20170792 Ver 1_Shellfish Lease Application_20170623

North Carolina Shellfish Lease Application
Page 1 of 16
1. Primary Applicant Information: *(Fill this out if applying as an individual)
Applicant: First Name
MI
Last Name
Race:Gender: ale ❑ Female
Height: Weight: Eye Color: Hair Color:
Have you been a legal resident of the state of North Carolina for at least 6 months? ❑ No es
Check One:
Driver's License No. Sta I.D. No. ❑ Military I.D. No. ❑ Reside t Alien .D. No. ❑ Passport No. ❑
Number: / t✓ Expiration Date: Z d/
Are you related by blood or marriage to any person now working for the North Carolina Division of Marine Fisheries? o
❑ Yes: Name and Relationship
Do you hold a Standard Commercial Fishing License?No❑ Yes: SCFL #
Do you currently own a vessel with current registration? 2"No ❑ Yes: Vessel ID#
Do you have four or more convictions of DMF fisheries violations in the past three years? 2rNo ❑ *Yes
*(If Yes you may not be eligible to obtain needed permits to work o lease other than cultch on bottom)
Do you currently have or hold an interest in any other shellfish leases? No ❑ Yes
List lease numbers you hold or have an interest in:
G.S. 113-202 (c): No person, including a corporate entity may acquire and hold by lease, lease renewal, or purchase more than 50
acres of public bottoms under shellfish cultivation leases. For purposes of this subsection, the number of acres of leases held by a
person includes acres held by a corporation in which the person holds an interest.
Applicant Mailing Address
PO Box
City
State
�j
�c'�l �QE.( J�
©�
//. .
Applicant Physical Address
City
State
�/Rf?If
Zip code
Daytime Phone No
Alt. Phone No
Email aclress /
Co -Applicant: First Name
MI
Last Name
Have you been a legal resident of the state of North Carolina for at least 6 months? ❑ No es
Check One:
Driver's License No. 2 State I.D. No. ❑ Military I.D. No. ❑ Res' en Alien I.D. No. ❑ Passport No. El
19 Number: Expiration Date: 7
Are you related by blood or marriage to any person now working for the North Caroli a Division of Marine Fisheries? 2`No
❑ Yes: Name and Relationship
Do you hold a Standard Commercial Fishing License? RTNo ❑ Yes/�* SCFL #
Do you currently own a vessel with current registration? ❑ No 1t7Yes: Vessel ID#
Do you have four or more convictions of DMF fisheries violations in the past three years? 21No ❑ *Yes
*(If Yes you may not be eligible to obtain needed permits to work a lease other than cultch on bottom)
Do you currently have or hold an interest in any other shellfish leases? ZrNo ❑ Yes
List lease numbers you hold or have an interest in:
Version: DMF Lease App 2/2017

Page 2 of 16
Co- Applicant Mailing Address
PO Box
City
State
Zip code
Daytime Phone No
Alt. Phone No
Email address
2. Business Entity Information (Article 16 of Ch. 113): *Fill this out if applying as a Business Entity
Business Name
Type of Business Entity:
❑Corporation (Please attach copy of current articles of incorporation and list of corporate officers)
❑Partnership (Please attach a current copy of your partnership agreement)
❑Sole Proprietorship
❑LLC
* Please attach copies of the Articles of Incorporation, current assumed name statements, and copies of current business privilege
tax certificates with Employer Identification Number (EIN) listed.
Business Mailing Address
PO Box
City
State
Zip code
Daytime Phone No
Alt. Phone No
Email address
Business Agent/Responsible Party Name:
Business Agent Mailing Address
PO Box
City
State
Zip code
Daytime Phone No
Alt. Phone No
Email address
Are you related by blood or marriage to any person now working for the North Carolina Division of Marine Fisheries? ❑ No
❑ Yes: Name and Relationship
Do you currently have or hold an interest in any other shellfish leases? ❑ No ❑ Yes
List lease numbers you hold or have an interest in:
G.S. 113-202 (c): No person, including a corporate entity may acquire and hold by lease, lease renewal, or purchase more than 50
acres of public bottoms under shellfish cultivation leases. For purposes of this subsection, the number of acres of leases held by a
person includes acres held by a corporation in which the person holds an interest.
3. Applicant Qualifications (Optional) - describe your capability to conduct the proposed. aquaculture activities
(including training, experience and education that you have obtained or will obtain)
-�E Z aP,uJ ar� a>✓ �'�a-✓..T3'�1�� �3� `+may
,/Q�`�
Version: DMF Lease App 2/2017

