20021255 Ver 1_COMPLETE FILE_20020808

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Michael F. Easley
Governor
William G. Ross, Jr., Secretary
Department of Environment and Natural Resources
Alan W. Klimek, PE, Director
Division of Water Quality
September 4, 2002
DWQ Project #02-1255
Pamlico County
Page 1 of 2
Jim Cox
361 Chapel Creek Drive
Bayboro, NC 28514
Subject Property: Jim Cox / Marcia Burger Property, 361 Chapel Creek Drive, Bayboro, NC 28515
Bay River/ Chapel Creek [03-04-13; 27-150-7-(2.5); SC Sw NSW (nutrient sensitive]
REQUEST for the use of the "General" MAJOR VARIANCE; From the Neuse and Tar-Pamlico Riparian
Buffer Rules for the Construction of Residential Structures on Existing Lots within the Coastal
Counties as defined by the Coastal Area Management Act with ADDITIONAL CONDITIONS
Dear Mr. Cox:
On September 3, 2002, you spoke to Mr. Bob Zarzecki of this office concerning your project. As a result of this
conversation, it is the understanding of the Division of Water Quality (DWQ) that you are proposing to convert an
existing bathhouse to a residential home on the subject property. You stated that this activity will be greater than
50 feet from the coastal wetlands as defined by CAMA and outside of the buffers protected- under the Neuse
Buffer Rules. If this is the case, then your proposed project will not require the use of the "General" Major
Variance as requested. Therefore, it is our understanding that you have chosen to withdraw your variance
request. No further action is required on your part.unless you plan to impact these protected buffers.
This letter completes the review of the Division of Water Quality under the Neuse River Riparian Buffer
Protection Rules (15A NCAC 213.0233 (9)(b)). Please call Mr. Bob Zarzecki at 919-733-9726 or Mr. Tom
Steffens at 252-946-6481 if you have any questions or require copies of our rules or procedural materials.
Sincerely,
P.E.
cc:
bz
Tom Steffens, DWQ Washington Region
File copy
Central Files
Office
North Carolina Division of Water Quality, 401 Wetlands Certification Unit,
1650 Mail Service Center, Raleigh, NC 27699-1650 (Mailing Address)
2321 Crabtree Blvd., Raleigh, NC 27604-2260 (Location)
919-733-1786 (phone), 919-733-6893 (fax), hftp://h2o.enr.state.nc.us/ncwetlands/
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August 22, 2002
DWQ # 02-1255
Pamlico County
CERTIFIED MAIL - RETURN RECEIPT REQUESTED
Jim Cox/ Marcia Burger
361 Chapel Creek Drive
Bayboro, NC 28514
Dear Mr. Cox and Ms. Burger:
On August 8, 2002 the Division of Water Quality (DWQ) was notified by receipt of your
application regarding your plan to fill wetland for the purpose of residential housing in Pamlico
County. Approval from DWQ is required to disturb these buffers. Please provide seven copies of the
following information and refer to the DWQ# listed above in your reply. In particular as described in
15A NCAC 2B .0502, we will require you to locate all streams and ponds on the property. Please
show these on maps of suitable scale (for instance 1" = 100 feet) so we can begin to determine your
projects' compliance with 15A NCAC 2H .0500.
1. Please provide the area of impact (in square feet) to the buffer. ,
2. Will any impacts occur to Zone 1 (30 feet from Coastal Wetlands as designated by CAMA)
of the buffer?
3. What is the existing vegetation within the proposed impact area (e.g. grass, forested, etc.)?
4. Will any trees be removed?
Please telephone me at 919-733-1786 if you have any questions or would require copies of
our rules or procedural materials. This project will remain on hold as incomplete in accordance with
15A NCAC 2H .0505(c). The processing time for this application will begin when this information is
received. If we do not hear from you by writing within three (3) weeks we will assume you no longer
want to pursue the project and will consider it withdrawn.
Program
cc: Washington DWQ Regional Office
Washington Corps of Engineers
Central Files
File Copy
N. C. Division of Water Quality, 401 Wetlands Certification Unit,
1650 Mail Service Center, Raleigh, NC 27699-1650 (Mailing Address)
2321 Crabtree Blvd., Raleigh, NC 27604-2260 (Location)
[phone] (phone), 919-733-6893 (fax), (http://h2o.enr.state.nc.us/ncwetlands
Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Alan W. Klimek, P.E., Director
Division of Water Quality
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oFFiCE USE ONLY: Date Received Request #
State of Noah Carolina
Department of Environment and Natural Resources
Division of Water Quality
"General" Major Variance Application Form •-
,From the Meuse and Tar Pamlico Riparian Bu#er Protection Rules for residential structures
on existing lots within the coastal counties as de, f Ined by the Coastal Area Management Act
(As approved by the Water Quality Committee of the Enviroune nW Ivtamgement Commission on 5/'9/2001)
----- - ---------
Please identify which Riparian Area Protection Rule applie$.
Neuse River Basin: Nutrient Sensitive Waters Management Strategy
Protection and Maintenance of Riparian Areas Rule (7 SA NCAC .0233)
v Tar-Pamlico River Basin INS n?n? ? of Riparian a Waters Areas Ru (15A
Strategy Protection and
NCAC.0259)
NOTE. In this form
To conatJtute a complete application,requested
to the PPllcant The
must be provided. Incomplete appl??? will be r+eturneo
orlgina/ and two copies of the completed "General" Variance AppikatJon Form and
any attacbmeni si-n?kis! be sent to the DWAQ 40!/Weilands Cerdllcation Unit, 1680 Mall
Service Center, Raleigh, NC 27698-16501 9196733,1786 to constitute a complete
submittal. This form maybe photocopied for use as an original.
Part V General Information
(Please include attachments if the room provided is insuf bient.)
1.
2.
3.
Print Owner/Signing
Name:
Title:
Street address:
City, State, Zip:.,
Telephone:
Fax:
Individual, etc. who owns the property):
YGenerar Variance Application Form
Version 1: May 2001
Contact person who can answer questions about the proposed project:
Name: r" COX ,
Telephone:
Fax: ( ..?
Email
4. Project Name (Subdivision, facility, or establishment name - oonsista t with project name on
plans, specifications, letters, operation and maintenance agreements, etc.):
d/tom GaX
a. Project Location:
Street address:
City, State, Zip:
County:
LatitudeRongttude:
6. Directions to site from nearest major intersection (Also, attach an 8 "A x 11 copy of the portion
of the USQSographic ma Indicating the locution of the site):
7. Stream to pe impoacted the
Stream name (for unnamed s
Stream ciatssmation [as identme
(Neuse) or.0316 (Tar-Pamlico)]:
activity:
et as °U
28.0316
8. Which of the following permits/approvals will be required or have been received already for
this project?
Required: Received: Date received: Permit Type: f
CAMA Major rc?e d ?ho ?oeP feet-,l J
CAMA Minor
401 Certhlcadon/404 Permit ?
c Ply @d On-site Wastewater Permit
Active Connection to Sanitary Sewer System
NPDES Permit (Indudi s mwa r
Non-discharge Permit Zli(RC'
Water Supply Watershed Variance
Others (spedfy) -- E/cri C4V-r
Part 2: Proposed Activity
(Please indude attachments if the room provided is insufficient.)
1. Descdp#i Rroposed activity [Also, please attach sufficient detail (such as a plat,
map ske p W to aocuratety delineate the boundaries of the land to be utilized in carty?ng
out the activity, the location and dimension of any dsturbance in the riparian buffers
assodated with the acd ty, and the extent of riparian buffers on the land. Include the area
of buffer impact in fe,: k

