89092A (MOD)- The Pony Pen

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I� -AMA EDGE & FILL N� 89()92 0B C ply'
Previous permit
GENERAL PERMIT Date previous permit issued
[` New 0 Modification ❑ Complete Reissue ❑ Partial Reissue
As authorized by the Stat of North Carolina, Department of Environmental Quality and the Coastal Resources Commission in an area of environmental concern pursuant to:
I SA NCAC q
s� = ❑ Rules attached. ❑ General Permit Runts available at the following link: wvvw.deq.nc.govyCAMArules
Applicant Name - "e� / Z r t._ Authorized Agent/ /14 —)c cA ✓117dA 4RA�( Uy
Address iJl J43 �ll-� 5'1 (aQ kr B A CGr project Location (County);
City Q. _ "State v r'r ZIP -a:L3 to l/ Z Street Address/State Rmd/Lot #(s) , e, 7Pr r C-
Phone#( .rGSrf- V701 Ct,Crya ".. .5/1 /2.53y
Email n d q/y(a�i'i Subdivis,�tof
City /` Awlf r0 zip 179Y;3
Affected ❑CW gIEW IPTA ❑ES ❑PTS Adj.Wtr.Body Q 0ACs
f ti (naV k)
AEC(s): ❑DEA ❑IHA ❑UW ❑SPIMA ❑PWS Closest Mal. Win Body
/ `��"��� SoU^a
ORW: yes o PNA; yes/60
Type of Project/ Activity 1�t � f LAi JL � r� (n r 45, 5-3 o 1 c� //�w a H
na
a-hOJ'� WQ+16i£f— 2` r�L it a�c4sa .d�afr J_ t5 2— (Scale: Al )
Shoreline Length .I^ // r aw�/1 .�{'� /�S JCr)� �iLr K. sI �' /.its �(O CMO✓rl 3 7A sCSS� th Y� / Ott
Access Length r t -_ N I`
Qrnl ica I�
Pier (dock) length 15(,S X.
Fixed Platform(s) 3 _/
r r I
Floating Platforms) r S(N Y 'Y
Finger pler(s)
Total Platform area el: s(tw•7 »ri a cj
rsrelRJength/Q '•P �aQ r S /2 r S
Bulkhead/Rlprap length "y mac`' A Fir V
�•
Avg distance offshore
Breakwater/Sill
Max distance/ length
Basin, channel CP7LCs' ��SS
Cubic yards
Boat ram
V V
P �
Boathou5 Boalli , �f X� -I- • ,_
) b p
ttwcl,.li„Rd.a,ng / S Sr'�. J � nw}�rNt v. v- � .✓" � 11(( �] 7
Other -'f lsr�vt'1 /.�N a6 U PLAY %
7 V� 1
pT3observed: yes no
Mo
Moratorium; n/a ye
Site Photos; yes n��
Riparian WalverAttathed: yes CD3.1
A building permit/zoning permit may be required by:
Permit Conditions TAR/PAM/NEUSE/BUFFER (circle one)
❑ See note on back regarding River Basin rules
See additional notes/conditions on back
AM AWARE
(Please
5,
Sig ature "PI ase rea compliance statement on ack of permit" Si tore
�{� c, /a �S lam7 -q&q Y
Application Feels) Check #/Money Order Issuing Date Expiration Date

ElDREDGE & FILL
N? 89092
�J B C D
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Previous
§"CARAA
GENERAL PERMIT
permit
Date previous permit issued
[New
§ZModification ❑ Complete Reissue
❑ Partial Reissue
As authorized by the Stat of North Carolina, Department of Environmental Quality and
the Coastal Resources Commission
in an area of environmental concern pursuant to:
15A NCAC
❑ Rules attached.
❑ General Permit Rules available at the following link: wwwc1eq.nc.gov/CAMArules
Applicant Name
L-L
Authorized Agent
/ ) c, fit+ ✓% rd n iv1 c y( Ct
CC
Address d� D/
IC
ckrT 5'1 aQk r ®U GG�1 Project Location (County):
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Ciry at-
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VA zIP�/_3 n7Z
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Street Address/State #(s)S%I
nn
Phone # ( 14
t/state
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,Road/Lot
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,i .$ � � .Z.53, Pa.rcF.J /¢
/
Email
Subdivisio
L
cityaf�EraJ
zlP Z 79Y�'
Affected ❑ cW6W
MPTA ❑ ES ❑ PTS
Adj. Wtr. Body a 0,4
a/ // ` 1 (nat/ n/ k)
AEC(s): ❑IDEA
❑IHA ❑UW SPIMA ❑ PWS
Closest Maj. Wtr. Body
/
7-ti ter"` a so ti'ccL
ORW: yes
PNA: yes/C.?
of Project/ ACtiVIt
Shoreline Length i/ 1 0y r /5
Access Length �� X- & � N
r
Pier (dock) length /v JC: P
Fixed Platform(s) '
3 37 '' 3
Floating Platform(s)
lo'.�gr
Finger pier(s)
Total Platform area-i7 0 6re{gaeagth,(
Bulkhead/ Riprap length
Avg distance offshore
Breakwater/Sill
Max distance/ length
Basin, channel `
Cubic yards
Boat ramp
Boathous Boatlift / ,
�g / 6, -A�'
Other
A
4" _r Wi
2' r QCces
Cc,Y_/,' ekcce
�d-
'3 < 3 ,P
V54e4 O7 sr
„rs
SAV observed: yes no (a
l3�ti PL /
Moratorium: n/a yes no �, �s/'L1
Site Photos: yes �n� /3 p
Riparian Waiver Attached: yes
�C�J I
A building permit/zoning permit may be required by:
Permit Conditions
OF
Agent or Applicant PRINTED Name
AND
A0 "J
b
.7-- (Scale: IV
y� 3 ?FJ. /)u�
0X•
k-
❑ TAR/PAM/NEUSE/BUFFER (circle one)
❑ See note on back regarding River Basin rules
❑ See additional notes/conditions on back
(Please
yj ro a Cr✓e-r- /u 71 5/,2Y
Pe it Officer's PRINTED Name
Sig ature *'Please read compliance statement on back of permit"" Si�t'ature
7 qC> C1 /a 2-5 %� yl2H %a ,y `Z-%
Application Fee(s) Check #/Money Order Issuing Date Expiration Date

A-7
N"tO°"" ❑CAMA El DREDGE & FILL
GENERAL PERMIT
N9 89092
Previous permit
Date previous permit issued
AJB CjD,
New
❑ 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:
I SA NCAC
❑ Rules attached.
❑ General Permit Rules available at the following link: www deq.nc goy/CAMArules
Applicant Name
-
r I -1
Authorized Agent _rr,f Ace,. ,' C,ui, i�dn n.a �., (��-u,
Address
U c
Project Location (County):
City
State
ZIP
Street Address/State Road/Lot#(s) -/�
Phone#
" ✓'� lY cl.� 5 /l i '_ 5_- Gj- r / A
Email <
Subdivision ----
City r/t'�'(e f'n5 ZIP
Affected ❑ CW
❑ EW ❑ PTA
❑ ES ❑ PTS
Adj. Wtr. Body Q Ck .1 C, � /�'<t.3 r ^ (nat(niaiVupk)
AEC(s): ❑OEA
❑IHA ❑UW
❑SPIMA ❑PWS
Closest Maj. Wen Body r4a i,, lr-. -S o`."c/
ORW: yes/no PNA: yes/no
Type of Project/ Activity
(Scale: it1_S )
�Flylennr
1�
1
�
-�-
'�—
Access Length
j
- --
I
L
'
-
-
��
IL
Pier (dock) length T
j
'L
❑
,/,j
y
,II
Fixed Platform(s)
Floating Platform(s)
IL
_-
Finger pier(s)
.t
_
---
Total Platform area
Groin length/#
Bulkhead/ Riprap length
--
Avg distance offshore-
Breakwater/Sill
—
Max distance/ length
—
-
Basin, channel
Cubicyards
Boat ramp
Boathouse/Boatlift
Beach Bulldozing
Other
� r
i �
f--
SAV observed: yes no
Moratorium: n/a yes no
Site Photos: yes no
�.
/1
/i
-
i_
_
-
RioarianWaiver Attached: ves no
A building permit/zoning permit may be required
Permit Conditions
❑ TAR/PAM/NEUSE/BUFFER (circle one)
❑ 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)?.
Agent or Applicant PRINTED Name Permit Officer's PRINTED Name
Signature ""Please read compliance statement on back of permit" Signature
Application Feels) Check#/Money Order Issuing Date
Expiration Date

AUTHORIZATION TO ACT AS REPRESENTATIVE FORM
Property Legal Description:
DEED BOOK: 2622 PAGE NO: 0573
PIN NO.: 959513130707
PROPERTY STREET ADRESS: 57161 Pricilla Curve Road Hatteras NC 22943
Please Print:
Property Owner: The Pony Pen 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):
2501 Haves Road Hayes, VA 23072
Property Owners Telephone Number: 757-254-4901
We hereby certify that the above information submitted in this application is true and
accurate to the best of our knowledge.
_ cr
Aud Signature ap Title Authorized Signature and Title
Date: �,/2 Date:
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N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONlWAIVER FORM
CERTIFIED MAIL RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent)
Name of Property owner: The Pony Pen, LLC -Christopher & Sarah Bucci
Address of Property: 57161 Pricilla Curve Road, Hatteras, NC 27943
Mailing Address of owner: 2501 Hayes Road, Hayes, VA 23072
owner's email: cbbeacon921 @gmail.com owner's Phone#: [phone]
Agent's Name: Doug Dorman Agent Phone#: [phone]
Agent's Email: dougdaec@gmaihcom
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
L9ottom 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 mu $t be orovided with this letter
Q 12S I DO NOT have objections to this proposal. I DO have objections to this proposal.
If you have obecnons to wart, es uenry-
Management (DCM) in writing within 10 days of receipt of this notice. Correspondence should be
malled 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 Certiffed 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 appiv to bulkheads or riprao 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-
1 DO NOT wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner: c--
TypedlPrinted name of ARPO: Rob Qt & P a f cjaBeran
Mailing Address of ARPO: 114 Deer Road, Boyers, PA 1620
bob@be ra nenvi ronmen tal-com
ARPO's email: ARPO's Phone#:
Date: 03/19/24 "waiver is valid for up to one year from ARPO's Signature`
Revised August 2022

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:
The Pony Pen, LLC-Chris Bucci
Address of Property: 57161 Pdcilla Curve Road, Hatteras, NC 27943
Mailing Address of Owner: P,O Box 68, Bena, VA 23018
Owner's email:
[e-mail] owner's Phone#: [phone]
Agent's Name: Doug Dorman Agent Phonefl: 252-599-2603
Agent's Emall: dougdaec@gmai(.com
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the, Adiacenl Property Owner)
I hereby certify that I own property adjacent to the above referenced property. The individual applying for this
Dermit has described to me, as shown on the attached drawing, the development they are proposing. 6
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 nOtt me n.v. urv�sw' u,
Management (DCM) In writing within 10 days of receipt of this notice. Correspondence should be
malted 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 1 from my area of riparian access unless waived by me
(this does not aooly to bulkheads or riprao revetments)• {If you wish to waive the setback, you mustsi n
the appropriate blank below.) _
�'"�!''iy,
1 p0 wish to waive some/all of the 15' setback �g-naturo of Ripayan Property finer
-OR-
1 DO NOT wish to waive the 15' setback requirement (Initial the blank)
Signature of Adjacent Riparian Property Owner:
Typed/Printed name of ARPO: Bailey Park, LLC - Dave Dixon
Mailing Address of ARPO: P.O. Box 250. Avon, NC 27915
ARPO's email: [e-mail] ARPO's Phone#: [phone]
Date: 03/18/24
ftellit4_,
`waiver Is valid for up to one year from ARPO's Signature'
Revised August 2022

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N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONlWAIVER FORM
CERTIFIED MAIL RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent)
Name of Property Owner: The Pony Pen, LLC -Christopher & Sarah Bucci
Address of Property: 57161 Pricilla Curve Road, Hatteras, NC 27943
Mailing Address of Owner: 2501 Hayes Road, Hayes, VA 23072
Owner's email: [e-mail] 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 Property Owner)
I hereby certify that 1 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 drawinciwith dimensions must be provided with this letter.
Q � 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 noury me ni.f— urvision or uuasrar
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 onel
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: Q� ---- -
TypedlPrinted name of ARPO: Rob et & P a t claBeran
Mailing Address of ARPO: 114 Deer Road, Boyers, PA 1620
[e-mail]
ARPO's email: _ ARPO's Phone#:
Date: 06/30/24 *waiver is valid for up to one year from ARPO's Signature*
Revised August 2022

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:
Address of Property:
The Pony Pen, LLC-Chris Bucci
57161 Pricilla Curve Road, Hatteras, NC 27943
Mailing Address of owner: P.O Box 68, Bena, VA 23018
Owner'semail:[e-mail] owners Phoneil:757-254-4901
Agent's Name: Doug Dorman Agent Phone#: [phone]
Agent's Email: [e-mail]
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adiacent 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
I DO NOT have objections to this proposal.._.__ I DO have objections to this proposal.
tf 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 aooly to bulkheads or riorgo revetments) (if you wish to waive the setback, you must sign
the appropriate blank below.) '
1 DO wish to waive some/all of the 15' setback
Signature of Adjacent Ripadan Property k21vner
-OR-
I DO NOT wish to waive the 15' setback requirement (initial the blank)
Signature of Adlacent Riparian Property Owner:
TypedfPrinted name of ARPO: Bailey Park, LLC - Dave Dixon
Mailing Address of ARPO: P•0• Box 250, Avon, NC 27915
ARPO's email: [e-mail] ARPO's Phone#: [phone]
Date: 07i1t24 *waiver is valid for up to one year from ARPO's Signature*
Revised August 2022

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