20161005 Ver 1_CAMA Application_20161020

•
PAT MCCRORY
Governor
DONALD R. VAN DER VAART
Secretary
OCT 2 6 2016
BRAXTON DAVIS
Coastal Management Director
ENVIRONMENTAL QUALITY
DEQ-WATER�iESOURCES
401 &BUFFER PERMITTING
October 14, 2016 °6
MEMORANDUM
TO: Karen Higgins, Compliance and Permitting Unit Supervisor
DWR - Water Quality Program
FROM: Doug Huggett, Major Permits Coordinator
Division of Coastal Management
SUBJECT: CAMA/DREDGE & FILL Permit Application Review
Applicant: Robert V. Owens,III
Project Location: 361 Mother Vineyard Road(SR-1120), Manteo, Dare County
Proposed Project: Bulkheads, Dock, Boatlift, Slips
Please indicate below your agency's position or viewpoint on the proposed project and return this
form by 11/04/16 to Courtney Spears,Assistant Major Permits Coordinator,400 Commerce
Avenue, Morehead City, NC 28557 (fax: [phone]). If you have any questions regarding
the proposed project, please contact Frank Jennings at [phone]. 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
''Nothing Compares
State of North Carolina I Environmental Quality I Coastal Management
1367 US Hwy 17 South I Elizabeth City,NC 27909
252-264-3901 I 252-264-3723[fax]

DIVISION OF COASTAL MANAGEMENT
FIELD INVESTIGATION REPORT
1. APPLICANT'S NAME: Robert V. Owens, III
2. LOCATION OF PROJECT SITE: 361 Mother Vineyard Road (SR-1120), Manteo, Dare
County, adjacent to the Roanoke Sound.
Photo Index— 2006: 183-7191, K: 6,7
Latitude: 35°55'14.10"N Longitude: 75°39'41.92"W
3. INVESTIGATION TYPE: CAMA/D&F
4. INVESTIGATIVE PROCEDURE: Dates of Site Visit— 10/04/2016
Was Applicant Present - NO
5. PROCESSING PROCEDURE: Application Received Complete - 09/28/2016
Office - Elizabeth City
6. SITE DESCRIPTION:
(A) Local Land Use Plan — Dare County
Land Classification From LUP - Conservation
(B) AEC(s) Involved: Estuarine Water, Public Trust Area, Coastal Shoreline
(C) Water Dependent: Yes
(D) Intended Use: Private residential
(E) Wastewater Treatment: Existing - N/A
Planned - N/A
(F) Type of Structures: Existing - None
Planned — Bulkheads, Dock, Boatlift
(G) Estimated Annual Rate of Erosion: 7 ft.
Source —Applicant by Google Earth, NC One Map
7. HABITAT DESCRIPTION: [AREA]
DREDGED FILLED OTHER
(A) Vegetated Wetlands --- --- ---
(B) Public Trust Area --- 2,335 612 shaded
Estuarine Waters
(C) Coastal Shoreline --- 3,197 Bulkhead
11,550 Lot Clearing
(D) Total Area Disturbed: 17,082 sq. ft. (.39 acre)
(E) Primary Nursery Area: No
(F) Water Classification: SA Open: Yes; SC Open: No
8. PROJECT SUMMARY: The applicant proposes to clear a lot and construct two
shoreline bulkheads, a dock and four slips.

