89020A - Bailey Park, LLC

CAMA VDREDGE & FILL NY 89020 CA C D
GENERAL PERMIT DatePrevious previous
Date previous permit issued
Wevv ❑Modification ❑Complete Reissue ❑Partial Reissue
As authorized by theStateof North Carolina. Department of Environmental Quality and the Coastal Resources Commission in an area of environmental concern pursuant to:
I SA NCAC I (r " 2. 7 ❑ Rules attached. R, General Permit Rules available at the following link: www.dea.nc.eov/CAMArules
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Affected ❑CW ®.EW M.PTA DS ©.P7S Adj. Wtr. Body Cw/ s�Lt I -- U S.^,.,t n c� nl�a✓`an/unk)
AEC(s): ❑OEA ❑IHA ❑UW ❑$PIMA ❑PWS Closest Maj.Wtr.Body ir'QM��i c,n -r`•u ti�
ORW: yes/t%j PNA: yes/
Type
Access Length _ ��} rry1 C / �, $ D v. Aj q ----tr-' � al
Pier (dock) length
Fixed Platform(s)
Floating Platform(s) - K
Finger piers)
r
Total Platform area
Groin length/N
Bulkhea Riprab ngth $
Avg distance shore (y
Breakwater/Sill
Max distance/ length
___Basin,
channel T'
Cubic yards
Boat ramp_
ky-T
Boathouse/ Boatlift
Beach Bulldozing
Other_____
1V
f�
--
A 6' a'd Q.
0Ct 1 / e C I •J(f rr^
SAV observed: yes no
Moratorium: n/a yes no
Site Photos: yes no
Riparian Waiver Attached: yes n� v
A building permit/zoning permit maybe required by: -D !Z�—C Q- TAWPAM/NEUSE/BUFFER (circle one)
Permit Conditions
See note on back regarding River Basin rules
See additional notes/conditions on back
I AM AWARE OF STATUTES, CRC RULES AND CONDITIONS THAT APPLY TO THIS PROJECT AND REVIEWED COMPLIANCE STATEMENT. (Please Initial)6w
Age n"t (cant PRINTED Name
Signs ure "•PI��� a ta[ement on back of permit••
Application Feels) Check p/Money Order
Permit Officer's PRINTED Name
Sign re��
A-.3 L2
Issuing Date Expiration Date

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�CAMAFdificatiREDGE & FILL N9 89020 �A B C D
GENEL PERMIT Previous permit
Date previous permit issued
�LLew ❑ on [:]Complete Reissue []Partial Reissue
As authorized by the State of�/North Carolina, Department of Environmental Quality and the Coastal Resources Commission in an area of environmental concern pursuant to:
I SA NCAC 7 H• 2. 7 � � ❑ Rules attached. 9 General Permit Rules available at the following link: www.deq nc gov/CAMArules
Applicant Name �1�iz.v
Address b e () cs pC
City—A't/a/l State N <' - zip._
Phone #
Email Ict 1 X o n Q 4T
Affected ❑cW ®.EW [&PTA
AEC(s): ❑OEA ❑IHA ❑UW
ORW: yes/no ; PNA: yes/0
Type of
Project/ Activity
Shoreline Length
Access Length
Pier (dock) length
Fixed Platform(s)
Floating Platform(s)
Finger pier(s)
110
Total Platform area
Groin length/# J��--77 �
Bulkhea RipraWt ngt J q�
Avg distance shore fD
Breakwater/Sill
,T
Max distance/length G
Basin, channel '—
Cubic yards
Boat ramp �-
Boathouse/ Boa[lift
,aJ�
Beach Bulldozing
Other
\ter
\
_
X
��
SAV observed:
yes no
Moratorium: n/a`
yes no
Site Photos:
<yes no
Riparian Waiver Attached:
yes
A building permit/zoning permit may be required by: _
Permit Conditions
Agent or Applicant PRINTED Name
Authorized Agent e,_—1 Vl O
Project Location (County):
Street Address/State Road/Lot #(s) SR ,,
Subdivicien �L0-1
City /fai'l QfitS ZIP_2`%
[6ES [jZj.PTS Adj. Wtr. Body P q (-K / r < O Sot.. A t/dtan/unk)
❑SPIMA ❑PWS Closest Maj. Wtr. Body_Ax, e-A sesa ld
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Sign,aIture "Please read compliance statement on back of permit*•
Y�� !02
Application Feels) Check tf/Money Order
�L
❑ TAR/PAM/NEUSE/BUFFER (circle one)
❑ See note on back regarding River Basin rules
❑ See additional notes/conditions on back
(Please Initial)
Permit Officer's PRINTED Name
Signt�re
S�'13,2y 2A-3/2Y
Issuing Date Expiration Date

