecton- notrapph_cable -=
r� r ;�°_ , ;s= �-•--- rte' -` __ _ - - - -_ -a-• _ - - _ a F„ ., va :i; mss.. _-, - ,. 4 _� ti �- ^t -- .._ �a.� 4., ,� .- � �' ��-.
1 ;[ °, :t_ '_uS .Y�`y s+-�' � '- `» = =..s �av- -. =_I, cir�� .= :c.u.0 . _= �iv =.=.. �, .'�rF... �.� *;u:_ =.`- .w..,,:�'cai,:'i:.Ze "-�=., _+. v �_`•. ,fit:
a . (i) Number
(u) Length }
(w) Width
a Length
c Maximum distance beyond NHW, NWL or wetlands
a Is the structure(s)
❑Commercial ❑Public/Government ❑Private /Community
c Distance to be placed beyond shoreline
Note This, should be measured from marsh edge, if present
e- Arc of the swing
CC. ( �
252 - 808 -2808 -: 1 -8
b Average distance from NHW, NWL, or wetlands
b Number
d Description of buoy (color, inscription, size, anchor, etc )
:: w wvv .nci�o&st<a1maseag}yment<.npA
.revised: 12/27/06

Foirm ®C P -4 (Structures, Page ,4 of 4)
a Proximity of structure(s) to adjacent riparian property lines
5' and 50'
Note For buoy or moonng, piling, use arc of swing including length
of vessel
-
c Width of water body
3/4 mile
e (Q Will navigational aids be,regwred as a result of the project?
❑Yes ®No ❑NA
(n) If yes, explain what type.and how they will be implemented
a Give complete description
see attached narrative
b Prozimitjr of structure(s) to adjacent docking facilities
150'
d Water depth at waterward end of structure at NLW or NWL
3'
2s2 -808 -2808 e: 9- 888- 4iRCOA a°T :; urww.ncersastalmanegement.ne4
i
i
JUN 18 2014
revised.- 12/27106

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AND WIFE
DIANA L. JA,,,CKS'-0N
LOT NO. 8 - CH
ESTERFIELD HEIGHTS
PARKVILLE TOWNSHIP
PEROUIMAMS COUNTY. NORTH CAROLINA
s.ALE: r vzo, ALC44T 04 9001,
0 25 50 loo 150' - 200
I ) REFERENCES:., PLAT CABINET 2. -SLIDE 3. MAP,12
DEED Bo6Kl123.,PAGE 799
2 ) AREA = 28,275 SQUARE FEET ( 0 649 ACRE)
3 ) THIS TRACT LIES WITHIN FitX-A. FLOOD ZONE -A-5"
�(BASEFLOOD,gE,VATION 7.0-M. I S.L.)
SEE FIRM 370315-0120 B_
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GEN A', L R
ER R IA 'FER MART,
Previous P tW
lew DRdif16tion ]C16 KeisiU e E �ti 'Reissue Dat preos Derm
tsu
LLr
1'.`iut*�zed by the•State of NorthICarohnaJ?q oninent and'Naiural Resources
OpAhieht bViEnvin
_4A C6 tal,Resources Commission in'
�e '-as _w area of O�rs 7 H,
virqnmental concern uant-to, I SA N CA,
NR6lqFO4ichdd"- art
�!, We
App canivi P�roikcitIocati6w CoUnty- w-
rM 5R",
M IV
ER-01 - I - . t
_9Vekk�&64/'Stat'k d /I o (s)
V%MYJ7.J M "110 PH
Address M OEM 11
011
21. REM MIN M 1
LMIVI Ma A jr
- , i, RE
_1 IN -
I Mt-ati—I WMMN
z
I�z
R
ON
OM M.
AN C] OfA Ve,4'.
M
El CVd Fd M PTA '&q ES CJ PTS Phone* River Basin
AdI,W (natJrnahJu6kn
�r. Body
Affected - - T
❑OEA ❑ HHF ❑IH ❑ USA 0 NIA
AEC(s):-
o-PVVS bFC
PRW yes / Co)' 'P' N'A yes / 0, Crit.- Hab yes
Type of� Project/ Activity
OtFu—) &C. I tjh
Pier (dock) length
W F
Platform(s)
_jHi
14-
2014
Fingq pier(s)
Groin I eqp h J
J
number -4
L
Bulkhead/ R;ppap length
avg distance offshore
J
max distance offshore L5 Ip L T --t
I A L
Basin, channel
T
J
cubic yards t T i
Boat ramp -
)0&0 Nis - 4-­ - - --L
Boathouse/ Boatlift
Ti 7- -
T
Beach Bulldozing
0 P, 4 y 7- T
ther-
Z7
Y
ME- U Q. , A-_sg�
�Shordlineil enkth
A
®r,
M ------
W,
a MdWg
t surev"-
t , e , Y I
M
K,
N V_ — - __ ___ __ — -1 - _- __T-_ - -- "
16S
L r, V
River Basin rules.
Abuilding'permit ft�ai'�l�e'r dqutr6dby: ❑,See note on back retirding
Notes/ Special Conditions
C116-s6sfMai. Wtr,146dy