epad -- em
c I?
to the nearest named stream):
'General" Vadanoe Appricaton Form, page 2
2. State reasons why this plan for the proposed activity cannot be practically accomplished,
reduced or reconfigured to better minimize or eliminate disturbance to the riparian buffers:
3. Description of any best management practices to be used to control impacts associated with
the proposed activity (l.e., control of runoff from impervious surfaces to provide diffuse Now,
replanting vegetation or enhancement of existing vegetation, etc.): ?- ,
4. Please provide an explanation of the following:
(1) The practical difficulties or hardships that would result from the strict apps of this
(3) If economic hardship is the major consideration, then include a specific explanation of the
economic hardships and the,propordonQf the hardship to theVntire value of the project.
Part 3: Deed Restrictions
By your signature in Part 5 of this application, you certify that all structural stormwater best
management practices required by this variance shall be located in recorded stormwater
easements, that the easements vinl run with the land, that We easements cannot be changed or
deleted without concurrence from the State, and that the easements will be recorded prior to the
sale of any lot.
Part 4: Agent Authorization
If you wish to designate submittal authority to another Individual or firm so that they may provide
information on your behalf, please complete.this section:
Designated agent (individual or firm):
Mailing address:
ueeneW Variance Application Form, page 3
(2) How these difficulties or hardships result from conditions that are unique to the property
involved.
City, State, zip:
Telephone:
Fax.
Email:
Part 5: Applicants Certification
I, (print or type name of person
listed In part 1, item 2? that the information in uded on this permit application form is
correct, that the project will be constructed in conformance with the approved plans and that the
deed restrictions in accordance with Part 5 of this form will be recorded with all required permit
conditions.
Signature:
Date:
Title:
No Division of Water Quality (DWO)
401 Wetiands Certltication Unit
2321 Crawree Blvd. (LOCATION)
185o Mail Senvk:e Center (MAILING ADDRESS)
Rafth, NO 27699.1650
[phone] (phone)
http:11h2o enr.sf&te naus/ncweiiands1
RALEIGH REGULATORY FIELD OFFICE
US Army Corps of Engineers
6508 Falls of the Neuse Road, Suite 120
Raleigh, North Carolina 27815
Oeneras Number [phone]
httoMW,N.Ssw.usice.amW.mWw*Wds/mgtour.htm
WASHINGTON REGULATORY FIELD OFFICE
US Amy Corps of Engineers
post Omos Box 1000
Washington, North Carolina 27889-1000
General Number. [phone]
http.j w Av.saw.usace.mw miVwettwWstmotour.htrn
Washington District Office
Division of Coastal Management
943 Washington Square Mail
Washington, NO 27889
phone: [phone]
Morehead City District Office
Division of Coasts! Management
151-8 Highway 24
Morehead City, NO 2807
phone: [phone]
'General" Variance Application Form, page 4
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RTH CAROLINA.
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HEALTH
DEPARTMENT
bn=ry 9, 2002
ram cox
PO Box 246
Hayboro, NC MIS
W.- Patod ID: 1043-31
Dear o or Madm
m t+K)Rm ww"T
PO O==
SAY80M. NC MIS
28Z-7466111
M746.7b84 FAX
The septic ss?Wmimftlied on your property (Farad M 1043.-31) was dammed for a 2-
t to hn n aareddeeca and a SO-* marina with a for a flow rata told of 1,490
od as per day. On 1!8102, you mdiowd that you did not want a mac3na and instead
de*c a dveo.bexinio reddme is its plane. You Ww wed that Om are skmady 10
r
10 dips nq&e 30 g/d of flow and d wafore vMw 300 Sid of yaouc d akfiidd. Tba two-
bedroom raddenoa vA utge 240 gld fw a coanbined totat of 540 WL This leaves 950
g/d of dram lice that is not b*8 utffn& Tlds flaw rata WE mm -1 a 3 badm m
bome at 360 g!d as w l as d w fw fltpae den?e3opmeat of 19 sdMkW boat dips at S70
Sid. Thb wN gee you saquaw dasLM gar a ttiraabadxrrasa ban*, a two-
bedroosr how% and s s"029 boat d%p&
If you bave any qucjdOW,or mead addstioaA asdatanme, please voubict this offft at 252-
745-5634.

PAMLICO COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH SECTION
BAYBORO, NORTH CAROLINA 28515
IMPROVEMENTS PERMIT
Permit valid for 5 years.
ISSUED TO•Jim Cox PERMIT * 13230
ADDRESS: P.O_. Bo 46 RECORD *
paarboro c. 23S MAP *.._ W311 _
REGISTERED PLAT: MAP BOOK PAGE N/A DATEt[/A
REGISTERED DEED: DEED BOOK NIA PAGE N/A DATE N/A
SUBDIVISION: N/A LOT
TOWN: Meribel. N.C. SR
THIS PERMIT IS HEREBY ISSUED TO SERVE A:
MOBILE HOME (xxx) and OTHER (xxx) 28R Ma
*BEDROOMS : _ _,I@$_ *.FACTORS
14900PD Max.-
WATER SUPPLY: ( ) PUBLIC
AR (x) PRIVATE 200 Peet from any part of septic system
SITE CLASSIFICATION: ( ) SUITABLE txxx) PROVISIONALLY SUITABLE
LAND DRAINAGE: t ) SUGGESTED t ) NECESSARY
( } DITCH NECESSARY t ) SUB-SURFACE TILE NECESSARY set deep
and ( ) TRENCH ROCKED TO WITHIN 1'OF GR_6_UKDS6RFACE
and t ) WITH POLYURITHANE CURTAIN: FRENCH DRAIN
and ( ) FINISHED AT OUTFALL W/ SOLID PIPE A SCREEN
and t ) FINISHED AT OUTFALL W/ CHECK VALVE
«.« If land drainage is necessary, you may need to contact CANA or
The Army Corps of Engineers for appropriate Permits
DESIGN.-( ) LOCATION OPTIONAL (xxx) LOCATION AS SPECIFIED ON PLOT PLAN
t ) CONVENTIONAL SYSTEM:(ref.195S) 18"X 31trench, rock 12"deep
(xxx) SHALLOW SYSTEM:(refi19S6)atrenches on 9' centers
36 " wide, rock 12"deep,
*** add fill = 6" soil cover, rock to natural ground surface
t ) MOUND SYSTEM:(ref.1950b) trench 18" deep A " Wide in
suitable fill extending. beyond any part of system
*«« ?" = depth of FILL; pump necessary if unable to
*** If fill material is prescribed gravity feed
, you may need to contact The Army Corps
of Engineers or CANA for appropriate permits.
( ) LFP SY5TEM:(ref.1957) see comments for design criteria
t ) BED SYSTEN:(ref.195Sd) see comments for design criteria
t ) OFF-SITE DISPOSAL:(ref.1957) see comments for design notes
al SEPTIC TANK Q gal PUMP TANK
QUARE FEET NITRIFICATION FIELD or NITRIFICATION BED
INEAR FEET NITRIFICATION LINE;_ 9(100') Lines
! E GR EAT ER
THAN FIVE FEET EROR JANK. SYSTE M, AND REPAIR, VIOLATIONS )(ILL VQJ D •

ADDITIONAL FOR ALL SYSTEMS:
LANDSCAPE SYSTEM AREA FOR SURFACE WATER RUNOFF AND GRASS
DO NOT PLACE DRIVE OR ANY BUILDING OVER SYSTEM AREA
OBSERVE ALL PROPER SETBACKS: ref .1950
TANKS MUST BE PUMPED CLEAN AS A PART OF ANY SYSTEM REPAIR.
DISC NATURAL GROUND BEFORE INSTALLATION OF ANY FILL
ALARM A ON-OFF FLOATS ON PUMPS MUST BE ON SEPARATE CIRCUITS
• IF BUILDING AREA EXTENDS INTO SYSTEM AREA THIS PERMIT KILL BE INVALID
• IF ANY OTHER REGULATORY AGENCY DENIES PERMITS FOR LAND ALTERATIONS AS
DESCRIBED HEREIN. THIS PERMIT WILL BE INVALID
PLOT PLAN MUST NOT BE ALTERED UNLESS BY SANITARIAN APPROVAL
t•ttetttetttttttttsssttstttests PLOT PLAN stt•sttttttttttettt•tt:ttt.tt
*DO NOT DRIVE ON.TANK, SYSTEM, OR REPAIR. BUILDING AREA TO BE GREATER
INA11 JIVE FEET FROM DANK. SYSTEM, AND REPAIR. VIOLATIONS WILL VOID PLRMITt
See Addendum Sheet R 1 for Plot Plan.