Page 3 of 19
4. Proposed Lease Site Information
Check one that you are applying for: *The designated, nonrefundable application fee must accompany each application.
❑ Bottom Lease ($200.00): A bottom lease primarily uses cultch, or low profile structures to cultivate shellfish. Cages
and gear are limited to a maximum height of 18" above the bottom. Rent: $30/acre per year.
❑ Water Column Amendment ($100.00): A water column lease amends all or part of an existing bottom lease footprint.
Floating bags, cages greater than 18" above the bottom or any other use of the water column will require this type of
lease. Rent: $100/acre per year.
® BOTH Bottom Lease with Water Column Amendment ($300.00): This lease is a joint application for both the bottom
lease and water column amendment. Rent: $110/acre per year.
Lease County:
Closest Town:
Waterbody:
6A2TCV..6r
1 GEOAG'"*#"0
6-e0AS-Ss-cA-10 (b*Y
Estimated total acreage: 1 •Gy Note: Acreage allowed must be consistent with the Lease Management Plan, prior lease
production history, public trust use of the area, etc.
Single lease acreage is currently
limited to 10 acres.
Does the lease site contain known sea grasses or Submerged Aquatic Vegetation (SAV)? t4 No ❑ Yes
Leases are restricted on sites with areas of SAV.
Approximate closest distance to existing shellfish bed or oyster rock? Ail* ft.
Leases must not be located on or within 10 ft. of existing natural shellfish beds or oyster rocks or seagrass beds.
Approximate distance to marked navigational channel 1 K)L4 yrs
Approximate distance to any unmarked navigational channel ft.
Leases cannot block navigation.
Does the applicant or co -applicant own all of the shoreline adjacent to the proposed lease?* ® No ❑ Yes
If the applicant or any co -applicant is not the sole riparian owner of any developed shoreline within 100 ft. of the proposes lease, the
riparian consent form in Section 6 of this application must be filled out and notarized to proceed with application processing.
Riparian property owners will be notified of your proposed lease site.
Approximate minimum distance of proposed lease from shoreline ISO ft.
Approximate minimum distance of proposed lease from vegetated marsh 20 ft.
Please list the coordinates for the proposed lease. The minimum number of coordinates required is three and the maximum is
eight: A survey is not required by law but is suggested as a best management practice. Any costs of a survey are the responsibility
of the lease holder. The lease site must be as compact as possible.
Corner Coordinates:
1.35 00.452,1'1 N, 7G 10-14S7L°( W 5. 3S o0.39 Z14- N, 18.53643 W
2. aS 00. gCvAS"f N,14 IS. HS(.55 W 6. N, W
3. 1.5 CC, .38Vt>8 N, 74 I19.If-1861 W 7. N, W
4.S oo. Sc (. N, 74 Igj.Sl840 W 8. N, W
Version: DMF Lease App 5/2017