—,
. , ? IT. . —
RZAMA FJ DREDGE & FILL
GENERAL PERMOT
❑New DModification *om-plete Reissue r-T--I-Fa--ft-ial-Ke­iis"u�
As Aithorize&by the State of North Carol i na,,Departmen!t of EnivironFnent-an Nat ��!s 0 1
I- I P'L! Uano�eSOU C'S.
and.the,Coastal'Resources Commission in an area,of envii o_ nmeltal Adl4n 15A CAC
, RUM ri!�, --Prqj6ci- -1afibr
�<EW 'W ES — PTS
AffeZted D., Cw TA C�,
AEC(s) - LJ EA O EHHF FOR EMBA, D N/A
cl Pws F— FC
lor'l
0RW- yes /W PNA yes Crit. )-lab. yes
Previous permit #
Date previous permit issued
State Road/ Lot 9(.,) /8-(,
I
Subdivision A(W*he-W�
City ZIP
Phone # River'Basin
B-
Adl Wtr. Body )Q�?' C#/Afow - A/yfk Im n unkn)
Closest Mal Wtr BodyA-/ 4,4404* /,e 509N'6'
Type cif'Pr6ject/ Activity Al ie- W, X81 A4 440epw Y^ 60 h, Q
(Scale:
Pler,(dock)i[ength ll,(?-)e(—
Platform(s)-ao—"
J-
A--
Finger pi6r(s)
IRiV9- 47 -1
Groin length -- A
number --- -- --
Bulkhead/ Riprap length L
avg distance offshore
max distance offshore —
,Basin, channel 7
cubic yards_.—,
Boat ramp
BoatHOLIse/,Boatlift /,(,,x
7
Beach Bulldozing
e
t"'. - " - - - ,
­4
Other
IW� --z-
Sffd'r4lin6 Lengthy &A-Z'Su'.,
s
iUM WE-
u e��,& yes;,,
ZSPW�' '1-
Sand6igg'zAnoi1sure—�g,yes L.�%
5.K"9 - 7--"+
VA,7
mkmgZ ��-ku-
-- " -W - -hk
ffirai(5rium'NO -0-ax W-%'
f
MA6..'
;Waiver Attached` 'W"!
TY, W�" ye
A building perms[ may be required by )%'14 'FII"N4V-S 60 4 tj 4�1 i See note on back regarding Nver Basin rules
Notes/ Special Conditions

