92834C - Upchurch

*1Q*`1AUSTV ❑CAMA ❑ DREDGE & FILL No 92834 A B
GENERAL PERMIT Previous permit 66
Date previous permit issued_,_.__._._
❑New ❑Modification ❑Complete Reissue ❑Partial Reissue
As authorized by the State of North CCarphria,Department of Environmental Quality and the Coastal Resources Commission in an area of environmental concern pursuant to:
15A NCAC I ' j'1VV ❑Rules attached. IV General Permit Rules available at the following link:www.dgq.nc.gov/CAMArules
Applicant Name t Authorized Agent
Address ^' �_' 't Project Location(County):
City te_ ZIP Street A dre S e Road/Lot#(s)
Phone#
Email Subdivision
City I`Y e ZIP
qP
Affected ❑eW EW PTA ❑ES ❑PTS Adj.Wtr.Body i �--- na an/unk)
AEC(s): ❑OEA HA ❑UW ❑SPIMA ❑PWS Closest Maj.Wtr.Body
ORW:yes/no PNA:yes/,no
Type of Project/Activity + /
(Scale:
Shoreline Length
Access Length
Pier(dock)length ;
Fixed Platform(s) - hh
Floating Platform(s)
Finger pier(s)
_1
Total Platform area
Groin length/# 4 $
Bulkhead/Riprap length """�'� �• �( i itr
Avg distance offshore""" i T
Breakwater/Sill
Max distance/length `" '"' N 7,'
Basin,channel ' /Vt-
Cubic yards + 't
Boat ramp
Boathouse/Boatlift
Beach Bulldozing
Other
SAV observed: yes no
Moratorium: n/a yes no t r
Site Photos: yes no
Riparian Waiver Attached: yes no
A building permit/zoning permit may be required by:
TAR/PAM/NEUSE/BUFFER circle one
Permit Co itions 1 `�/t ( )
1 ! 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)
{ �
T' V �T \, y -•
Agent or Applicant PRINTED Name Permit Officer's.PRINTED Name
{
Si nature"Please Lead compliance statement on back of permit" Signature -,...
Application Feels) Check#/Money Order Issuing Date Expiration bate

Statement of Compliance and Consistency
This permit is subject to compliance with this application and permit 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: 1) 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 from the adjacent riparian property owner(s)
has been obtained, or proof of delivery of certified mail notification of the adjacent riparian property owner(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:
1-1 Tar- Pamlico River Basin Buffer Rules 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. If you have any questions, please contact the Division of Water Resources at the
Washington Regional Office (252-946-6481) or the Wilmington Regional Office (910-796-7215).
Notes/Additional Permit Conditions:
Please ensure all debris associated with the removal or construction of the permitted development is contained within the authorized
project area and disposed of in an appropriate upland location.
Division of Coastal Management Offices
Morehead City Headquarters Washington District
400 Commerce Ave Morehead City, NC 28557 943 Washington Square Mall Washington, NC 27889
252-808-2808/1-888-4RCOAST Fax: [phone] 252-946-6481
(Serves:Carteret,Craven—south of the Neuse River,Onslow Fax: [phone]
Counties) (Serves: Beaufort,Craven—north of the Neuse River, Hyde, Pamlico,
Tyrrell and Washington Counties)
Elizabeth City District Wilmington District
401 S.Griffin St.Ste.300 127 Cardinal Drive Ext.Wilmington, NC 28405-3845
Elizabeth City, NC 27909 910-796-7215
252-264-3901 Fax:[phone]
(Serves: Bertie,Camden,Chowan,Currituck, Dare,Gates, Hertford, (Serves: Brunswick, New Hanover and Pender Counties)
Pasquotank and Perquimans Counties)
http://portal.ncdenr.org/web/cm/dcm-home Revised 6/01/2021

�❑CAMA ❑ DREDGE & FILL N0 92834 A B
Date previous permit issued_.
GENERAL PERMIT Previous permit - ~'
.._._
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:
15A NCAC Tj �")lJ�/' ❑Rules attached. General Permit Rules available at the following link:www.dgg.nc.gov/CAMAruies
Applicant Name Authorized Agent 7 ���1
Address Project Location(County):
City State ZIP Street Address/State Road/Lot#(s)
Phone#
i
Email Subdivision
City ZIP r.
Affected ❑cW AEW PTA ❑ES ❑PTS Adj.Wtr.Body (nat/man/unk)
AEC(s): ❑OEAHA UW ❑SPIMA ❑PWS Closest Maj.Wtr.Body
ORW:yes/no PNA:yes/no
Type of Project/Activity
(Scale:
Shoreline Length
Access Length _
Pier(dock)length
Fixed Platform(s)—���^" ._._
j
Floating Platform(sy' ( s
Finger pier(s) s.._......... I _..
Total Platform area T
Groin length/# i
Bulkhead/Riprap length
Avg distance offshore-^^'"" Pq
Breakwater/Sill
t
Max distance/length I _.
Basin,channel'
i
Cubic yards
Boat ramp
Boathouse/Boatlift
Beach Bulldozing
t._.._. _
Other 1 -
SAVobserved: yes no �-� _ '"' ""-f`" """
_
Moratorium: n/a yes no
Site Photos: yes no ..;__. __.._... .... ._. ._.........._ __.._.l _ _ ...._ ...._ _.. �_.......
..........._
Riparian Waiver Attached: yes no
A building permit/zong permit may be required by:
it f
TAR/PAM/NEUSE/BUFFER(circle one)
Permit Co ditions ! `
;: r See note on back regarding River Basin rules
,,, , I��,,�� `J ` ❑ See additional notes/conditions on back
;l i-
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 Expiiation bate

Statement of Compliance and Consistency
This permit is subject to compliance with this application and permit 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: 1) 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 from the adjacent riparian property owner(s)
has been obtained, or proof of delivery of certified mail notification of the adjacent riparian property owner(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:
F-1 Tar- Pamlico River Basin Buffer Rules F-1 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. If you have any questions, please contact the Division of Water Resources at the
Washington Regional Office (252-946-6481) or the Wilmington Regional Office (910-796-7215).
Notes/Additional Permit Conditions:
Please ensure all debris associated with the removal or construction of the permitted development is contained within the authorized
project area and disposed of in an appropriate upland location.
Division of Coastal Management Offices
Morehead City Headquarters Washington District
400 Commerce Ave Morehead City, NC 28557 943 Washington Square Mall Washington, NC 27889
252-808-2808/1-888-4RCOAST Fax: [phone] 252-946-6481
(Serves:Carteret,Craven—south of the Neuse River,Onslow Fax: [phone]
Counties) (Serves: Beaufort,Craven—north of the Neuse River, Hyde, Pamlico,
Tyrrell and Washington Counties)
Elizabeth City District Wilmington District
401 S.Griffin St.Ste.300 127 Cardinal Drive Ext.Wilmington, NC 28405-3845
Elizabeth City, NC 27909 910-796-7215
252-264-3901 Fax:[phone]
(Serves: Bertie,Camden,Chowan,Currituck, Dare,Gates, Hertford, (Serves: Brunswick, New Hanover and Pender Counties)
Pasquotank and Perquimans Counties)
http://portal.ncdenr.org/web/cm/dcm-home Revised 6/01/2021

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be j/"Vcoompleted by owner or their agent)
Name of Property Owner: Pfl6ect
Address of Property: ( (mil L o✓411AL ✓Q. &��zC4D u/ IV'6 7
Mailing Address
//of/IOwner:
Owner's email: l,e,(,WxiM Owner's Phone#: 7ol S�
Agent's Name: /A/ r17r J A4 S ) Agent Phone#:;-5,- e��/1- 7 J�
Agent's Email: /. oyi , %n'" // z-,p-ro
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
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 400 Commerce Ave.,Morehead City,NC 28557.DCM representatives can also be contacted
at(252) 808-2808. 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'setb c
-OR-
Signature of A cent Riparian Property Owner
I do not wish to waive the 15'setback requirement(initial the blank)
Signature of Adjacent Riparian Property Owner:
Typed/Printed name of ARPO: 0AJ -
Mailing Address of ARPO: " 7wigTk //f/RG�P.dy bay ffC A53—V
ARPO's email: ARPO's Phone#:,7&
Date: *waiver is valid for up to one year from ARPO's Signature*
RECEIVED Revised July 2021
AUG 0 5 2024
DCM-MHD CITY

TIPS FOR ADJACENT RIPARIAN OWNER NOTIFICATION &WAIVER FORMS
CAMA Regulations require notice of proposed development to the Adjacent Riparian Property Owners(15A
NCAC 7J.0204(b)(5)). Proof of actual notice (a sign-off by the owner on this form) or certified mail return
receipts (showing delivery of notice) are needed.
The purpose of this notice is to make adjacent riparian property owners aware of the proposed development
so that they have an opportunity to provide comments (or potentially object to)the proposed development,
and to give DCM an opportunity to consider these comments/objections before a permit decision is made.
"Permission" of adjacent property owners is not necessarily required for DCM to issue a permit; however,
permission must be obtained for certain types of proposed developments if they fall within a 15'setback area
along the riparian access area of the adjacent property,as determined solely by DCM. It is in the applicant's
best interest to provide comprehensive and accurate notice so that any concerns or objections can be
resolved early in the permit review process. In addition, if the adjacent riparian property owner appeals the
permit decision, insufficient notice could be a basis for granting such an appeal.
Who is an Adjacent Riparian Property Owner?
What is Adjacent? (Note: DCM reads this broadly to ensure comment by potentially impacted neighbors)
• A property that shares a boundary line with the site of proposed development;AND
• A property that fronts a natural or manmade waterbody that is connected to coastal waters and
can support some form of navigation, even a kayak or canoe, including a common canal system
or a manmade basin.
• Easement holders?Yes, if the easement could be impacted by the proposed development.
• Streets/Roads? Only if the street/road could be impacted by the proposed development. This
might include street-ends which might be used for parking and beach access.
• Holders of recognized submerged lands claims/shellfish franchises.
What is Riparian?
Do the boundaries of the adjacent property legally intersect with the water at mean high tide? If there is a
question about whether an adjacent property is considered "riparian," please reach out to DCM Staff -
especially on the oceanfront beach where there may be undeveloped parcels on the beach or in the water.
Who/What is a Property Owner?
For private individuals(or families),send notice to the address listed on the tax card. If the property is owned
by an Inc. or LLC, please send notice to the person listed as the registered agent on the NC Secretary of
State's Corporations Look Up site: https://www.sosnc.gov/search/index/corp. For Condominiums or
neighborhoods with an owners' association (HOA/POA), send notice to the association (which is usually a
corporation,for which you send notice to its registered agent).
What is Notice, and how do I ensure it is received?
• You can meet with your adjacent property owner, provide a description or drawing of the
proposed development, and ask them to sign this form and return it to DCM; OR
• You can hand-deliver this form and a description or drawing, and ask your neighbor to return it to
DCM (consider providing them with a stamped envelope); OR
• You can mail this form by USPS Certified Mail, return receipt requested (the Green Card). If you
choose this option, you must provide either the signed & returned green card OR track the
certified mail package number on USPS.GOV's online tracking system, and provide the tracking
print-out as proof of delivery to DCM
If you have any questions about this process, please reach out to DCM Staff and DCM Legal Counsel
and we will work to answer your questions.
Revised July 2021

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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: �Ij?berf /�' L1146ijl,(,Ra1
Address of Property: a I ` aCo✓Ai�� 1�✓e //I�%�,�e�D G, �C
/-�1• 5��
Mailing Address of Owner:
Owner's email:4
17G�U/K1'Ut Owner's Phone#: K)- 21Z'✓� r,, Sr
Agent's Name: �1 r/'Mif--f Agent Phone#:
Agent's Email: SU I^Fhj,^ I�L GCS 19Wd -On
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
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 400 Commerce Ave.,Morehead City,NC 28557.DCM representatives can also be contacted
at(252) 808-2808. 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 Mdjakent Riparian Property Owner
-OR-
I do not wish to waive the 15'setback requirement(initial the blank)
Signature of Adjacent Riparian Property Owner:,{
Typed/Printed name of ARPO: JG, J
Mailing Address ofARPO: 2� l G�✓'4'.9!v Ale, „ry�&Y-64'e'e AlC s7
ARPO's email: ARPO's Phone#: ��
Date: "waiver is valid for up to one year from ARPO's Signature`
RECEIVED Revised July 2021
AUG 0 5 2024
DCM-MHD CITY

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