Page 4 of 16
4. Proposed Lease Site Information
Check one that you are applying for: *The designated, nonrefundable application fee must accompany each application.
0 Bottom Lease ($200.00): A bottom lease primarily uses cultch, or low profile structures to cultivate shellfish. Cages
and gear are limited to a maximum height of 18" above the bottom. Rent: $10/acre per year.
Water Column Amendment ($100.00): A water column lease amends all or part of an existing bottom lease footprint.
Floating bags, cages greater than 18" above the bottom or any other use of the water column will require this type of
lease. Rent: $100/acre per year.
BOTH Bottom Lease with Water Column Amendment ($300.00): This lease is a joint application for both the bottom
lease and water column amendment. Rent: $110/acre per year.
Lease unty:
C est Town:
aY Ts/
Wat r od
:/3�-y
Estimated total acreage: Note: Acreage allowed must be consistent with the Lease Management Plan, prior lease
production history, public trust use of the area, etc.
Single lease acreage is currently
limited to 10 acres in areas where
oyster mechanical harvest is allowed.
All other areas limited to 5 acres.
Does the lease site contain known sea grasses or Submerged Aquatic Vegetation (SAV)? Plfqo ❑ Yes
Leases are restricted on sites with areas of SAV.
Approximate closest distance to existing shellfish bed or oyster rock? ft.
Leases must not be located on or within 10 ft. of existing natural shellfish beds or oyster rocks or seagrass beds.
Approximate distance to marked navigational channe ft.
r
Approximate distance to any unmarked navigational channe
Leases cannot block navigation.
Does the applicant or co -applicant own all of the shoreline adjacent to the proposed lease?* AKo ❑ Yes
If the applicant or any co -applicant is not the sole riparian owner of any developed shoreline within 100 ft. of the proposes lease, the
riparian consent form in Section 6 of this application must be filled out and notarized to proceed with application processing.
Riparian property owners will be notified of your proposed lease site.
Approximate minimum distance of proposed lease from shoreline / 'SN' ft.
Approximate minimum distance of proposed lease from vegetated marsh ft.
Please list the coordinates for the proposed lease. The minimum number of coordinates required is three and the maximum is
eight: A survey is not required by law but is suggested as a best management practice. Any costs of a survey are the responsibility
of the lease holder. The lease site must be as compact as possible.
Corner Coordinates:
, W
3:577,0679
1. :57 679 N, 5. N,
2.Jq o M I N, 14 6. N, W
JE ` �I(O N, 7//p 7. N, W
4. , 5 N, JW 8. N, W
Version: DMF Lease App 2/2017

Page 3 of 16
LEASE SITING INSTRUCTIONS AND INFORMATION
It is the responsibility of the applicant to site the lease. Shellfish Leases area special use of Public Trust submerged land and waters
that allow individuals to grow shellfish for commercial production only. To protect access to Public Trust resources the Division
Director is given broad authority to ensure that leases are granted in areas that will be compatible with the lawful utilization of
marine and estuarine resources. The UNC Wilmington Aquaculture Siting Tool is an excellent resource to assist you with Site
Selection. htto://uncw.edu/benthic/sitinatool/
Areas where leases cannot be sited:
➢ In areas unsuited to the species of shellfish or grow -out method you have selected.
➢ In areas closed by Shellfish Sanitation because of pollution.
➢ Within 10 feet a natural shellfish bed.
• By MFC rule, a natural shellfish bed is defined as 10 bushels of shellfish (oysters, clams, mussels) per acre.
• The US Army Corps of Engineers Nationwide Permit #48 sets strict limits for the placement of aquaculture sites
near naturally occurring oyster reefs, oyster aggregations and shell bottom
➢ On areas containing significant Submerged Aquatic Vegetation (SAV, i.e. sea grasses).
• The US Army Corps of Engineers Nationwide Permit #48 sets strict limits for the placement of aquaculture sites
where the presence of SAV is greater than very sparse coverage on a small percentage of the applied for site.
➢ Where the lease site extends more than one-third of the distance across any water body (creek, bay, river, etc.); except
where the aquaculture method only uses cultch-on-bottom, or clam -on -bottom methods.
➢ In areas incompatible with traditional uses such as, but not limited to; commercial or recreational fishing, swimming areas,
navigational channels (marked and unmarked), areas designated as shellfish management areas and enhancement sites
including cultch planted sites.
➢ In areas where leases are otherwise prohibited by law.
➢ Over recognized Submerged Land Claims. For a map listing any recognized claims in your county link here:
http://portal.ncdenr.org/web/mf/submerged-lands-maps
Shellfish Leases must:
➢ Be as compact as possible and be compatible with the Lease Management Plan (see size restrictions pg.4).
➢ Not impinge upon the rights of riparian property owners.
• Within 100 feet of a developed shoreline you will need written and notarized consent of the riparian property
owner.
• All riparian property owners near your proposed lease will be notified by the division of your application during the
public comment period.
➢ Not be sited within 20 feet of a vegetated marsh to allow public access to the marsh.
➢ Not exclude or attempt to exclude the public from allowable public trust use of navigable waters on shellfish leases and
franchises including, but not limited to, fishing, hunting, swimming, wading and navigation.
• Lease sites using bottom or floating cages must place them in parallel rows with at least 10 feet between each row
to allow for navigation by the public. Rows may be configured in any direction.
➢ Be continuously marked with proper legible signage on all corner markers. All corner markers shall be marked with either
reflective tape or reflectors.
➢ Not conduct development activities listed below without permitting by the Division of Coastal Management.
*NCITE: The Division of Marine Fisheries has no authority to permit the following structures on a lease. If you wish to use these
structures they will require a LAMA permit from the NC Division of Coastal Management. For more information, contact DCM at
[phone].
• Lease markers greater than 4 inches X 4 inches or > 4 inches in diameter
• Floating Upwelling Systems (FLUPSYs) not on lease site, tank downwellers, upwellers, raceways, etc.
• Docks, Piers, Bulkheads, or other development activities
• Permanently anchored barges or platforms
• Dredging or Fill activities or Utilities
Version: DMF Lease App 2/2017

