89263A - Kozachuk, Alexander and Regina

NCAMA ❑ DREDGE & FILL No 89263 UA B C D rt )/
GENERAL IPE rm Previous peit V
RMIT
Date previous permit issued
®New ❑Modification ❑ Complete Reissue
❑Partial Reissue
As authorized by the State of North Carofina, Department of Errvironmental Quality and the Coastal Peaaaces Commission In an area of emironmsntai Concern Purstram m:
ISANCAC_.%9'12.Q0 ❑ Rules attached,
MGeneral Pem* Rules available at the followi fink: m /Gaats� -
pH s... mien "' g'n I
r/ 11__
Appikam Name_._ e)kQrKkF.Y- tC Rgfi''TsA KD'jyp6'rliw
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Authorized Agrrn_
Address��_,,��Q,
ryry
Ctty sy�Ll. _ SEate KIC Z1P _a
Project Location(County); Bt2r"'f('C
Street Ackke /St:ae Road/Lot #(a) (0
Phone#e!Ll) sag-,3%0
�ao Kif+astri.-ew
Email ��02_!hCk/w.i� CTyy� �'Om
Subdivision Occhnp
City Men-,Lt- �Ii(1
Affected ❑CW ®EW ©PTA []ES ❑PTS
Adj. Win Body, l knWan i�j .i .-(�a 'man/unk)
AEC(s): ❑OEA ❑IHA ❑UW ❑SPIMA PWS
❑
pp
Ckuxsst Mall Wtr. Body TT1"riQ. S5-1'tSJ
ORW: y-/a PNA: yes/4D
Type Of Project/ Activity
Shoreline Length k-- (2a r
Access Length f I
Pier (dock) length
rl-
F1xe4J Pletform(s)
Floating Platform(s)
Finger pleds)
Total Platform area `4r7$Ss�l-
Groin lenflu,14
Bulkhead/Riprap length_ ^
Avg distance offshore
Breakvvarar/Sill
Max distance/length
Rosin, channely "^
CUbicvards-_
Boot ramp
Boathouse 41 i6lnil
Beach Bulldozing I
Other
SAV observed: yes
Moratorium: fiz) yes no
Site Photos: yes 41
Riparian Waiver Attached; yes
A building pennIt/mning permit may be I
(Scale:
' I
I i i i
r
I
I I :
❑ TAR/PAWNEUSE/BUFFE-R(cirde, one)
❑ See note on back regarding River Basin rules
❑ See additional notes/conditions on back
I AM AWARE OFSTATUIMS CRC RULES AND CDNDITIONSTHAT APPLY TO THIS PROJECT AND REVIEWED COMPUAWESTATEMENT. (Please initial)
A.+piP�PrnE N e Permit sPRINTED Name
back
Application Feels) Check#/Money Order Issuing Date Expiration Date

�oACM1" NCAMA ❑ DREDGE & FILL
GENERAL PERMIT
© New ❑ Modification ❑ Complete Reissue ❑ Partial Reissue
NY 89263 B C D
Previous permit
Date previous permit issued
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 7/1 � 1200 ❑ Rules attached. M General Permit Rules available at the following link: ,de .nc. ov CAMArules
Applicant Name le—)LanC. e, � 4� —Irw 1,OZctehttk Authorized Agent
Address
A _� r.o. 11''��&,r, ( ( b , ` n Project Location (County):
City I r te'na.l 1Wa State N C zip Da'7 '( 57 Street AAdddress/St�atte Road/Lot #(s) lC1�T+1 aN
Phone#('Il`�)) 53 U—srwo 1v+v0 Kjt�gsy1nw `� -
Email KoZClCk\t,ksTcl c5mct kl.ioyy, Subdivision
� 0CC Ct&0
City f r crry wt zip 27157
Affected ❑ CW © EW M PTA ❑ ES ❑ PTS Adj. Wtr. Body l {nO t..i�7f p n F. iVP�r- (avman/unk)
AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS Closest Mal. Wen Body (Q �;J
ORW: yes, fig PNA: yes/0
Type of Project/ Activity_ Tirt:3110-11i Ct to, X 12, Wc1+11 ItF-
(Scale: 0IL 4c; )
Shoreline Length +/— 12,2(
Access Length
Pier (dock) length
Fixed Platform(s)
Floating Platform(s)
Finger pier(s) ^
Total Platform area WN's,,)-
Groin length/#
Bulkhead/ Riprap length
Avg distance offshore
Breakwater/Sill
Max distance/length
Basin, channel
Cubic yards '^
Boat ramp
Boathouse oatli (Ory)V
Beach Bulldozing r�
Other
SAv observed: yes a %00�1
Moratorium: AZ) yes no
Site Photos: yes `� KQ^twCP'°`
Riparian Waiver Attached: yes
A building permit/zoning permit may be required by: (x'-r �OKtiT"4
Permit Conditions
I AM AWARE OF STATUTES. CRC RULES AND
Agent or Applicant PRINTED Name
Permit OfflEgr's PRINTED Name
A
V'
❑ TAR/PAM/NEUSE/BUFFER (circle one)
❑ See note on back regarding River Basin rules
❑ See additional notes/conditions on back
(Please Initial)
Signature "Please read compliance statement on back of permit*' Signature r
4 L/00, uu ibi 4/1y/2,1 (/lc/LY
Application Fee(s) Check#/Money Order Issuing Date Expiration Date