Robert V. Owens, III
Field Investigation Report
Page 2
Project Setting
The site of the proposed development is located at 361 Mother Vineyard Road (SR-1120),
Lot 30, Mother Vineyard Subdivision, Roanoke Island, Dare County and adjacent to the
Roanoke Sound and a manmade canal that is a tributary of Shallowbag Bay. The property
has an area of approximately 20,213 sq. ft., an elevation of approximately 3 feet above normal
water level (NWL) and has sandy soils. The property is vegetated with Pine, Wax Myrtle,
Yaupon, cat brier, Virginia Creeper, Live Oak Magnolia, Red Bay, wild grape and native
grasses.
The property has approximately 102 feet of shoreline on a manmade canal on the western
boundary and 102 feet of shoreline on the Roanoke Sound on the eastern boundary. The
north and south boundaries are adjacent to lots that are developed with single family
dwellings, shoreline stabilization bulkheads and various boating use structures. The eastern
shoreline has a small section of a relic bulkhead at the northeastern corner as well as a small
area of riprap rubble. Based on aerial photography, the relic bulkhead section appears to be
a remnant of a bulkhead that had severe failure between July 2006 and October 2008.
Currently there is a crescent shaped erosion area with an erosion escarpment along that
shoreline. A small area of riprap located at the end of the southern adjacent property owner's
return wall is present. Erosion along the western shoreline, while not as aggressive, has
resulted in some undermining of vegetation.
The waters of Roanoke Sound in this area are classified as SA and are open to shellfish
taking. The waters of Shallowbag Bay are classified as SC and are closed to shellfish taking.
Development Proposal
In order to prevent further erosion along the Roanoke Sound shoreline, the applicant proposes
to construct a 102-foot long bulkhead to connect with the corner of the adjacent lots and have
a straight alignment. The proposed bulkhead alignment will have a maximum distance of 35
feet from the shoreline and an average distance of 23 feet.
In order to prevent further erosion along the canal shoreline, the applicant proposes to
construct a 102-foot long bulkhead along the NWL of the canal and in a straight alignment.
The applicant proposes to construct a 6-foot wide and 102-foot long shoreline dock, with 13
integral tie pilings, in the canal that will provide docking space for four small boats. A lift,
8'x10', is proposed for one of the slips. The canal width along this shoreline is 41 feet and
water depths range from 2-4 feet.
The applicant proposes to clear and fill the lot in preparation for a future residential dwelling.
Approximately one foot of fill material will be used to raise the elevation of the lot so that it is
consistent with neighboring lots.

1 t
•
Robert V. Owens, III
Field Investigation Report
Page 3
Anticipated Impacts
The proposed soundside bulkhead alignment with backfill will result in the filling of
approximately 2,335 sq. ft. of eroded area that is Public Trust Areas (PTA) and Estuarine
Waters (EW)Areas of Environmental Concern (AECs) and 2,381 sq. ft. of Estuarine Shoreline
(ES) AEC. Approximately 86 cubic yards of fill material will be placed below NWL for the
backfill.
The proposed canal-side bulkhead will result in the filling of approximately 816 sq. ft. of ES
AEC.
The proposed dock will shade 612 sq. ft. of canal waters, PTA and EW, AECs.
The proposed dock will provide docking for four small boats, of which one will have a boatlift.
The lot clearing and fill will result in 14;100 sq. ft. of land disturbance, of which approximately
11,550 sq. ft. will be located within the ES AEC.
Temporary water turbidity will occur during construction.
Submitted by: Frank Jennings
Date: 10/14/2016

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's CREATIVE ENGINEERING SOLUTIONS,PLLC
11! FIRM LICENSE P-0970
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WWW.CREATIVEENGINEERINGOBX.COM
GREATIV .- ' 10'4 TJTIONS
Lot 30 Mother Vineyard Subdivision, Section One, Manteo, NC Project Narrative
Introduction:
The subject property is located along the southern extents of Mother Vineyard Rd. (NCSR 1120) on
Roanoke Island,Manteo NC.The applicant proposes to install approximately 102 I.f. ,of estuarine
shoreline timber bulkhead on the east side of the property, (Roanoke Sound) and approximately 1021.f.
of estuarine shoreline timber bulkhead along the west side of the property, (man-made canal) in
conjunction with an elevated 6' wide dock and (4) wet boat slips with (1) boat lift.The site can be
accessed by heading east on US 64/264,turning right onto Mother Vineyard Rd.and following east and
then south to 361 Mother Vineyard Rd..The property is currently undeveloped with a dense stand of
trees and understory.The property has approximately 102 linear feet of estuarine shoreline along the
Roanoke Sound and 102 liner feet of estuarine shoreline along the manmade canal.The intent of this
application is to mitigate erosion along the shoreline in association with developing boat access to the
subject property via the manmade canal.
Project Description:
The project consists of the following elements;
• Construction of approximately 102 l.f.of bulkhead along the Roanoke Sound
• Construction of approximately 102 I.f.of bulkhead along the adjoining man made canal
• Construction of (4) 8' x 25' boat slips with (1) of the boat slips containing a 8'x10' boat lift
Existing Conditions:
The site is currently undeveloped on the eastern and western portions of the property. It should be
noted that the adjoining property owners,to the north and south, have installed supplemental erosion
control measures in an effort to protect their existing shoreline retaining walls,which currently encroach
onto the subject property.
There was no observed evidence of submerged aquatic vegetation (SAV) along the estuarine
shorelines or coastal wetlands in the proximity of the subject property.
Stormwater Management:
No upland improvements, pavements,walkways or other impervious surfaces will be constructed as
part of the project. No stormwater management or additional stormwater measures are proposed for
this project.
Methods of Construction:
Dock and bulkhead components shall be timber and or vinyl/composite material frame construction.
Installation will be by conventional marine construction marine methods.
Project Schedule:
Construction will be initiated upon issuance of a CAMA permit.
Compliance with CAMA Land Use Plan:
The property is classified as Community Residential, by the Dare County Land Use Plan.
LOT 30 MOTHER VINEYARD SUBDIVISION,SECTION ONE