Page 5 of 19
5. Lease Management Plan
Shellfish species to be grown: ® Oysters ❑ Clams ❑ Scallops ❑ Other
Capital Investment: Year 1: $ 7.4;',CX;)0 Year 2-5: $ SC),OOd
Vessel Available: Vessel: ❑ N U Y Length: l 9 Power: `fO tiP Trailered? ❑ N 15Y
If other vessels will be used, please list here:
• What types of harvest gears will you use? NA2u&ar 13Y RAS
• Will you require the use of mechanical harvest gear? (dredge, power rake, etc.) 54N ❑ Y
*Mechanical gears are not allowed on leases located in Primary Nursery Areas
Shellfish Grow -out Method: Please check the grow -out method(s) you propose to use on your lease and the estimated amount of
equipment and effort.
*Floating Upweller Systems (FLUPSYs), tank downwellers, upwellers, raceways, etc... are restricted to 18" maximum height unless
otherwise conditioned in the lease contract.
Bottom Methods Year 1 Years 2-5
❑ Cultch on -bottom only _442>0 bushels/acre 60D bushels/acre
❑ Spat-on-shell/clam seed N/A spat/seed/acre ,u 100c spat/seed/acre
❑ Relayed oysters (Polluted or seed oyster l,«:0 bushels i3OzO bushels
relay sources)
❑ Predator netting/bags # of units # of units
❑ Rack and bag system # of racks/bags IL % 'rano # of racks/bagsr�/ti«+O
❑ Cage system # of cages V000 # of cages govo
❑ Tray culture # of trays # of trays
❑ Solar Floating Upweller Specify Specify
How is it anchored to the lease: Dimensions: Material:
Water Column Methods Year 1 Years 2-5
❑ Floating bags (Taylor float'", # of floating bags IWO # of floating bags '(00
mesh bags, flip bags, etc.)
❑ Floating cages (Oyster Gro', etc.) # of floating cages _ # of floating cages
❑ Suspended system, long line # of units # of units
❑ Rack and bag system >18" # of racks/bagsr!n+Wr # of racks/bagsr�vaoo
❑ Bottom Cage system >18" # of cages # of cage s
❑ Type of Anchor used (screw anchors, rods, Type 6d.Q4fJ Type SCD-cl�
etc.) # of Anchors V # of Anchors G
❑ Solar Floating Upweller
How is it anchored to the lease: Dimensions: Material:
Shellfish seed source:
Do you plan to participate in the following permit relay DMF activities?
(Circle all that apply)
X Polluted Area Relay ® Yes ❑ No
*Onlyshellfish native to NC maybe
® Seed Oyster Mgt. Relay 9 Yes ❑ No
cultured. Shellfish seed obtained
In-state hatchery: Hatchery Name: KIL-061oT gpugc LR d, J"tF- "`ae
from outside of NC will require an
❑ No ❑ Yes Phone No: ?H SZ
Introduction of Species or Transfer
Out of state hatchery* Hatchery Name:
Permit from DMF prior to shipment.
Address:
This permit application must have a
❑ No ❑ Yes City:
pathology report attached and is
State: Zip Code:
good for 30 days after the report
Phone No:
date.
Version: DMF Lease App 5/2017