STEPHEN D. LANE
ENVIRONMENTAL HEALTH SPECIALIST
E f ='F-U
ALL SEPTIC SYSTEMS MUST BE INSPECTED A RECEIVE APPROVAL BY THE LOCAL HEALTH
DEPARTMENT BEFORE BEING COVERED OR PLACED INTO USE AND NO ELECTRICAL
CONNECTION SHALL BE ALLOWED UNTIL APPROVAL HAS BEEN RECEIVED. (GS 130A)
A PLOT PLAN (TO SCALE) SHOWING ALL BUILDINGS,' DRIVEWAYS. WATER LINES A SEPTIC
SYSTEM LOCATIONS MUST BE APPROVED BY THE ENVIRONMENTAL HEALTH DEPARTMENT
PRIOR TO RECEIVING A BUILDING PERMIT.
p e.ELEVATIONCERTIFICATE E s" ay, 111 3
FEDERAL EMERGENCY MANAGEMENT AGENCY
NATIONAL FLOOD INSURANCE PROGRAM .
ATTENTION: Use of this certificate does not provide a waiver of the flood insurance purchase requirement. This form is used only to
ovide elevation information necessary to ensure compliance with applicable community Qoodplain management ordinances, to
termine the proper insurance premium rate, and/or to support a request for a Letter of Map Amendment or Revision (LOMA or LOMB).
Instructions for completing this form can be found on the following pages.
SECTION A PROPERTY INFORMATION FOR INSURANCE COMPANY USE
au1LDING OWNER'S NAME
• POLiCYNUMBER
STREET ADDRESS (Inciuding Apt, Unit, Suits and/or Bldg. Number) OR P.O. ROUTE AND BOX NUMBER COMPANY NAIL NUMBER
( 1
OTHER DESCRIPTION (Lot and Block Numbers, eta)
GILY
Heg t?P"O 1 STATE ZIP CODE
W ? ?• .
SECTION 6 FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
Provide the following from the proper FIRM (See Instructions):
1. COMMUNITY NUMBER 2. PANEL NUMBER & SUFFIX 4. DATE OF FIRM INDEX It. FIRM ZONE 6. BASE FLOOD ELEVATION
70! o/ q o 51_ 4 0515 i9.5 ?,AD 8 ;aedeFUrl
7. Indicate the elevation datum system used on the FIRM for Base Flood Eievatlons (BFE): ? NGVD '29 ? Other (describe on back)
8. For Zones A or V, where no BFE is provided on the FIRM, and the community has established a BFE for this building site, indicate
the community's BFE: L l I I I I,U feet NGVD (or other FIRM datum-see Section S, Item 7),
SECTION C BUILDING ELEVATION INFORMATION
1. Using the Elevation Certificate Instructions, Indicat the diagram number. from the diagrams found on Pages 5 and 6 that best
describes the subject building's reference level
2(a). FIRM Zones Al -A30, AE, AH, and A (with BFE). The top of the reference level floor from the selected diagram is at an elevation
of (-L _1JR-VJ feet NGVD (or other FIRM datum see Section 8, item 7).
(b). FIRM Zones V1430, VE, and V (with BFE). The bottom of the lowest horizontal structural member of the reference level from
the selected diagram, is at an elevation of L l I IJ U feet NGVD (or other FIRM datum-see Section B. Item 7).
(c). FIRM Zone A (without SFE). The floor used as the reference level from the selected diagram Is L LU feet above ? or
below ? (check one) the highest grade adjacent to the building.
(d). FIRM Zone AO. The floor used as the reference level from the selected diagram is LLj.U feet above ? or below ? (check
one) the highest grade adjacent to the building. If no flood depth number is available, is the building's lowest floor (reference
level) elevated In accordance with the community's floodpiain management ordinance? ? Yes ? No ? Unknown
3. Indicate'the elevation datum system used in determining the above reference level elevationsJ, FNGVD'29 ? Other (describe
under Comments on Page 2). (NOTE. If the elevation datum used In measuring the elevations Is different than that used on
the FIRM (see Section B, Item 71, then convert the elevations to the datum system used on the FIRM and show the conversion
equation under Comments on Page 2.) 2/No
4. Elevation reference mark used appears on FIRM: ? Yes (See Instructions on Page 4)
5. The reference level elevation is based on: ©-actual construction ? construction drawings
(NOTE.- Use of construction drawings Is only valid ff the building does not yet have the reference level floor In place, In which
case this certificate w111 only be valid for the building during the course of construction. A post-construction Elevation Certificate
will be required once construction is complete.)
6. The elevation of the lowest grade immediately adjacent to the building is:1 I I I .2 feet NGVD (or other FIRM datum-see
Section B, Item 7).
SECTION D COMMUNITY INFORMA_T10N
1. If the community official responsible for verifying building elevations specifies that the reference level indicated In Section C, Item 1
Is not the "lowest floor" as defined in the community's floodplafn management ordinance, the elevation of the building's "lowest
floor" as defined by the ordinance is: j I l 1 i f ,(_j feet NGVD (or other FIRM datum-see Section B. Item 7).
Date of the start of construction or substantial improvement ,
FEMA Form 81-3Is MAY 4o REPLACES ALL PREVIOUS EDITIONS SEE REVERSE SIDE FOR CONTINUATION
1`. SECTION E CERTIFICATION
-)A
This certification is to be signed by a land surveyor, engineer, or architect who is authorized by state or local law to certify elevation
Information when the elevation inrormation for Zones Al-A30, AE, AH, A (with BFE),V1-V30,VE, and V (with BFE) is required.
?ommunity officials who are authorized by locai,law or ordinance to provide ftoodplain management information, may also sign the
certification. In the case of Zones AO and A (without a FEMA or community issued 8FE), a building official, a property owner, or an
oWner's representative may also sign the certification. _
Reference level diagrams 6, 7 and 8 - Distinguishing Features-if the certifier is unable to certify to breakaway/non-breakaway wall,
enclosure size, location of servicing equipment, area use, wall openings, or unfinished area Feature(s), then list the Feature(s) not
included in the certification under Comments below. The diagram number, Section C. item 1, must still be entered.
• •1
I certify that the information in Sections 8 and C on this ceri frcate represents my best efforts to Interpret the data available.
I understand that any false statement may be punishable by fine or imprisonment render 18 U.S Code, Section 1001.
CE TIFIER•S NAME LICENSE NUMBER (or AMIx sea!)
r,2Jr A(0 r3c.s 2 JR.; L z7c,
TITLE
n .. 1, 1.... 1 . t^ ' N V. COMPAN3 NAME - _?
yr
ADD
RESS
/? ^?{'??? ?•/+.?? LL,, vCITY STATE ZIP
Avo >0
rn%.M=
Copies should b made of this Certificate for: 1) community official, 2) Insurance agent/company, aria- 3) building owner.
COMMENTS:.,C?'/?'l'/L+L'/lf'C' /17t N«5 32 r•
1,11i•!• - ? ?rS
q.1!
ON
sue
WITH
BASEMENT
A
ON PILES,
PIERS, OR COLUMNS
A S6? v
The diagrams above illustrate the points at which the elevations should be measured In A Zones and V Zones.
Elevations for all A Zones should be measured at the top of the reference level floor. Ki.
Elevations for all V Zones should be measured at the bottom of the lowest horizontal structural membert•
.:...
Page 2
A v
ZONES ZONES