Receiver!
ece ve
s,^F, ,s 2016
®CM MP-1
APPLICATION for Dem-Er
Major Development Permit
(last revised 12/27/06)
North Carolina DIVISION OF COASTAL MANAGEMENT
1. Primary Applicant/Landowner Information
Business Name Project Name(if applicable)
Lot 30 Mother Vineyard Subdivision
Applicant 1: First Name MI Last Name
Robert V Owens Ill
Applicant 2: First Name MI Last Name
If additional applicants,please attach an additional page(s)with names listed.
Mailing Address PO Box City State
301 W. Fresh Pond Dr., Unit 1 Kill Devil Hills NC
ZIP Country Phone No. FAX No.
27948 252 - 216 - 8079 ext. -
Street Address(if different from above) City State ZIP
Email
2. Agent/Contractor Information
Business Name
Creative Engineering Solutions, PLLC
Agent/Contractor 1: First Name MI Last Name
David M Ryan
Agent/Contractor 2: First Name MI Last Name
Mailing Address PO Box City State
262 Mother Vineyard Rd Manteo NC
ZIP Phone No. 1 Phone No. 2
27954 252 - 475 - 0038 ext. - - ext.
FAX No. Contractor#
252.473.5566
Street Address(if different from above) City State ZIP
Email
[e-mail]
<Form continues on back>

Received
Form DCM MP-1 (Page 2 of 4) APPLICATION for
c:-ci= i; a208
"` Major Development Permit
3. Project Location C
County(can be multiple) Street Address State Rd.#
Dare 361 Mother Vineyard Rd. NCSR 1120
Subdivision Name City State Zip
Mother Vineyard, Section 1 Manteo NC - 27954
Phone No. Lot No.(s) (if many,attach additional page with list)
ext. 30 ,
a. In which NC river basin is the project located? b. Name of body of water nearest to proposed project
Pasquotank Roanoke Sound
c. Is the water body identified in(b)above,natural or manmade? d. Name the closest major water body to the proposed project site.
®Natural ®Manmade ❑Unknown Roanoke 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 County
4. Site Description
a. Total length of shoreline on the tract(ft.) b. Size of entire tract(sq.ft.)
102'+/- along sound 102' +/- along canal 20,213
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) 2.75' ®NHW or❑NWL
e. Vegetation on tract
Dense stand of trees and understory
f. Man-made features and uses now on tract
Undeveloped
g. Identify and describe the existing land uses adiacent to the proposed project site.
single-family residential development
h. How does local govemment zone the tract? i. Is the proposed project consistent with the applicable zoning?
R-1 Low Density Residential (Attach zoning compliance certificate,if applicable)
®Yes ❑No DNA
j. Is the proposed activity part of an urban waterfront redevelopment proposal? Oyes ®No
k. Has a professional archaeological assessment been done for the tract? If yes,attach a copy. Oyes MNo DNA
If yes,by whom?
I. Is the proposed project located in a National Registered Historic District or does it involve a ❑Yes ®No DNA
National Register listed or eligible property?
<Form continues on next page>
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Form DCM MP-1 (Page 3 of 4) �= �, "1x16 APPLICATION for
Major Development Permit
m. (i) Are there wetlands on the site? ales No
(ii)Are there coastal wetlands on the site? Oyes No
(iii)If yes to either(i)or(ii)above,has a delineation been conducted? Oyes OW
(Attach documentation,if available)
n. Describe existing wastewater treatment facilities.
N/A
o. Describe existing drinking water supply source.
Dare County Water System
p. Describe existing storm water management or treatment systems.
N/A
5.Activities and Impacts
a. Will the project be for commercial,public,or private use? El Commercial ❑Public/Government
®Private/Community
b. Give a brief description of purpose,use,and daily operations of the project when complete.
The project intent is to mitigate erosive impacts along the soundfront and canalfront. Boating
operations are anticipated to originate from the subject property occurring intermittently.
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.
Timber piles are anticipated to be a combination of"washed in" and driven. A portable water
tank is anticipated to be utilized. A skid steer, backhoe and excavator shall be used for
clearing, pile driving and backfilling activities.
d. List all development activities you propose.
Proposed 102' +/- timber 4' exposed height bulkhead along soundfront,
Proposed 102'+/- timber 3' exposed height bulkhead along canalfront with adjoining
6' wide dock w/4 total boat slips, (1) containing a boat lift
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? ®Sq.Ft or❑Acres
19,819
g. Will the proposed project encroach on any public easement,public accessway or other area Oyes ®No DNA
that the public has established use of?
h. Describe location and type of existing and proposed discharges to waters of the state.
N/A
i. Will wastewater or stormwater be discharged into a wetland? ❑Yes ®No DNA
If yes,will this discharged water be of the same salinity as the receiving water? Dyes ❑No DNA
j. Is there any mitigation proposed? Oyes ®No DNA
If yes,attach a mitigation proposal.
<Form continues on back>