OVWrAf1t, L-ICAMA ❑ DREDGE & FILL NY 89M AEI B C D
GENERAL PERMIT Previous permit
Date previous permit issued
RDNew ❑ Modification ❑ Complete Reissue [-]Partial Reissue
As authorized by the State of North Carolina, Department of Environmental Quality and the Coastal Resources Commission in an area of environmental concern pursuant to:
15A NCAC ❑ Rules attached. Z. General Permit Rules available at the following link: wwwdea nc cov/CAMArules
Applicant Name
Address�t j _
City A ✓''/y State ZIP
Phone#(�-��)
Email A J i X
Affected ❑ cW EEW ❑ PTA 't❑ ES PTS
AEC(s): ❑OEA ❑IHA ❑UW ❑SPIMA ❑PWS
ORW: yes/no PNA: yes/no
Type of Project/ Activity
Shoreline Length
Access Length _
Pier (dock) lengtl
Fixed Platformis)
Floating Platform(s)
Finger pier(s)
Total Platform area
Groin length/4
Bulkhead/ Riprap length
Avg distance offshore
Breakwater/Sill
Max distance/ length
Basin, channel
Cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
SAV observed: yes no
Moratorium: n/a yes no
Site Photos: yes no
Riparian Waiver Attached: yes no
A building permit/zoning permit may be required by:
Permit Conditions
CRC RULES
Agent or Applicant PRINTED Name
rz �
Signature *'Please read compliance statement on back of permit**
Application Feels) Check #/Money order
Authorized Agent I
Project Location (County):
Street Address/State Road/Lot #(s)
Subdivision
City
Adj. Wtr. Body
Closest Maj. Won Body
AND
Permit Officer's PRINTED Name
(Scale:
❑ TARIPAM/NEUSE/BUFFER (circle one)
❑ See note on back regarding River Basin rules
❑ See additional notes/conditions on back
(Please Initial)
Signature
Issuing Date Expiration Date

AUTHORIZATION TO ACT AS REPRESENTATIVE FORM
Property Legal Description:
DEED BOOK: 2720 PAGE NO: 271
PIN NO.: 959513130535
PROPERTY STREET ADRESS: 0 Pricilla Curve Road, Hatteras, NC 27943
Please Print:
Property Owner: Bailey Park, LLC
Property Owner:
The undersigned property owners of the above noted property, so hereby authorize
Fv
Doug Dorman of Atlantic Environmental Consultants, LLC to,
(Contractor/Agent) (Name of consulting firm)
1. Act on any 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 750. Avon. NC 27915
Property Owners Telephone Number: 252-995-6086
We hereby certify that the above information submitted in this application is true and
accurate to the best of our knowledge.
� c � � �� 6Via�a
Authorized Signature and Title Authorized Signature and Title
Date: I t�gt ZaZ Date:

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONNVAIVER FORM
CERTIFIED MAIL RETURN RECEIPT REQUESTED or NAND DELIVERY
(Top portion to be completed by owner or their agent)
Name of Property owner: Bailey Park, LLC - Manageing Member,Dave Dixon
Address of Property: 0 Pricilla Curve Road, Hatteras, NC 27943
Mailing Address of Owner: P•0 Box 750, Avon, NC 27915
ddixon hatteraslaw.com owner's Phone#: [phone]
Owner's email. @
Agent's Name:
DougDorman Agent Phone#: [phone]
Agent's Email: dougdaec@gmaiLcom
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adjacent Pro 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
tlesc pt on 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 noary urn 1-. -• ------
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 (Choose only one
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 012rap 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
Im
1 DO NOT wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property
Typed/Printed name of ARPO:
Mailing Address of ARPO: PO Box 68, Bena, VA 23018
ARPO's email: [e-mail] ARPO's Phone#: [phone]
Date: 03/21/24
'waiver is valid for up to one year from ARPO's Signature*
Revised August 2022
Scanned with CarnScanner

DocuSign Envelope ID: 442BEEC5-8858-4E68-9478-E8CBB470C7AF
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-- Eli IleV Park, LLC - Una q nq I%mber Da oe D ixgn
Address of Property: 0 Pricilla Curve Road, Hatteras NC 27943
Mailing Address of Owner: -PO Box 750-1 Avon NC 27915
Owners email: ddixon(@hatteraslaw .corn Owner's Phone#: [phone]
Agent's Name: -Doug Dorman Agent Phone#:_252-599-2603
Agent's Email: [e-mail]_
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom Portion to be completed by the Adjacent Properl(, 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.
1 DO NOT have objections to this proposal. 100 have objections to this proposal.
N 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 (Choose only one
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: i—
Typed/Printed name ofARPO: Allen & Marlene
urr Is
Mailing Address of ARPO:? O. Box 24, Hatteras, NC 27943
ARPO's email: ARPO's Phone#:
Date:.-04i09124 waiver is valid for up to one year from ARPO's Signature"
Revised August 2022

Carver, Yvonne
From: Carver, Yvonne
Sent: Friday, May 24, 2024 7:32 AM
To: Doug Dorman
Subject: Fwd: Scanned document from HP, Bailey Park GP
Attachments: HPSCAN_20240524064547003_2024-05-24_064634669.pdf
Doug,
A copy of the general permit (GP) for authorization of Bailey Park's riprap revetment project in Hatteras is
attached for your review.
To finalize the permitting process, please address the following:
1) print, sign and initial the GP on the dedicated lines on bottom left and right, and
2) scan and email me a copy for our records.
Please let me know if you have any questions in this regard.
Thankyou,
Yvonne B. Carver
Environmental Specialist II
Division of Coastal Management
NC Department of Environmental Quality
252-621-6453
[e-mail]
401 S. Griffin St., Ste 300
Elizabeth City, NC 27909

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