Page 6 of 16
S. Lease Management Plan
Shellfish species to be grown: Oysters ❑ Clams ❑ Scallops ❑ Other
Capital Investment: Year 1: $ J �9 oN r7 Year 2-5: $
Vessel Available: Vessel: O N LIT_ Length:19 _ Power:
Trailered? ❑ N
If other vessels will be used, please list here:
• What types of harvest gears will you use? pf-,✓'08�
• Will you require the use of mechanical harvest gear? (dredge, powe rake,
etc.) ❑ N ❑ Y
*Mechanical gears are not allowed on leases located in Primary Nursery Areas
Shellfish Grow -out Method: Please check the grow -out method(s) you propose to use on your lease and the estimated amount of
equipment and effort.
*Floating UpwellerSystems (FLUPSYs), tank downwellers, upwellers, raceways, etc.., are restricted to 18" maximum height unless
otherwise conditioned in the lease contract.
Bottom Methods Years 1 -
Years 2-5
❑ Cultch on -bottom only bushels/acre
5tOO bushels/acre
❑ Spat-on-shell/clam seed spat/seed/acre
__,dyjQ-epat/seed/acre
❑ Relayed oysters (Polluted or seed oysterbushels
[t�r� bushels
relay sources)
❑ Predator netting/bags # of units
# of units
❑ Rack and bag system # of racks/b�ags # of racks/bao!��O
❑ # of cages MW�/�p
# of cages _ 100 .
Cage system F�
❑ Tray culture # of trays
# of trays
❑ Solar Floating Upweller Specify
Specify
How is it anchored to the lease: Dimensions:
Material:
Water Column Methods Years I
❑ Floating bags (Taylor float', # of floating bags
Years 2-5
# of floating bags -J
mesh bags, flip bags, etc.)
❑ Floating cages (Oyster Gro'", etc.) # of floating cages
# of floating cages
❑ Suspended system, long line # of units
# of units
❑ Rack and bag system >18" # of racks/t} ao aill_j�kpj# of racks/bag0jV_5K-_D0
❑ Bottom Cage system >18" # of cages
# of cage s
❑ Type of Anchor used (screw anchors, rods, Type 5 C
Type !^&__n) -
etc) # ofAnchors
# of A chars
❑ Solar Floating Upweller
How is it anchored to the lease: Dimensio s:
Material:
Shellfish seed source:
Do you plan to participate in the following permit relay DMF activities?
(Circle all that apply)
Polluted Area Relay
.®'Yes ❑ No
*Only shellfish native to NC maybe
Seed Oyster Mgt. Relay
Lves ❑ No
In-state hatchery: Hatchery Name:i!4
cultured. Shellfish seed obtained
from outside of NC will require an
❑ No ®,Yes Phone No:
—
Introduction of Species or Transfer
Out of state hatchery* Hatchery Name:
Permit from DMF prior to shipment.
Address:
This permit application must have a
❑ No ❑ Yes City:
pathology report attached and is
State:
Zip Code:
good for 30 days after the report
Phone No:
date.
Version: DMF Lease App 2/2017
Em

Page 5 of 16
LEASE PRODUCTION REQUIREMENTS AND MANAGEMENT PLANNING INFORMATION
PRODUCTION
Shellfish Leases in NC must meet Production Standards by rule. Failure to meet production standards is the number one reason for
leases being terminated. Proper sizing of the lease and a sound management plan are key to meeting your production standards.
The following are the minimum Shellfish Lease Production Standards in MFC Rule:
Bottom Lease:
1. Harvest 10 bushels of shellfish per acre, per year; AND
2. Plant 25 bushels of seed; OR Plant 50 bushels of cultch; OR Combination of 2 and 3 where the total equals 100% of planting
requirement
Water Column Lease:
1. Harvest 40 bushels of shellfish per acre, per year; OR
2. Plant 100 bushels of seed or cultch or a combination that equals 100% of planting requirement
Note: The Shellfish Lease Program uses the following conversion numbers to determine bushels in planting and marketing. These
numbers apply to ail sizes; seed to market size:
o Clams and Scallops:
1 bu. = 400 count
o Oysters:
1 bu. = 300 count
o Cultch:
o
Scallop shell:
1 bu. = 40 pounds
o
Oyster Shell:
1 bu. = 60 pounds
o
Clam Shell:
1 bu. = 75 pounds
0
2 in. fossil stone (marl):
1 bu. = 90 pounds
LEASE MANAGEMENT PLAN
The Lease Management Plan details what type of aquaculture operation you plan. This is an important step when planning your
shellfish lease activities. Division staff will review your Lease Management Plan to help determine if your lease type and acreage is
compatible with the equipment, capital investment, and grow -out methods you intend to use.
When your shellfish lease is approved by the division director, the Lease Management Plan will become a part of the legal lease
contract by reference. Significant changes to grow -out methods, species, and navigational clearance will require submission of a
modified management plan and approval by the division.
AQUACULTURE TECHNICAL ASSISTANCE:
North Carolina Sea Grant can provide valuable assistance in helping you determine capital investment, lease size, grow -out
methods, seed sources, and many other important items that will help your aquaculture venture succeed.
https://ncseagrant.ncsu.edu/aquaculture/
Brunswick Community College: http•//www brunswickcc edu/professional-technical/aquaculture-technology/
Carteret Community College: http://www carteret edu/certificate-diploma-programs/aquaculture-technology-diploma/
The North Carolina Shellfish Growers Association, is an industry group that shellfish growers can join and network with other
growers. http://www.ncshellfish.org/
The East Coast Shellfish Growers Association, is a regional association that includes great information on shellfish aquaculture
including Best Management Practices. http://ecsga.org/
Version: DMF Lease App 2/2017