'poil f .,
State of North Carolina
Department of Natural Resources and Community Development
Nordwastem Region
1424 Carolina Avenue, Washington, North Carolina 27889
James G. Martin, Goyemor Haward D. Moyne, Jr.
S. Thomas Rhodes, Secretary September 24, 1985 Regional Manager
LETTER OF APPROVAL
Mr. James B. Cox, Jr.
P.O. Box 246
Bayboro, North Carolina 28515
RE: Land-Disturbing -Activities Adjacent to
Chapel Creek
Pamlico County
Dear Mr. Cox:
We have reviewed the erosion/sedimentation control plan for the above
referenced project and are approving the plan for construction.
Approval of the plan is subject to satisfactory performance of the
measures indicated under actual field conditions. Should any of the measures
indicated fail to provide adequate control, this office may require additional
measures.
If additional development related to this site is to occur, aadztdments
must be submitted to reflect the changes'or additions.
If you should have any questions, feel free to call; otherwise, we will
be making periodic inspections.
Sincerely,
F1oyd.R. Williams, C.P.G.S.
Regional Engineer
Division of Land Resources
Land Quality Section
FRWIRA9:mar

Pm Baer 15D7, WaftWim North CamAn 27MIS07 Telephone [phone]
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OFFICE USE ONLY: Date Received Request #
State of North Carorma
Departrnwd of EWronment and Natural Resources
DMsion of Water Quality
"General" Major Variance Application Form --
From the Neese and Tar PaWico Riparian Bsfer Protection Rules for residential structures
on existing lots within the coastal counties as de, fined by the Coastal Area Management Act
(As approved by the waxer Quality Committee of the EuvironmmW Managema t 519MO 1)
- - - -------- --- --------
Please identify which Riparian Area Protection Rule applies.
Neuse River Basin: Nutrient Sensitive Waters Management Strategy
Protection and Maintenance of Riparian Areas Rule (15A NCAC.0233)
o Tar-Pamlico River Basin: Nutrient Sensitive Waters Management
Strategy Protection and Maintenance of Riparian Areas Rule (15A
NCAC.0259)
NOTE.
To constitute a complete application, all of the Information requested in this form
must be provided. incomplete applications will be returned to the applicant. The
original and two copra of the completed aGenerW Variance Appikat/on Form and
any mwchmenEs must be sent to the DWQ 441IWetlands CeMff cation Unrtl 1660 Mall
Service Center, Raleigh, NC 27899x1850, 949-733-1786 to constitute a complete
submittal. This form may be photocopied ibr use as an original.
Part 1: General information
(please include atfachments if the room provided is insufircient.)
1. Applicant's name (the corporgatlon, Individual, etc. who owns the property):
2. Print cwnert819nin4
Name:
Title:
Street address:
city, State, Zip:..
Telephone:
Fax:
3. Contact person who can answer questions about the propbsed project:
Name: J IM C-404
Telephone:
Fa "7.4?
x: .(..?..,?._._.'..?_? _? ..,.
'Genre Variance Application Fonn
Version 1: May 2001
Email:
4. Project Name (Subdivision, facilityy. or establishment name - consistent with project name on
plans, specifications, letters, operation and maintenance agreements, etc.):
U tfn co X
5. Project Location:
Street address:
City, State, 23p:
County:
Latitude/fongitude:
6. Diredons to site from nearest major intersection (Also, attach an 8 % x 11 copy of the portion
of the USGSAqp-ographic m indicating the location of the site):
7. Stmain-to bb impacted by the
Stream name (for unnamed s
dwarf -- P

(Nauss) ".0316 (Tar-Pamilco)]:
as "Ur to the nearest named stream):
the
2B .0315
8. Which of the following pennWapprovals will be required or have been received already for
this project?
Required: Reeved: Date received: Permit Type: Z
? CAMA Major ee? cl (too t&ve*- fee, J
CAMA Minor
/ 401 Certification1404 Permit ?
_?., cc:"+Pte ?d On-site Wastewater Permit
Active Connection to Sanitary Sewer System
_.? NPDES Permit (lncludi sfSfnt'e? DNKC D
Non-discharge Permit
Water Supply Watershed Varlange
-? Others (specify) - 4&--, Cw
Part 2: Proposed Activity
(Please Indude attachments if the room provided is Insuff?dent.)
1. Descri roposed activity [Also, please attach jfra& sufficient detail (such as a plat j
map si#e pW to accurately delineate the boundaries of the land to be utilized in carryYrig
out the act€vlty, the location and dimension of any disturbance in the riparian buffers
associated with the activity, and the extent of riparian buffers on the land. Include the area
of buffer impact In fe.:
Scc ? ?D
'General" Variance Application Form, page 2
2. State reasons why this plan for the proposed actI ft cannot be practically accomplished,
reduced or reconfigured to better minimize or eliminate disturbance to the riparian buffers:
3. Description of any best management practices to be used to control Impacts associated with
the proposed activity p.e., control of runoff from Impervious surfaces to provide diffuse flow,
replanting vegetation or enhancement of existing vegetation, etc.): / _ _/ r
4. Please provide an explanation of the following:
(1) Tire practical difficulties or hardships that wouid result from the strict application of this
Part 3: Deed Restrictions
By your signature in Part 5 of this application, you certify that all structural stormwater best
management practices required by this variance shag be located in recorded stormwater
easements, that the easements wig run with the land, that the easements cannot be changed or
deleted without concurrence from the State, and that the easements will be recorded prior to the
sate of any tot.
Part 4: Agent Authorization
If you wish to designate submittal authority to another Individual or firm so that they may provide
information on your behalf, please compiete.this section:
Designated agent (individual or firm):
Mailing address:
meeneW Variance Application Form, page 3
(2) How these di cultles or hardships result from conditions that are unique to the property
involved. ..?
Xl _S7ir1?, r? v? 7 St le- In o elf.
(3) If economic hardship Is the major consideration, then Include a specific explanation of the
Cit16 State, Tip:
Telephone:
Fax:
Email:
part 5: Applicant's Certification
(print or type name of person
i Jr( e7- 4131
listed In Part 1, item 2 that the information Intruded on this permit application form is
correct, that the project will be constructed in ca1brmarice with the approved plans and that the
deed restrictions In accordance with Part 5 of this form will be recorded With all required permit
conditions.
Signature:
Date:
Tide:
NG Melon of water Qualtly (DWO)
401 Wetlands Certification Unit
2321 Crebtoee Blvd. (LOCATION)
1650 Marl Service Center (MAILING ADDRESS)
Raleigh, NO 27699-1850
[phone] (phone)
http:llh2o.enr.stateAr-us/mmetionds/
RALEIGH REGULATORY FIELD OFFICE
US Army Corps of Engineers
6508 Fans of the Neuse Road, Suite 120
Raleigh, North Carolina 27615
General Number: [phone]
httpJ/www.saw.unce.arrrry mWwetlands/regtour.Mm
WASHINGTON REGULATORY FIELD OFFICE
U8 Army Corps of Engineers
Post Office am 1000
Washington, North Carolina 27889-1000
General Number: [phone]
http:/ www.saw.usaos.amny mlVwetlandstroomr htm
Washington District Office
Division of Coastal Management
943 Washington Square Mail
Washington, NO 27689
phone: [phone]
Morehead City District Office
"Ion of Coastal Management
151-8 Highway 24
Morehead City, NC 28557
phone. [phone]
`Generar Variance Application Form, page 4
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and
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any adlac ".'yr property MAMA
that no d ?dfacent property ?•i i COLL/ER SURVEY COMPANY
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ATE MOREHEAD CITY, NORTH CAROLINA 28557
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HEALTH
DEPARTMENT
J mn" 9, 2002
Tim Coat
Fo Box 246
Baybw% NC =5?15
U-. i'n U : 1443-31
n.raka
209 NOM STREET
PCB D= 906
mAvww, W. X615
259-746 Il
202-746.7M FAX
1o ul& systaranbo" onyavt peq ty (Fames M I043-31) was dawned for s 2-
bedmm ile sbx and a 50-* matb wide a bstblrmm fora Bow mft toW of I,490
Sdba per drj. On I/8I02, you ixHa fed that you did not wmt a natrio- and imtod
doin a dbria*4*&om reddmw in its pbm You Ww wed fiat there m Wkwdy 10
r
10 slips requi o 30 g/d of flow and themfom utib 340 g!d of your draoaEield. The two-
bedroom residence wgi utM= 240 g/d ibr a c ud ined total of 340 g4 This hwws 950
10,11- g/d ofdrab be that ie oat belt util O& This ibw rW wdl a -cc- v I 11, I- P, a 3 bedroom
home at 360 g/d as wa l as albw hr t nre dav?eiopoaaat of 19 additional boat abps at 570
g/d. Thb wW gl,?e you adagate drahdkM lbr a trreawbedrooas base, a two-
bedrom bame, and a torsi 0 29 boat dips
Ifyoubave any quadow.or need addirkmd aadomwe, pbsre comsat this of= at 252-
745-5634.