Form DCM MP-1 (Page 4 of 4) APPLICATION for
Major Development Permit
6. Additional Information
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)—(f)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.
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 George & Andrea Bonner Phone No.
Address 371 Mother Vineyard Rd., Manteo,NC 27954 252.473.2379
Name David & Debra Perrot Phone No.
Address 357 Mother Vineyard Rd., Manteo, NC 27954 252.473.3370
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.
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 and Permission to Enter on Land
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. t-
ed
Date Sept. 1, 2016 Print Name R.V. Owens III � �
7Ca' 44t liilti
Signature .I�
Please indicate application attachments pertaining to your proposed project. DC WE r
®DCM MP-2 Excavation and Fill Information ❑DCM MP-5 Bridges and Culverts
®DCM MP-3 Upland Development
®DCM MP-4 Structures Information
7 P. 'i : '1-r',tiv-3 .f:C: '3`a' •: „1.+:a axr u... .+,ai:x::a 415=„-a sn;^A z.a2; not

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Form DCM MP-2
EXCAVATION and FILLDLi
(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.
Access Other
Channel Canal Boat Basin Boat Ramp Rock Groin Rock (excluding
(NLW or Breakwater shoreline
NWL) stabilization)
Length
Width
Avg.Existing NA NA
Depth
Final Project NA NA
Depth
1. EXCAVATION This 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 d. High-ground excavation in cubic yards.
(CW),submerged aquatic vegetation(SAV),shell bottom(SB),
or other wetlands(WL)? If any boxes are checked,provide the
number of square feet affected.
OCW ❑SAV OSB
OWL ❑None
(ii)Describe the purpose of the excavation in these areas:
2. DISPOSAL OF EXCAVATED MATERIAL This section not applicable
a. Location of disposal area. b. Dimensions of disposal area.
c. (i)Do you claim title to disposal area? d. (i) Will a disposal area be available for future maintenance?
Oyes ONo DNA ❑Yes ONo DNA
(ii)If no,attach a letter granting permission from the owner. (ii)If yes,where?
e. (i)Does the disposal area include any coastal wetlands/marsh f. (i)Does the disposal include any area in the water?
(CW),submerged aquatic vegetation(SAV),shell bottom(SB), ❑Yes ONo DNA
or other wetlands(WL)? If any boxes are checked,provide the
number of square feet affected. (ii)If yes,how much water area is affected?
❑CW ❑SAV OSB
OWL ❑None
(ii)Describe the purpose of disposal in these areas:

Form SCM 2111P-2 (Exc.:0,4.s on and Fill, 'a 9g',' 2 43 .3y
3. SHORELINE STABILIZATION 0 This section not applicable
(If development is a wood groin, use MP-4—Structures)
a. Type of shoreline stabilization: b. Length: 101' sound, 102 canal
®Bulkhead ❑Riprap ❑Breakwater/Sill ❑Other: Width:
c. Average distance waterward of NHW or NWL: d. Maximum distance waterward of NHW or NWL:
23' soundfront, 0' canalfront 34.72' sound, 0' canal
e. Type of stabilization material: f. (i) Has there been shoreline erosion during preceding 12
timber and/or vinyl bulkhead months?
®Yes ❑No DNA
(ii)If yes,state amount of erosion and source of erosion amount
information.
7' +p/-, comparative analysis of aerial
g. Number of square feet of fill to be placed below water level. h. Type of nh rn tea hy, (google earth, nc one map)
Bulkhead backfill 2335 SfRiprap clean earthen fill
Breakwater/Sill Other
i. Source of fill material.
off-site borrow source, (mine)
4. OTHER FILL ACTIVITIES ®This section not applicable
(Excluding Shoreline Stabilization)
a. (i) Will fill material be brought to the site? Oyes ❑No DNA b. (i)Will fill material be placed in coastal wetlands/marsh(CW),
If yes, submerged aquatic vegetation(SAV),shell bottom(SB),or
Amount of material to beplaced in the water other wetlands(WL)? If any boxes are checked,provide the
(ii) number of square feet affected.
(iii)Dimensions of fill area ❑CW ❑SAV OSB
(iv)Purpose of fill OWL ❑None
(ii)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.,dragline,
controlled? backhoe,or hydraulic dredge)?
silt fence backhoe, skid steer, excavator
c. (i) Will navigational aids be required as a result of the project? d. (i) Will wetlands be crossed in transporting equipment to project
Oyes ❑No ®NA site? Oyes ®No DNA
(ii)If yes,explain what type and how they will be implemented. (ii)If yes,explain steps that will be taken to avoid or minimize
environmental impacts.
R c&& .
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Date Sept. 1, 2016 DCM-EC Applicant Name R.V. Owens, Ill
Project Name 361 Mother Vineyard Rd. Applicant Signature \ D '„/�

• 1I
43n+P- G. -.1
Form DCM MP-3 ?i, 1.016
UPLAND DEVELOPMENT D -
(Construction and/or land disturbing activities)
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.
GENERAL UPLAND DEVELOPMENT
a. Type and number of buildings,facilities,units or structures b. Number of lots or parcels.
proposed.
One
N/A
c. Density(give the number of residential units and the units per d. Size of area to be graded,filled,or disturbed including roads,
acre). ditches,etc.
N/A 19,819 s.f. +1-
e. If the proposed project will disturb more than one acre of land,the f. List the materials(such as marl,paver stone,asphalt,or concrete)
Division of Land Resources must receive an erosion and to be used for impervious surfaces.
sedimentation control plan at least 30 days before land-disturbing N/A
activity begins.
(i) If applicable,has a sedimentation and erosion control plan been
submitted to the Division of Land Resources?
Dyes ❑No ®NA
(ii)If yes,list the date submitted:
g. Give the percentage of the tract within the coastal shoreline AEC to h. Projects 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?
N/A ❑Yes ❑No ®NA
i. Give the percentage of the entire tract to be covered by impervious (ii)If yes,list the date submitted:
and/or built-upon surfaces,such as pavement,building,rooftops,
or to be used for vehicular driveways or parking.
N/A
j. Describe proposed method of sewage disposal. k. Have the facilities described in Item(i)received state or local
N/A approval?
Dyes ❑No ®NA
If yes,attach appropriate documentation.
I. Describe location and type of proposed discharges to waters of the m. Does the proposed project include an innovative stormwater
state(e.g.,surface runoff,sanitary wastewater,industrial/ design?
commercial effluent,"wash down"and residential discharges). Dyes ❑No ®NA
Surface Runoff If yes,attach appropriate documentation.

•
•
Form DCM - p). mi. eve—o m 3 Page 2 o s
• m. Describe proposed drinking water supply source(e.g.,well, n. (i) Will water be impounded? Oyes ❑No ®NA
community,public system,etc.) (ii)If yes,how many acres?
N/A
o. When was the lot(s)platted and recorded? p. If proposed development is a subdivision,will additional utilities be
May 31, 1957 Map Book 2 Pg. 94 installed for this upland development?
Yes ❑No ®NA
Mother Vineyard - Section One
Received
Date Sept. 1, 2016 SEP 6 IA
Project Name 361 Mother Vineyard Rd. DCM-EC
Applicant Name 0y( ns, III
Applicant Signature