Page 6 of 19
S. Lease Management Plan (continued)
Planting/Seeding Dates and Expected Harvest:
Planting dates Year AbAP (month)
Expected first harvest date: Expected yield per acre: _ bushels; or #
Do you plan to harvest oysters anytime during April — September? ❑ No ® Yes
Will you operate as a Shellfish Dealer? A No ❑ Yes
*Closed oyster season harvest requires a Closed Oyster Harvest Certification. A Shellfish Dealer must have a Certification from
Shellfish Sanitation [phone], and a DMF Dealer License to operate.
*A Commercial Fishing Vessel Registration will be required annually for boats used to harvest or transport seafood. The registration
is separate from the NC Wildlife Resource Commission's registration.
Lease Marking
Type and number of markers to be used
Lease corners must be marked and proper durable
❑ Wood post (3-4 inch) #_
signage attached including all lease numbers,
® Plastic/PVC dia. 3" # -1
reflective tape, and the name of the leaseholder.
❑ Other (composition and dimension):
Water Column leases must also have yellow floats
#
marking each corner. Boundary markers should be
every 150 feet.
*Markers greater than 4x4 inches may require a permit from the Division
of Coastal Management.
NOTE: Leases maybe conditioned to reduce or
increase the number of markers required depending
#The DMF has no duty to protect any lease or franchise that is not
upon location, navigational issues, etc.
properly marked.
Land/Dock Based Facilities: (check all that apply) ❑ Raceway/trays
91 Dock ❑ Graders/Sorters
❑ Floating Upweller ❑ Tumblers
❑ Tank Upweller or Downweller ❑ Storage facilities, sheds, etc.
❑ Pumps ❑ Other: (specify)
* NOTE: These structures, if proposed, may require a
permit from the Division of Coastal Management
Lease Cleanup Provisions
*If your lease is surrendered, cancelled, terminated for lack of production or failure to pay rent, or you simply choose to relinquish
the lease, the leaseholder is responsible for removing all markers, posts, and aquaculture gear except planted cultch. You will be
given a 30 -day notice to remove all posts, markers, and aquaculture gear. If you do not remove the markers, posts, and gear after
the 30 -day notification, the Division of Marine Fisheries may pursue legal action to have it removed at your cost. These provisions
will be included in the lease contract.
The leaseholder is also responsible for collecting any gear that is displaced due to storm events. It is highly recommended that all
lease equipment is labeled with your contact information to facilitate collection in case of storm loss.
By signing I agree that I have read and understand the Lease Cleanup Provision/s:
Signature: 42 Date:
For Staff Use Only: Aquaculture Permits needed for described lease management plan:
❑ ACP ❑ ACP ❑ ASTP ❑ Intro ❑ Mechanical Harvest ❑ Polluted Area Relay ❑ SOMA
Version: DMF Lease App 5/2017

Proposed Lease Site Diagrams #1
LOCATION MAP: (Insert below or on a separate piece of paper)
Version: DMF Lease App 2/2017
`^ wtyG�f�YY��`
Page 9 of 16

EXAMPLE: TOP VIEW DIAGRAM
110 ft.
lat/long for each corner
--------
250 ft.
Marsh
Min 20 ft.buffer
Clam netting
E;�
\ V
�\ Floating cage lines 250 ft. Cultch
\ Bottom cage lines
'\ �\ Distance from developed shoreline _ft.
\� Oyster CreekEst. distance across water body
ft.
\ �
Dock Ch\annel --- —
O N
1 125 ft
Page 10 of 16
sr
---- -------
Version: DMF Lease App 2/2017

Page 11 of 16
Proposed Lease Site Diagrams #2
TOP VIEW DIAGRAM: (Insert below or on separate piece of paper)
Version: DMF Lease App 2/2017

EXAMPLE. SIDE VIEW DIAGRAM
Floating Cages
Mean Low Water (MLW)
4 ft. MLW
6.5 ft. MLW
8 ft. MLW
Indicate Clearance in ft.
Water Column structure >18"
Bottom Lease structure 18" max ht.
Deep End
Version: DMF Lease App 2/2017
6.3 ft. MLW
Cultch or Shell
Shallow End
Page 12 of 16

Proposed Lease Site Diagrams #3
SIDE VIEW DIAGRAM (insert below or on separate piece of paper)
III i -a
Page 13 of 16
Version: DMF Lease App 2/2017

Page 14 of 16
7. Consent Form for Riparian Property Owners
I/We, the undersigned, hereby give my/our consent to (Name)
who resides at (Physical Address:)
to lease:
2' Shellfish bottom
2rShellfish bottom and the water column
within 100 feet of my/our shoreline.
Signature
Signature
a S LarAa—
Name (Ple se Print)
Name (Please Print)
Street Address or PO Box City State/Zip
SWORN to and subscribed before me
This the day of 20_
NOTARY PUBLIC
My Commission Expires:
Version: DMF Lease App 2/2017
Phone

Page 15 of 16
8. Public Health Information
The following information is to provide awareness of the public health risks with shellfish as well as causes and impacts
from temporary and permanent shellfish closures. An illness from your product or growing area closures can have a
significant impact on your shellfish aquaculture business. We encourage applicants review and consider the permanent
and temporary closure status where you site your lease and implement safe handling practices.
Because shellfish are filter feeders, they provide valuable water quality benefits by filtering up to 40 gallons of water per
day. However, they can also concentrate potential pathogens (bacteria and viruses) that cause illness in consumers,
particularly when shellfish are consumed raw or undercooked. The DMF Shellfish Sanitation and Recreational Water
Quality Section continuously sample waters to ensure the shellfish harvest areas of the coast are properly classified.
Classification maps showing permanent closure areas can be viewed at: http://portal.ncdenr,org/web/mf/shellfish-
closure-maps
In addition to the permanent closures, heavy rainfall and the resultant runoff, or other events such as septic or sewage
failures, chemical spills, etc. may cause temporary shellfish water closures. These events result in heavy pollutant loads
washing into growing areas and may close growing areas for days to weeks depending upon the event. No shellfish
harvest is allowed during this time.
Not all pathogenic bacteria are associated with polluted waters. The National Shellfish Sanitation Program (NSSP) Model
Ordinance and the US Food and Drug Administration require safe harvest and handling practices to reduce illness caused
by post-harvest growth of Vibrio bacteria. Two species of concern are Vibrio vulnificus and Vibrio parahaemolyticus.
Vibrio bacteria occur naturally in our warm coastal waters and multiply rapidly once shellfish are removed from the
water and exposed to warm ambient air temperatures.
In order to decrease the risk of Vibrio illnesses, which are rare in NC, Shellfish Sanitation and the DMF have developed
Time to Temperature limits for harvesting oysters and clams. Leaseholders harvesting oysters outside of the regular
oyster season from shellfish leases must document time of harvest and follow restrictions set forth in DMF annual
proclamations. Shellfish dealers must also document time to temperature for receiving, storage and shipping. Current
proclamations specifying time to temperature controls are SS -1 and SS -2 on the DMF website.
In some instances, a portion or the entire lease may be closed when the surrounding growing area is later reclassified
and permanently closed by reason of pollution. Staff from DMF Shellfish Sanitation and Resource Enhancement work
closely to notify lease holders that are impacted, by these reclassification closures so they can relay material off before
the closure takes place. At this point, the lease may either be relinquished by the leaseholder or it will either be
terminated for lack of production over time, or automatically expire at the end of the contract period and may not be
renewed. No shellfish harvest is allowed once the permanent closure goes into effect.
Contact the Shellfish Sanitation & Recreational Water Quality Section for up-to-date information at [phone].
Subscribe to DMF and/or Polluted Area proclamations at: http://Portal.ncdenr,org/web/mf/email-subscribe
Version: DMF Lease App 2/2017

Page 16 of 16
9. Final Signature
By signing below, the Applicant hereby states that the information included in the application is true and correct, and
that the Applicant(s) understand the following:
1. The Applicant will accept the lease or franchise subject to all the provisions of the North Carolina Marine Fisheries
Commission Rules and applicable General Statutes 113-201, 113-202 and 113-202.2.
2. The annual Lease rental fee shall be $10.00 per acre for bottom leases and $100.00 per acre for water column leases.
Lease rent is prorated for the first year, and is due prior to the issuance of the lease contract. Annual rent shall be paid a
year in advance on or before March 31. Unpaid or delinquent rent will result in the termination of the lease.
3. The applicant agrees to use the lease for commercial production of shellfish and shall provide annual production
reports as required by the division. Failure to meet production requirements may result in the termination of the lease.
Applicant Name:
A�IIWIZ914-
Co-Applicant:
No
Business Agent:
SWORN to.and subscribed before me
My Commission Expires: Nl,&, 1-1 qu�o
Version: DMF Lease App 2/2017
Date: l /
Date:
Date:
BUS
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