11 DREDGE FILL
G-ENERAL PERMIT
Previous permit #
New ❑Modifcation ElComplete Reisstue R e �m I Date previous permit issued
As authorized by the State of North Carolina, Department of Environment and N�ura�����esources r/ 0,30
and the Coastal'Resources Commissron;rn an area of environmenta�il conce'C�r�pursuant to''ll 5A' NCAC f !r �`� . I �
A Iicant N rned H Y I ; ��_g Pro, ecf Lo tioh Coun s he
_ _ __ = Rule attac d 3°
t3�� ' v C�? -- I ca ty r=
INS ,� t ' -
dclres.'- +[ t r �` .Y� Stree't_Address/ State Road /`Lof #(s) -
d "� h *
City ; Ir ' b(r�� _ — 0 spat zlP `6 (� I �e
_K 3 rl U
. '`�'' �'�'`���� .s- `` `' - "•, `'; ? =F� °� ; +. rte,.: p , ='_ . i�",, a,�. _. - ;� "- :- �s;�
LPhO # ( �i ZC� :3 1. -Fax # ) _ LIMA 0 Subdivision,.
Jam- M
'uth6rir ddAA -9 � i �. _ y ' m City'
''. sue: 2,1i'; r.' -`! `� � i�9:{'.r.' {n.'`C :."rd's MZE 'iY�?da�.J � >I . ... �x'�' pµp;,r>'it' „ - :ix � _ �-ie•, r - .,
Affected ❑ CwEW ,PTA DES p PTS Phone # (_) River Basin
❑ OEA ❑ HHF ❑7H ❑ UBA ❑ N/A
AEC(s), r _ - = Adl. Wtr- Body , r.n _ trG , • na an unkn
`= ❑'PWS; ;r, s.' ❑F.C'., :. ;5' 5 k,
E , - C-losestiMal Wtr ,Body, r,
ORW yes / o I,N ' -yes / io Cr'iCHa6. "yes I%fio J -
Type of Project/ Activiq Co n Sbru -d o..- 3 'X j a` f1G J1 r p i cr n kL_i_
add I`h,UY1S:LJ 0'1 1 .S 'r Q+ ! f_,V!
Pier(dock)length I `� ___ _ r _ E �—T- - °
Platform(s) -- - i
' —�
Finger pier
•"" s)
- w_. . s �f` __ �t : q ___}_ - -�`Cr j _I, sy._- ,,•_ i- �� ,I• •' t 3< W - ttl',',_a l��'
Groin Length _ - - -- -= ,( _i,'_z__ '
x3 _ ^- r '?j_ = >'` —f t` ! _ t' t' _b:�' _p o- _t' ,'L' '''i _i
number -� _ ° — ��_: ', _ _ - °
.� i -',+qu i ei 1• S i s [f.3_,.%"!V t _ t
?s 3 y t '> ? = =i= l- =1- -= '� =`�, 1�,. tr, -. -' -j22 _1�� Sj - - ='1
Bulkhead /'ftipiap length [ u+ _L_ ! -��' ( f_ E -,L .fir t Q� t -- A . -_ _ -t- ` i
avg,distance offshore
max distance offshore t. - - -- - - _ Ij - -- ; i I r - -, - -t - - - -' - - I L - E -t•
j {�� i —_I _r 1 S
Basin, channel A
cubic yards
Boat ramp - -- -- - -- E =,- - - =- -- = - -i
t
Boathouse/ Boatlift,12'X20
=L
�lih1 ?L�r`,
Beach'Bulldozing
Other _ - I- �= r t I _
`
I`
65�y.. _i —__ _ _ —fi=— r A -- 4 3 � `.:v:���y cif -, .� l� _ , -__ ____ t __'� _., F_y _�s �- ,�._� –___ � �, >- k;. F_• ,
it t = -' , ,v' ! , I - ��• Sy..i ;-° rl 1 , i + _'_ -E .`t %;_ss ',' ..J,�t i' �
—
t _i." ,rSh' --
t.- .� a'�; - ` ( 'i. .f gyp. - {, F -- i I ry�? -�� -f :iss:�$
SAV j_nottisure ' no,� .` 1_ ,.—S __ i .1 : t ; - I - i = =_�. _ - �_-i
Sandbags 66004 esof -
'',5 - .a`_.,'
,P,fioCO�
�Wa,ver•_ °Attache
A buddm..... mit may be requrred,by: ( I S ' ` Q "k • ❑,See,nJe on back,regarding River Basin rules
[dotes/ Special Conditions y�. �: i't _� d• e S S f ��° £ �_ �i�`l� - ,,_
��vCL L(3

MAJOR PERMIT FEE MATRIX
Applicant: R 6 B 6_� % J r4- (—<S _,� A/
Selection
Development Type
Fee
DCM %
DWQ %
(14300 1601435100093 1625 6253)
(243001602 435100095 2341)
I Private, non - commercial
development that does not
$250
100%($250)
0%($0)
involve'the,filling or
excavation of anywetlands
or open water areas
II , Public or,commercial
development that does not
'filling
$400
100%($400)
0%($0)
involve the or
f
excavation of any wetlands
or open water areas
Mayor Modification to a
$250
100% ($250)
0%($0)
CAMA Ma or ermit
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,
lies
B, C, or D below applies
III(A) Private, non -
Q'
commercial.development, if
$250
100%($250)
0%($0,)
General'Water Quality
Certification No 3490 (See
attached ) can be ap2lied
HI(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
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%($1,90)
excavation of more than
one acre of wetlands and /or
open water areas
C ffec-%< "'P 3y Z 8 : f2, 5 Ao f t c e. ? v 4-d rf-'4 /4?,Z 1 t-r f 70-c. Jr*A ,-L-