PAMLICO COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH SECTION
BAYBORO, NORTH CAROLINA 28SIS
IMPROVEMENTS PERMIT
Permit valid for S years
ISSUED TO.-- Jim CRI PERMIT d 13230
ADDRESS% E.O. Box 246 RECORD e
as* oro. Z851S MAP *_HiP31 -`
REGISTERED PLAT: MAP BOOK WA PACE Ma- ATE WA
REGISTERED DEED: DEED BOOK,WI PAGE [ ATE N/A
SUBDIVISION: N/A LOT
TOWN: Maribel. N.C. SR d
LOCATION DIRECTIONS South on SR1219. TR-oato dirt rd
THIS PERMIT IS HEREBY ISSUED TO SERVE A:
MOBILE HOME (xxx) and OTHER (xxx)2BR -M
*BEDROOMS.- 28R eFACTORS
WATER SUPPLY: ( ) PUBLIC
OR W PRIVATE 100 Feet from any part of septic system
SITE CLASSIFICATION: t ) SUITABLE (xxx) PROVISIONALLY SUITABLE
LAND DRAINAGE: ( ) SUGGESTED ( ) NECESSARY
( ) DITCH NECESSARY ( ) SUB-SURFACE TILE NECESSARY set deep
and t ) TRENCH ROCKED TO WITHIN 1'OF GROUND SURFACE
and t ) WITH POLYURITHANE CURTAIN: FRENCH DRAIN
and ( ) FINISHED AT OUTFALL W/ SOLID PIPE A SCREEN
and t 3 FINISHED AT OUTFALL W/ CHECK VALVE
*** If land drainage is necessary, you any need to contact CAMA or
The Army Corps of Engineers for appropriate Permits
DESIGN:( ) LOCATION OPTIONAL (xxx) LOCATION AS SPECIFIED ON PLOT PLAN
( ) CONVENTIONAL SYSTEM:(ref.19SS) 18"K 3'trench, rock 12"deep
nitrification lines on 9' centers
(xxx) SHALLOW SYSTEM:(ref.19S6) trench 6 " wide, rock 12"deep,
*** add fill = 6" soil cover, rock to natural ground surface
t ) ROUND SYSTEM:(ref.19SOb) trench 18" deep A " wide in
suitable fill extending beyond any part of system
*** 6" = depth of FILL; pump necessary it unable to gravity feed
*** If fiii material is prescribed, you may need to contact The Army Corps
of Engineers or CAMA for appropriate permits.
( ) LPP SY5TEM:(ref.1957) see comments for design criteria
( ) BED SYSTEM:(ref.1955d) see comments for design criteria
t ) OFF-SITE DISPOSAL:(ref.19S7) see comments for design notes
al SEPTIC TANK ?gO_ gal PUMP TANK
QUARE FEET NITRIFICATION FIELD or NITRIFICATION BED
WEAR FEET NITRIFICATION LINE; 9(100') Lines
=
B27 RRIVI ON TANK, SYSTRK, 02 RE21JR, BUILDING AUA TO BE GREATER
FIVE FEET EROX TANK - SYSTEM - AND IR. VI IOJJS WILL VQJD PERMIT*
ADDITIONAL FOR ALL SYSTEMS:
LANDSCAPE SYSTEM AREA FOR SURFACE WATER RUNOFF AND GRASS
DO NOT PLACE DRIVE OR ANY BUILDING OVER SYSTEM AREA
OBSERVE ALL PROPER SETBACKS: ref .1950
TANKS BUST BE PUMPED CLEAN AS A PART OF ANY SYSTEM REPAIR.
DISC NATURAL GROUND BEFORE INSTALLATION OF ANY FILL
ALARM A ON-OFF FLOATS ON PUMPS MUST BE ON SEPARATE CIRCUITS
t IF BUILDING AREA EXTENDS INTO SYSTEM AREA THIS PERMIT WILL BE INVALID
t IF ANY OTHER REGULATORY AGENCY DENIES PERMITS FOR LAND ALTERATIONS AS
DESCRIBED HEREIN, THIS PERMIT WILL BE INVALID
PLOT PLAN MUST NOT BE ALTERED UNLESS BY SANITARIAN APPROVAL
ttttettettttttttt:ttttttttttttt PLOT PLAN tttttt:tttttt.etet:tt:ttett•t.
=DO NOT DRIVE ON TANK, SYSTEM, OR REPAIR. BUILDING AREA TO BE GREATER
IRAANrIVE FEET FROM TANK. SYSTEM. AND REPAIR. VIOLATIONS WILL VOID PERMIT*
See Addendum Sheet i 1 For Plot Plan.
. ? DATE .! - ? 14
a
STEPHEN D. LANE
ENVIRONMENTAL HEALTH SPECIALIST
ALL SEPTIC SYSTEMS MUST BE INSPECTED A RECEIVE APPROVAL BY THE LOCAL HEALTH
DEPARTMENT BEFORE BEING COVERED OR PLACED INTO USE AND NO ELECTRICAL
CONNECTION SHALL BE ALLOWED UNTIL APPROVAL HAS BEEN RECEIVED. (GS 130A)
A PLOT PLAN (TO SCALE) SHOWING ALL BUILDINGS,' DRIVEWAYS, WATER LINES A SEPTIC
SYSTEM LOCATIONS MUST BE APPROVED BY THE ENVIRONMENTAL HEALTH DEPARTMENT
PRIOR TO RECEIVING A BUILDING PERMIT.
ELEVATION CERTIFICATE E M eshi y., 1993
FEDERAL EMERGENCY MANAGEMENT AGENCY
NATIONAL FLOOD INSURANCE PROGRAM .
ATTENTION: Use of this certificate does not provide a waiver of the flood Insurance purchase requirement. This form is used only to
avid* alovation Inforfiation necessary to ensure compliance with applicable community tloodplain management ordinances, to
termine the proper Insurance premium rate, and/or to support a request for a Letter of Map Amendment or Revision (LOMA or LOMR).
Instructions for completing this form can be found on the following pages.
SECTION A PROPERTY INFORMATION FOR INSURANCE COMPANY USE
ButtI DING OWNER'S NAME POLICY NUMBER
!J, Vh t?
STREET ADDRESS (Includlnp ApL, Urdt, Suite and/or Bldg. Number) OR P.O ROUTE AND BOX NUMBER COMPANY NAIC NUMBER 4
OTHER DESCRIPTION (Lot and Block Numbers, eta.)
STATE ZIP CODE
SECTION B FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
Provide the following from the proper FIRM (See Instructions):
t, COMMUNITY NUMBER 2. PANEL NUMBER SUFFIX 4. DATE OF FIRM 1NDP-X S. FIRM ZONE Q- BASH FLOOD ELRVATION
1-13 E F_ 2g6 el 7SL5 ?95 70 1 O / (M AO zones. depth)
7. Indicate the elevation datum system used on the FIRM for Base Flood Elevations (BFE): ?NGVD'29 ?Other (describe on back)
a. For Zones A or V. where no BFE Is provided on the FIRM, and the community has established a BFE for this building site, Indicate
the community's 13FE:1 I I ( ! I.H feet NGVD (or other FIRM datum-see Section B, Item 7).
SECTION C BUILDING ELEVATION INFORMATION
1, Using the Elevation Certificate Instructions, Ind)cat the diagram number from the diagrams found on Pages 5 and 6 that best
describes the subject building's reference level
2(a). FIRM Zones Al-A30. AE, AH, and A (with BFE). The top of the reference level floor from the selected diagram Is at an elevation
of Li_LUB-0 feet NGVD (or other FIRM datum-see Section B. Item 7).
(b). FIRM Zones V1430, VE, and V (with BFE). The bottom of the lowest horizontal structural member of the reference level from
the selected diagram, Is at an elevation of 1 I 1 1 I I,Lj feet NGVD (or other FIRM datum-see Section B, Item 7).
(c). FIRM Zone A (without BFE). The floor used as the reference level from the selected diagram is U. LU feet above ? or
below ? (check one) the highest grade adjacent to the building.
(d). FIRM Zone AO. The floor used as the reference level from the selected diagram is 111.U feet above ? or below ? (check
one) the highest grade adjacent to the buildtng. If no flood depth number is available, is the building's lowest floor (reference
level) elevated In accordance with the community's Iloodplain management ordinance? ? Yes ? No ? Unknown
3. Indicate'the elevation datum system used in determining the above reference level elevations:,Q'NGVD '29 ? Other (describe
under Comments on Page 2). (NOTE. if the elevation datum used In measurfng the elevations is different than that used on
the FIRM (see Section B, Item 71, then convert the elevations to the datum system used on the FIRM and show the conversion
equation under Comments on Page 2.) ONO 4. Elevation reference mark used appears on FIRM: ? Yes LJ No (See Instructions on Page 4)
5. The reference level elevation is based on: ©'aclual construction ? construction drawings
(NOTE. Use of construction drawings Is only valid if the building does not yet have the reference level floor In place, In which
case INS certificate will only be valid for the building during the course of construction. A post-construction Elevation Cerfillcate
will be required once construction Is complete.)
6. The elevation of the lowest grade immediately adjacent to the building Is: L I ( I 131,LJ feet NGVD (or other FIRM datum-see
Section B, Item 7).
SECTION D COMMUNITY INFORMATION
1. It the community official responsible for verifying building elevations specifies that the reference level indicated In Section C, Item 1
Is not the "lowest floor" as defined in the community's ftoodplain management ordinance, the elevation of the building's "lowest
(loot" as defined by the ordinance is: I ( 1 I i.LJ feet NGVD (or other FIRM datum-see Section B. Item 7).
bate of the start of construction or substantial improvement
FEMA Form 81-31; MAY 90 REPLACES ALL PREVIOUS EDITIONS SEE REVERSE SIDE FOR CONTINUATION
SECTION E CERTIFICATION
.!A
This certification is to be signed by a land surveyor, engineer, or architect who Is authorized by slate or local law to certify elevation
Information when the elevation information for Zones Al-A30, AE, AH, A (with 8FE),V1-V30,VE, and V (with OFE) Is required.
;ommunity officials who are authorized by locai.law or ordinance to provide floodptain management information, may also sign the
certification. In. the case of Zones AO and A (wfthout a FEMA or community issued SIZE), a building official, a property owner, or an
owner's representative may also sign the certification. _
Reference level diagrams 8, 7 and 8 - Distinguishing Features-41 the certifier Is unable to certify to breakaway/non-breakaway wail,
enclosure size, location of servicing equipment, area use, wall openings, or unfinished area Feature(s), then list the Feature(s) not
included in the certification under Comments below. The diagram number, Section C, Item 1, must still be entered.
• '1
I certify that the information in Sections 8 and C on this certificate represents my best efforts to Interpret the data available.
I understand that any false statement may be punishable by me or imprisonment under 18 U.S. Code, Section IW I.
CE TIFIER'S NAME / LICENSE NUMBER (or Affix Seal)
TITLE
ADDRESS CITY STATE ZIP
0
rr,vnc
Copies should b made of this Certificate for: 1) community offfelal, 2) insurance agent/company, atitj 3) building owner.
COMMENTS: i?'/491kl -32 !•
,,?,.? to •
U.
ON WITH
BLAB EASEMENT ON PILES.
PIERS, OR COLUMNS
A v A A •16+ v
ZONES ZONES ZONES ZONES 7
ZONES •,

....._ l
RErERENCE ...t.. J(REF •? - - ._-... ...?.

L
LEVEL .,v,. • FLOOD
LEVEL
lLEVAT

BASE
FLOOD • • •,• t 1?7=;, ABJACENr RfiVERENCF BASE
AN .
ELEVATx7N REFEREMCE ADJACENT i OMBE LEM . i1,•, ' FL
?EVATION '
LEVEL
owe

'
`
E
7
i r
1±
L
':
iv E
':' SA ?St
€
?
"
?t
?;r. ,.v.. F
••' •r?:p.AOJACENT?

The diagrams above illustrate the points at which the elevations should be measured In A Zones and V Zones.
Elevations for all A Zones should be measured at the to
al
f th
f
e l
p o
e re
erenc
evel floor.
Elevations for all V Zones should be measured at the bottom of the lowest horizontal structural member.:'

Paos 2 '
. r

State of North Carolina
Department of Natural Resources and Community Development
Northeastern Region
1424 Carolina Avenue, %shk oon, North Carolina 27889
James G. Martin, Governor Howard lL Moye, Jr.
S. Thomas Rhodes, Secretary September 24, 1985 RCV r
LETTER OF APPROVAL
Mr. James E. Cox, Jr.
P.O. Box 246
Bayboro, North Carolina 28SIS
RE: Land-Disturbing -Activities Adjacent to
lapel Creek
Pamlico County
Dear Mr. Cox:
We have reviewed the erosion/sedimentation control plan for the above
referenced project and are approving the plan for construction.
Approval of the plan is subject to satisfactory performance of the
measures indicated under actual field conditions. Should any of the measures
indicated fail to provide adequate control, this office may require additional
measures.
If additional development related to this site is to occur, amendments
must be submitted to reflect the changes,or additions.
If you should have any questions, feel free to call; otherwise, we will
be making periodic inspections.
Sincerely,
Floyd.R. Williams, C.P.G.S.
Regional Engineer
Division of Land Resources
Land Quality Section
FRWIRAS:mgr

pa Baas 15W, VW*Ww, Noatb CarAw zXF.4-13W Telephone 91%9*60

1

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cad ° o / t T`I
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=OFFICE E ONLY. Date Received Request #
State of Noah Carolina
Department of Environment and Natural Resources
Division of Water Quality
"General" Major Variance Application Form -
From the Neese and Tar Pamlico Riparian Buffer Protection Rules for residential structures
on existing lots within the coastal counties as def lased by the Coastal Area Management Act
(As approved by the water Quality Committee of the a vironme9ntal Mmagemeat Commission on 5/9!2001)
----- - -------
please identify which Riparian Area Protection Rule applies.
? Nsuse River Basin: Nutrient Sensitive
Riparian i?Areas Rule (95A NCAC?O )
Protection and Maintenance o
a Tar-Pamlico River Basin: Nutrient Sensitive Wafters Management
strategy Protection and Maintenance of Riparian Areas Rule (15A
NCAC .0259)
NOTE:
To constitute a complete application, all of the informadon requested In c is form
must be provided. Incomplete appIkst ons will be returned to the app! The
original and two copies of the completed llGenerW Variance Appilcalion Form and
any a chmm'u?t be sent to the DVIQ 4011Wetlands GerfiAcation Unit, 18M Mall
Service Center, Ra/elgh, NC 276991650, 979-733-4786 to constitute a complete
submittal. This form may be photocopled for use as an original.
Part 1: General Information
(please include attachments if the room provided is Insufficient.)
1. Applicants name
2. Print Owner/Signing
Name:
Title:
Stred address:
City, State, Zip:..
Telephone:
Fax:
jatlon, individual, etc. who owns the property):
(person legacy responsible for the arty and
3. Contact person who can answer
Name: .?...?.:?
Telephone: f?a
Fax:
YGenerar Variance Application Form
Version 1: May 2001
about the proii project:
Email:
4. Project Name (Subdivision, facility, or establishment name - consistent with project name on
plans, speciflcatlons, letters, operation and maintenance agreements, etc.):
"/ / rA G a X _
5. Project Location:
Street address:
City, State, Zip:
County.
L,stitude/iongltude:
a. Directions to site from nearest major intersection (Also, attach an 8 "A x 14 copy of the portion
of the USGSographic ma indicating the location of the site):
11P
Impactedgby tttieipropvdPs'?9d aCt'A'y. 41q?
?. Stream o
Stream name (for unnamed streams Wbet as "U[" to the nearest named stream):
Stream ciassmcation tat idenmo
(Meuse) or.0316 (Tar-Pamlico)]:
or
2B .0315
8. Which of the following permitslapprovals vdl be required or have been received already for
this project?
Required: Received: Date received: Permit Type: /`
CAMA Major v rtP- c1 6qO /&r r
CAMA Minor
! 401 CertificsdtoN404 Permit ?
1 Ca-?+pjr?-f ed On-alts Wastewater Permit
Active Connection to Sanitary Sewer System
NPDES Permit (Inciu(flr I)KKC
No"scharge Permit
Water Supply Watershed Martan?e
. ??, others (specify) Oar/ C?-T
Part 2: Proposed Activity
(Please Include attachments If the room provided is insufficient.)
1. Descripti Rroposed activity [Also, please attach ' a sufficient detail (such as a plate
map or site play to accurately delineate the boundaries of the land to be utilized In crtg
out the activity, the location and dimension of any disturbance In the riparian buffers
associated with the activity, and the extent of riparian buffers on the land. Include the area
of buffer Impact In fe.:

'General" Valiance Apprication Fort, page 2
2. State reasons why this plan for the proposed activity cannot be practiiC* accomplished,
reduced or reconfigured to better minimize or eliminate disturbance to the riparian buffers:
3. Description of any beat management practices to be used to control impacts associated with
the proposed activity (i.e., control of nmoff from impervious surfaces to provide diffuse flow,
re-planting vegetation or enhancement of existing vegetation, etc.): /
4. Please provide an explanation of the folkrMng:
(1) The practical dittic ulties or hardships that would result from the strict application of this
(3) tf economic hardship is the major consideration, then Include a specific explanation of the
economic hardships and the,proportion V the hardship to ft,,pntlrs value of the project.
Part 3: Deed Restrictions
By your signature in Part S of this application, you certify that all structural stormwater best
management practices required by this variance shall be located in recorded storrrwvater
easements, that the easements A run with the land, that t'te easements cannot be changed or
deleted without concurrence from the State, and that the easements will be recorded prior to the
sale of any lot.
Part 4: Agent Authorization
if you wish to designate submittal authority to another individual or firm so that they may provide
information on your behalf, please complete.this section:
Designated agent (Individual or firm):
[Nutting address:
"Gent Variance Application Form, page 3
(2) How these difficulties or hardships result from conditions that are unique to the property
Involved. O X' .W c? !n a u .
!?'? _S ?1r__ ? u try ?°.. 077S°/'
City, State, zip:
Telephone:
Fax:
Emali:
parts: Applicant's Certification
It (print or type name of person
listed In Part 1, item 2?oteM that the Information In uded on this permit application form is
oorrect, that the project will be constructed in caftrmance with the approved plans and that the
deed restrtcdons in accordance with Part 5 of this form will be recorded with all required permit
conditions.
Signature:
Date:
Title:
NO "ion of Water Quality (DWQ)
401 Watlands Certification Unit
2321 Crabtree Blvd. (LOCATION)
1650 Mail Servim Center (MAILING ADDRESS)
Raleigh, NO 276994850
[phone] (phone)
http:llh2o.enr state nc.uslncwetlandst
RALEIGH REGULATORY FIELD OFFICE
US Army Corps of Engineers
6508 Fags of the Neuse Road, Suite 120
Raleigh, North Carolina 27615
General Number: [phone]
http:/Avw w saw.usaoe.amiy.mll/wetlandsheocur.htm
WASHINGTON REGULATORY FIELD OFFICE
US Amoy Carps of Engineers
Post Office Box 1000
Washington, North Carolina 27889-1000
General Number: [phone]
http:/Avww.aaw.uaaea.army mlVwetiandalregtour htm
Washington Distrfcl Office
Division or Coastal Management
943 Washington Square Mail
Washington, NO 27889
phone: [phone]
Morehead City District Office
"Ion of Coastal Management
151-B Highway 24
Morehead City, NC 28557
phone: [phone]
'Generar Variance Application Form, page 4
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PA=M1CO C?FUN TY
HEALTH
DEPARTMENT
may 9, "M

r
Tim Cox
PO BU 246
ftboro, NC MIS
M. Psroel 1D: 1043-31
Dar ft or Madam;
209 iVO M MIMT
POWX=
BAYAOM M 29615
26'?-7611 t
22-7,W"U FAX
The septipc systamxwW d on your property (Parcel M 1043-31) was daWoed for a 2-
bedroomwsklewe nd a 30-s 1 u1 wkh a far a Saw rase total of 1,490
gdkm per day. On 1/8102, you indicated that you did not vast a marbta end iostaad
deive a three4admem residence in its piece. You also bxHoeted that 6me are already 10
14 slips r*qWm 30 Sid of Saw and diare6ore mace 300 gld of your dra ieid. The two-
bedroom resident wail utilise 240 g!d tw a combined loud of 540 gld. M leaves 950
g/d of drain Has that is not bft utibed. lU Sow aft wiU a 3 bedroom
boom at 360 Sid as weR as allow Ak ftwe daveiopmeirt of 19 addkional boat dp at 370
8ML Thk wN give yam adequate dnin" hr a di boom, a two.
bedroom hemp acid a t*W 029 boat dip&
If you bane any queWww,or need ak*kmd m W"WC6 plere coataat this ofce at 252-
745-5634.
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F?romsemtHa?hspe?