Ppcelynd
74s 'ai6
Form DCM MP-4
STRUCTURES •LUM
S
(Construction within Public Trust Areas)
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 OThis section not applicable
a. (i) Is the docking facility/marina: b. (i)Will the facility be open to the general public?
❑Commercial ❑Public/Govemment ®Private/Community Oyes ®No
c. (i)Dock(s)and/or pier(s) d. (i)Are Finger Piers included? Oyes ®No
(ii)Number 1 If yes:
(iii)Length 102' (ii)Number
(iv)Width 6' (iii)Length
(v)Floating Oyes ®No (iv)Width
(v)Floating Oyes ❑No
e. (i) Are Platforms included? Oyes ®No f. (i) Are Boatlifts included? ®Yes ❑No
If yes: If yes:
(ii)Number (ii)Number 1
(iii)Length (iii)Length 10'
(iv)Width (iv)Width 8'
(v)Floating Oyes ❑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.
4 ❑Full service,including travel lift and/or rail,repair or
(ii)Number of slips existing maintenance service
0 ❑Dockage,fuel,and marine supplies
®Dockage("wet slips")only,number of slips: 4
Dry storage;number of boats:
❑Boat ramp(s);number of boat ramps:
❑Other,please describe:
i. Check the proposed type of siting: j. Describe the typical boats to be served(e.g.,open runabout,
❑Land cut and access channel charter boats,sail boats,mixed types).
['Open water;dredging for basin and/or channel open runabout
®Open water;no dredging required
❑Other;please describe:
k. Typical boat length: 25' +1- I. (i)Will the facility be open to the general public?
Oyes No
m. (i)Will the facility have tie pilings?
®Yes ❑No
(ii)If yes number of tie pilings?
13

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Detv
2. DOCKING FACILITY/MARINA OPERATIONS ®This section not applicable
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.
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.
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?

pipe p
Form DCM IP-4 ?a-'94-.:.
->, r.
v5 i0
m. Is the marina/docking facility proposed within a primary or secondary nursery area?
Dyes ❑No
n. Is the marina/docking facility proposed within or adjacent to any shellfish harvesting area?
Oyes ❑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 OSB
OWL ['None
p. Is the proposed marina/docking facility located within or within close proximity to any shellfish leases? Oyes ❑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 ❑Public/Government ❑Private/Community
(ii)Number
(iii)Length
(iv)Width
Note: Roofed areas are calculated from dripline dimensions.
4. 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
5. BREAKWATER(e.g., wood,sheetpile,etc.) ®This section not applicable
a. Length b. Average distance from NHW,NWL,or wetlands
c. Maximum distance beyond NHW,NWL or wetlands
6. MOORING PILINGS and BUOYS ❑This section not applicable
a. Is the structure(s): b. Number 13
❑Commercial ❑Public/Govemment ®Private/Community
c. Distance to be placed beyond shoreline 6' +/- d. Description of buoy(color,inscription,size,anchor,etc.)
Note: This should be measured from marsh edge,if present.
e. Arc of the swing

form OCM N1P-4 NMP-4 (StnLw..3res, 4
7. GENERAL
a. Proximity of structure(s)to adjacent riparian property lines b. Proximity of structure(s)to adjacent docking facilities.
1' will adjoin ex. docks to north & south
Note: For buoy or mooring piling,use arc of swing including length
of vessel.
c. Width of water body d. Water depth at waterward end of structure at NLW or NWL
54' +1- -1.33' +1-
e. (i) Will navigational aids be required as a result of the project?
Oyes No DNA
(ii)If yes,explain what type and how they will be implemented.
8. OTHER ®This section not applicable
a. Give complete description:
ReCeiVPrl
Date Sept. 1, 2016
SD' 2016
Project Name 361 Mother Vineyard Rd. DC M-EC-
.
Applicant Name R.V. Owens, Ill
Applicant Signatur / D _/�

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DATE: 9_15_16 SHEET NUMBER
PROJEC7 NO.
P1044 1 OF 2

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CAD FILE NAME:
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DRAWINGSCALE:
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DATE: 9_15_15
SHEET NUMBER
PROIECT NO.:
P1044
2 OF 2

,
MAJOR PERMIT FEE MATRIX
Applicant: ROBERT V. OWENS,III
Selection Development Type Fee DCM % DWQ%
(14300 1601 435100093 1625 6253) (24300 1602 435100095 2341)
I. Private, non-commercial
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:
❑ Major Modification to a $250 100% ($250) 0%($0)
CAMA Major permit
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
111 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
El involves the filling and/or $475 60% ($285) 40% ($190)
excavation of more than
one acre of wetlands and/or
open water areas: