79407A_NC 12 Investor 1, LLC_20210825

CAMA / ❑ DREDGE & FILL N9 79407 J B C D
GENERAL PERMIT Previous permit#
:]New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality i
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC
Rules attached.
Applicant Name 0 C I z-rAJeS4,or 1 Li-r; Project Location: County ;
Address �J J Q ° X / S Street Address/ State Road/ Lot #(s) Z % K
City State ZIP 2% 9
Phone # (4L7) 91 f.' O ""1 E-Mail f o a f '-°, a l,-12 f el l ky. ""Subdivision
Authorized Aeent Doug Por r.% City
Affected ❑ CW E'EW E/ 1"A ❑ ES ❑ PTS
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ USA ❑ N/A
❑ PWS:
ORW: yes / no PNA yes / no -)
ZIP Z-") 5 i 3
Phone # ( ) River Basin
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Agent or Applicant Printed Name
SignaturePlease read compliance statement on back of permit*
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Application Fee(s) 1 Check #
XVZ>, 7 /f L_ C --, (v ,c,
PermkOfficer's Printed Name
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Signature
12-512L1
Issuing Date Expiration Date

Statement of Compliance and Consistency
This permit is subject to compliance with this application, site drawing and attached general and specific conditions. Any
violation of these terms may subject the permittee to a fine or criminal or civil action; and may cause the permit to become
null and void.
This permit must be on the project site and accessible to the permit officer when the project is inspected for compliance. The
applicant certifies by signing this permit that I) prior to undertaking any activities authorized by this permit, the applicant will
confer with appropriate local authorities to confirm that this project is consistent with the local land use plan and all local
ordinances, and 2) a written statement or certified mail return receipt has been obtained from the adjacent riparian
landowner(s) .
The State of North Carolina and the Division of Coastal Management, in issuing this permit under the best available
information and belief, certify that this project is consistent with the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
Tar - Pamlico River Basin Buffer Rules Other:
Neuse River Basin Buffer Rules
If indicated on front of permit, your project is subject to the Environmental Management Commission's Buffer Rules for the
River Basin checked above due to its location within that River Basin. These buffer rules are enforced by the NC Division of
Water Resources. Contact the Division of Water Resources at the Washington Regional Office (252-946-6481) or the
Wilmington Regional Office (910-796-7215) for more information on how to complywith these buffer rules.
Division of Coastal Management Offices
Morehead City Headquarters Washington District
400 Commerce Ave 943 Washington Square Mall
Morehead City, NC 28557 Washington, NC 27889
252-808-2808/ I-888-4RCOAST 252-946-6481
Fax: [phone] Fax: [phone]
(Serves: Carteret, Craven, Onslow -
North of New River Inlet- and Pamlico
Counties)
Elizabeth City District
401 S. Griffin St.
Ste. 300
Elizabeth City, NC 27909
252-264-3901
Fax: [phone]
(Serves: Camden, Chowan, Currituck,
Dare, Gates, Pasquotank and Perquimans
Counties)
(Serves: Beaufort, Bertie, Hertford, Hyde,
Tyrrell and Washington Counties)
Wilmington District
127 Cardinal Drive Ext.
Wilmington, NC 28405-3845
910-796-7215
Fax: [phone]
(Serves: Brunswick, New Hanover,
Onslow - South of New River Inlet -
and Pender Counties)
http://portal.ncdenr.org/web/cm/dcm-home
Revised 7/06/ 17

AUTHORIZATION TO ACT AS REPRESENTATIVE FORM
Property Legal Description:
DEED BOOK: 2363 PAGE NO: 883
PIN NO.: 959513030185
PROPERTY STREET ADRESS: 57174 Altona Lane, Hatteras, NC 27943.
Please Print:
Property Owner. Trafton Reynolds - NC 12 Investor 1, LLC
Property Owner:
The undersigned property owners of the above noted property, so hereby authorize
Doug Dorman —___,of Atlantic Environmental Consultants, LLC to,
(Contractor/Agent) (Name of consulting firm)
1. Act on my behalf and take all actions necessary for the processing, issuance and
acceptance of permits and/or certifications and any all standard and special
conditions attached.
2. Enter the property to obtain site information including inspections with regulatory
agencies (Dare County, North Carolina Department of Environmental Quality,
U.S. Army Corps of Engineers, etc.) for the purpose of obtaining permits and/or
certifications.
Property Owners Address (if different than property above):
PO Box 125. Buxton. NC 27920
Property Owners Telephone Number. 252-996-0104
We hereby certify that the above information submitted in this application is true and
accurate to the best of our knowledge.
Auth ' Si tore and Title
Date: n �1i 5 "-LA
Authorized Signature and Titic
Date:

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
CERTIFIED MAIL - RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent)
Name of Property Owner: Trafton Reynolds
Address of Property: 57174 Altona Lane, Hatteras, NC 27943
Mailing Address of Owner: PO Box 125, Buxton, NC 27920
Owner's email: [e-mail] Owner's Phone#: [phone]
Agent's Name: Doug Dorman
Agent's Email [e-mail]
Agent Phone#: [phone]
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adjacent Property Owner)
I hereby certify that I own property adjacent to the above referenced property. The individual applying for this
permit has described to me, as shown on the attached drawing, the development they are proposing. A
descri tion r drawing,with dimensions,_must be provided with this letter.
I DO NOT have objections to this proposal. I DO have objections to this proposal.
If you have objections to what is being proposed, you must notify the N.C. Division of Coastal
Management (DCM) in writing within 10 days of receipt of this notice. Correspondence should be
mailed to 401 S. Griffin St., Ste. 300, Elizabeth City, NC, 27909. DCM representatives can also be
contacted at [phone]. No response is considered the same as no objection if you have been
notified by Certified Mail.
WAIVER SECTION
I understand that any proposed pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or
groin must be set back a minimum distance of 15' from my area of riparian access unless waived by n)e
(this does not apply to bulkheads or riprap revetments). (If you wish to waive the setback, you must sign
the appropriate blank below.)
I DO wish to waive some/all of the 15' setback
A
si7:21
I do not wish to waive the 15' setback requiremenT initial the blank)
Signature of Adjacent Riparian Property Owner:
Property Owner
Typed/Printed name of ARPO: Jeffrey Aiken - Fishermans Heritage, LLC
Mailing Address of ARPO: PO Box 473, Hatteras, NC 27943
ARPO's email: [e-mail]
ARPO's Phone#:
252-4
Date: 08/18/21 *waiver is valid for up to one year from ARPO's Signature*
Revised July 2021

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent)
Name of Property Owner: Trafton Reynolds
Address of Property: 57174 Altona Lane, Hatteras, NC 27943
Mailing Address of Owner: PO Box 125, Buxton, NC 27920
Owner's email: [e-mail] Owner's Phone#: [phone]
Agent's Name: Doug Dorman
Agent's Email:
[e-mail]
Agent Phone#: [phone]
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adjacent Property Owner)
I hereby certify that I own property adjacent to the above referenced property. The individual applying for this
permit has described to me, as shown on the attached drawing, the development they are proposing. A
description or drawing, with dimensions, must be provided with this letter.
I DO NOT have objections to this proposal. I DO have objections to this proposal.
If you have objections to what is being proposed, you must notify the N.C. Division of Coastal
Management (DCM) in writing within 10 days of receipt of this notice. Correspondence should be
mailed to 401 S. Griffin St., Ste. 300, Elizabeth City, NC, 27909. DCM representatives can also be
contacted at [phone]. No response is considered the same as no objection if you have been
notified by Certified Mail.
WAIVER SECTION
I understand that any proposed pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or
groin must be set back a minimum distance of 15' from my area of riparian access unless waived by me
(this does not apply to bulkheads or riprap revetments). (If you wish to waive the setback, you must sign
the appropriate blank below.)
I DO wish to waive some/all of the 15' setback
Signature of Adjacent Riparian Property Owner
-OR-
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner: P.AZZ
Typed/Printed name of ARPO: Ricky Scarborough
Mailing Address of ARPO: PO Box 572, Buxton, NC 27920
ARPO's email: [e-mail] ARPO's Phone#: [phone]
Date: 08/18/21 *waiver is valid for up to one year from ARPO's Signature*
Revised July 2021

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-. *AMA / REDGE & FILL NO 79237 A B C D
O
GENERAL
PERMIT Previous permit #
I ; w . Modification 'Complete Reissue Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality
N
and the Coastal Resources Commission
in an area of environmental concern pursuant to I SA NCAC
les attached.
ii
Applicant Name 'i 5 ih w.'_As.c. S P fiR i L_L� -� Project Location: County_,.,., eD c_<-
Address _. iU H '1:3 A Street Address/ State Road/ Lot # s L 3
-----------
City_ - 144ff'ls- s ---
--- State_N ZIP 27 `1 q'3 -- '% f t4_-Z A J h^ �. Lrc n •�
Phone # 7j....'� U�
..E-Mail _�_� ker+.,;. �� t c" I.t.�ubdivision
Authorized Agent ,L
"_'r``cti� _..__ City �-t" # -e «S -_ ......... _ _.... _....._._.... ZIP Z ?_I � 3
cw ¢EW
VkA -ES ` PTs Phone # ( ) �- River Basin f a s k-
Affected
-:OEA - HHF
AEC(s):
- IH - UBA -1 N/A i
Adj. Wtr. Body _ c� roc tt.n_.� nat man unkn)
- PWS:
ORW: /� PNA
n
Closest Maj. Wtr. Body ._._._ �..,, ,..1_r G .._S o �.. ......... .........
/on -
yes
yes
Type of Project/ Activity
A t b f�� ci ��
ACC ha �► c G
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7�
w/ �'t c..� a , tor' .1" , n a c;- T psi
+ .\ (Scale: )
Pier (dock) length
Fixed Platform(s)
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Floating Platform(s)
Finger
f
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pier(s).
Groin length
number
Bulkhead/ Riprap length
yy�
Y 1 b c or 1c
¢ 9QEwe
avg distance offshore
^
✓f EJ4
max distance offshore
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i annel �s" xydX'I
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cubic yards
Boat ramp
Boathouse/ Boatlift
X �.J f L
J
Z
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�,'RoS� Sartrto M-
Beach Bulldozing _ _ ......_. _._
Other
Shoreline Length -__,,_ _
dc
SAV: not sure yes no
Moratorium: n/a yes no
Photos: C YSS' no
Waiver Attached: yes no 17.S
A building permit may be required by: ` • See note on back regarding River Basin rules.
( Note Local Planning Jurisdiction)
Notes/ Special Conditions
/tI t
JaZt_ { ! ' f-A c e i n S f a. sect - a toL'i
Agent or Applicant Printed Name
Please � � ,► . _
a ure. read com liance statement on back of ermit
Applicatio Fee(s) C11 heck #
V o .'l .z� C o'4 yJ" _
—
Permit Officer's Printed Name
Si ure
77
Issuing Date Expiration Date