CAMA ❑ DREDGE & FILL N9 89263 (ny B C D
Previous permit
3 GENERAL PERMIT Date previous permit issued
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. F°❑ General Permit Rules available at the following link: www.deq nc.9ov/CAMArules
Applicant Name _
Address
Ciry
Phone # ( )
Email
Authorized Agent
Project Location (County):
Street Address/State Road/Lot #(s)
Subdivision
City
Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS Adj. Wtr. Body (nat/man/unk)
AEC(s): ❑ IDEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS Closest Mal. Wtr. Body
ORW: yes/no PNA: yes/no
Type of Project/ Activity l 1,
(Scale:" +)
ONE
ME
MEMMEMMOM
SEENER
ENE
Finger
NM
pler(s)
:
:..::Ing
IN
Total Platform area
Groin length/#
Bulkhead/ Riprap length
Avg distance offshore
Breakwater/Sill■;;
Max distance/ length
Basin, channel
Cubic yards Boat ramp.■:.■�ii■■■■I
Boathouse/ Boatlift.......:
Bulldozing
:...■:'
...
■N■■:■■■■
......�
...::.....
■.
■■■
:
..■
.
;.:0M
loom
ilo
0
■■■■,■■B■■■■■■N■■■■■■■■■■■■
MEMO
■
■■..Beach
..:....■■.........■.
ME
0
Other
ME
SAV observed: yes no
Moratorium: n/a yes no
Site Photos: yes no
YlnariarAlVaifve�
i
■:::■
ii
■■■n■■■■■■■■■■■■■■
MOM
MIIIIM
on
A building permit/zoning permit may be required by:
❑ 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"
Application Feels) Check 11/Money Order
Signature
Issuing Date
Expiration Date

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top
Name of Property Owner.
Address of Property:
to be completed by owner or their agent)
RECEIVED
AUG 1 9 NA
t,)CM-EC
Mailing AddressofOwner: 1) \' U Ivy
Owner's email:! `J )cam �Ci\(�u V ; fu�-N(,�'&nCerrs Phone#:Agent's Nawh Ae l t% �� V�QS' FrJ� Agent Phone#:
Agent's Email: �W16'C Zo- • C =n�
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adjacent Property Owner)
I herebycertify that I own property adjacent to the above referenced property. The individual applying forthis
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. 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 Mall.
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 somelall of the 15' setback
-OR-
Signature of Adjacent Riparian Property Owner
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner. -ac t C�cP ~_s ue`► �-
TypediPrinted name of ARPO: -:N
Mailing Address of ARPO: ��EJ��O?C ®��� 0 �C Cc.-�-t N T�t VIP-,-
ARPO's email:SAM-DS% WyAQgr pRPO's Phone#:
Date: $ 3 QK'- 'waiver Is valid for up to one year from ARPO's Signature'
Revised July 2021

N.G. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERY
AUG 1 9 2024
(Topo(rtion to be completed by owner or their agent)
Name of Property Ow,er. t� ' "M
w��
Address of Property: N U Ir L�
Mailing Address
soof�Owner..{Qn QdX �yt �Q �fL1 A k1 cV l t S�
Owners email:► YJ CS��y` �"bwner s Phone#:
AgentC
's Na wi t) U,-) \`S` ) Agent Phone#: 1
Agent's Email:
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.
X 100 NOT have objections to this proposal. I DO have objections to this proposal.
if you have objections to what Is being proposed, you must notrry the N.G. urwsron or wasrar
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 /s considered the same as no objection if you have been
notified by Certified Mail.
WAIVER SECTION
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 PPbperty 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:
Mailing Address of ARPO:
ARPO's email:
Date:
ARPO's Phone#:
'waiver is valid for up to one year from ARPO's Signature'
Revised July 2021

Jean Kozachuk Dock Diagram
[T] Done
LEFT Side
(720sgft)
Dock 6'W x 120'L
Right Side
6'W x 50'L
(300sgft) walkway Platform 16'W x 16'L(256sgft)
2 Mooring Pilings Boat Lift
150ft
11
0
*
Stepdown 11'W x 11'L (121sgft)
Total Pier Length
* Pilings will be 10" Roun
*Joist 6"x 6"
Jean Kozachuk
*Girders 4"x10"
24 Kingsview Court
* Facer Boards 5"x 10"
Merry Hill, NC 27957
* Decking Concrete
* All Bolts ;ra- Timber Bol
0
RECEIVE®
AUG 19 2024
DI. M-EC

n�
LEFT Side Dock 6' W x 120'L
(720sgft) Right Side
6'W x 50'L
(300sgft) walkway Platform I6'W x 16'L(256sgft)
2 Mooring Pilings Boat Lift
Stepdown IVW x II'L(121 sgft)
Total Pier Length
150ft
*Pilings will be 10" Round
*Joist 6"x 6"
Jean Kozachuk
*Girders 4"x 10"
24 Kingsview Court
* Facer Boards 5"x 10"
Merry Hill, NC 27957
* Decking Concrete
* All Bolts z^ Timber Rnlfa

9
0

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