PAMLICO COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH SECTION
BAYBORO, NORTH CAROLINA 28SIS
IMPROVEMENTS PERMIT
Permit valid for S years
ISSUED TO:_ tin Cox PERMIT * 13230
ADDRESS: P.O. Box A46 RECORD e
9SYboro, N.C. 28515 HAP # 1043-31
0
REGISTERED PLAT: MAP BOOK- PAGE ATE N/A
REGISTERED DEED: DEED BOOK&A PAGE____DATE N/A
SUBDIVISION: N/A LOT
TOWN: arlpp_l. N.C. SR d
LOCATION DIRECTIONS South on SR1219. TR onto dirt rd
THIS PERMIT IS HEREBY ISSUED TO SERVE A:
MOBILE HOME (xxx) and OTHER (xxx) 2BR MOBILE HOXE, AMID So SLIP- 11ARINA
#BEDROOMS: 2BR #FACTORS
WATER SUPPLY: ( ) PUBLIC
OR X) PRIVATE 100 feet from any part of septic system
SITE CLASSIFICATION:
LAND DRAINAGE: ( )
( ) DITCH NECESSARY
and
and
and
and
'?** If land drainage
The Army Corps of
) SUITABLE (xxx) PROVISIONALLY SUITABLE
SUGGESTED { ) NECESSARY
SUB-SURFACE TILE NECESSARY set deep
TRENCH ROCKED TO WITHIN 1'OF GROUND SURFACE
WITH POLYURITHANE CURTAIN: FRENCH DRAIN
FINISHED AT OUTFALL W/ SOLID PIPE A SCREEN
FINISHED AT OUTFALL W/ CHECK VALVE
is necessary, you may need to contact CANA or
Engineers for appropriate Permits
DESIGN:( ) LOCATION OPTIONAL (xxx) LOCATION AS SPECIFIED ON PLOT PLAN
( ) CONVENTIONAL SYSTEM:(ref.1955) 18"X 3'trench, rock 12"deep
nitrification lines on 9' centers
(xxx) SHALLOW SYSTEM:(ref.1956) trench 36 „ Wide, rock 12"deep,
*** add fill = 6" soil cover, rock to natural ground surface
( ) MOUND SYSTEM:(ref.1950b) trench 18" deep A „ wide in
suitable fill extending. beyond any part of system
# 6" = depth of FILL; pump necessary if unable to gravity feed
If fill material is prescribed, you may need to contact The Army Corps
of Engineers or CANA for appropriate permits.
t ) LPP SYSTEMs(ref.1957) see comments for design criteria
t ) BED SYSTEM:(ref.19SSd) see comments for design criteria
( ) OFF-SITE DISPOSAL:(ref.19S7) see comments for design notes
al SEPTIC TANK 50 gal PUMP TANK
QUARE FEET NITRIPMATTU FIELD or NITRIFICATION BED
INEAR_FEET_NITRIFICATION LINE; 9(100') Lines
*DO N
T
O
DRIVE ON 16NK. SYSTEM. O R REPAIR. BUILDING AREA IQ IS GREATE R
THAN FIVE FEET FROM TANK, SYSTEX = AND RZEAI R ?VIOLATIONS WILL VOID PE RMIT*

ADDITIONAL FOR ALL SYSTEMS:
LANDSCAPE SYSTEM AREA FOR SURFACE WATER RUNOFF AND GRASS
DO NOT PLACE DRIVE OR ANY BUILDING OVER SYSTEM AREA
OBSERVE ALL PROPER SETBACKS: ref .1950
TANKS MUST BE PUMPED CLEAN AS A PART OF ANY SYSTEM REPAIR.
DISC NATURAL GROUND BEFORE INSTALLATION OF ANY FILL
ALARM A ON-OFF FLOATS ON PUMPS MUST BE ON SEPARATE CIRCUITS
t IF BUILDING AREA EXTENDS INTO SYSTEM AREA THIS PERMIT WILL BE INVALID
s IF ANY OTHER REGULATORY AGENCY DENIES PERMITS FOR LAND ALTERATIONS AS
DESCRIBED HEREIN, THIS PERMIT WILL BE INVALID
PLOT PLAN MUST NOT BE ALTERED UNLESS BY SANITARIAN APPROVAL
sssettttettttttststtttttttttttt PLOT PLAN s«tstsssttststtsssssstttsttss
*DO NOT DRIVE ON TANK, SYSTEM, OR REPAIR. BUILDING AREA TO BE GREATER
THAN rIVE FEET FROM TANK. SYSTEM. AND- REPAIR, VIOLATIONS WILL VOID PERMIT*
See Addendns Sheet i 1 for Plot Plan.
DATE
STEPHEN D. LANE
ENVIRONMENTAL HEALTH SPECIALIST
ALL SEPTIC SYSTEMS MUST BE INSPECTED A RECEIVE APPROVAL BY THE LOCAL HEALTH
DEPARTMENT BEFORE BEING COVERED OR PLACED INTO USE AND NO ELECTRICAL
CONNECTION SHALL BE ALLOWED UNTIL APPROVAL HAS BEEN RECEIVED. (GS 130A)
A PLOT PLAN (TO SCALE) SHOWING ALL BUILDINGS,, DRIVEWAYS. WATER LINES A SEPTIC
SYSTEM LOCATIONS MUST BE-APPROVED BY THE ENVIRONMENTAL HEALTH DEPARTMENT
PRIOR TO RECEIVING A BUILDING PERMIT.
ELEVATION CERTIFICATE E" esM y3/ .1 77
1 193
FEDERAL EMERGENCY MANAGEMENT AGENCY
NATIONAL FLOOD INSURANCE PROGRAM .
ATTENTION: Use of this certificate does not provide a waiver of the flood Insurance purchase requirement. This form is used only to
-ovide olevatgan Inrorrrlatlon necessary to ensure compliance with applicable community fioodpTaln management ordinances, to-
termine the proper insurance premium rate, and/or to support a request for a Letter of Map Amendment or Revision (LOMA or LOMB).
Instructions for completing this torn can be found on the following pagtis.
SECTION A PROPERTY INFORMATION FOR INSURANCE COMPANY USE
BUILDING OWNER'S NAME POLICY NUMBER
STREET ADDRESS (Including Apt., Unit, Sulle and/or Bldg. Number) OR P.O. ROUTE AND BOX NUMBER COMPANY NAIL NUMBER
Ju/,L ..._C' z C f l
QTHER.DESCRIPTION(Lot "Block Numbers. elm)
CLTY
CTATE ZIP O
&5 L6-
SECTION B FLOOD INSURANCE RATE MAP (FIRM) INFORMATION J
Provide the following from the proper FIRM (See Instructions):
COMMUNITY NUMBER 2. PANEL NUMBER S. SUFFIX ;44. ATE OF FIRM INDEX 8. FIRM ,ZONE e. BASE FLOpp EFVATtON
171.0 ! o? 4? v T S? A.5" ?AD Zenas. ;m.de?,,
7. Indicate the elevation datum system used on the FIRM for Base Flood Elevations (BFE): ? NC3VD '29 ?Other (describe on back)
S. For Zones A or V, where no BFE is provided on the FIRM, and the community has established a BFE for this building site, indicate
the community's BFE: LI ! i ! i.U feet NGVD (or other FIRM datum-see Section B, Item 7),
SECTION C BUILDING ELEVATION INFORMATION
1. Using the Elevation Certificate Instructions, indicat the diagram number from the diagrams found on Pages 5 and 6 that best
describes the subject building's reference level
P(a). FIRM Zones Al-A30, AE, AH, and A (with BFE). The top of the reference level floor from the selected diagram is at an elevation
of ( J I LJ-SJ W feet NGVD (or other FIRM datum-see Section B, Item 7).
(b). FIRM Zones V 1-V30, VE, and V (with BFE). The bottom of the lowest horizontal structural member of the reference level from
the selected diagram, is at an elevation of LI I 1 I I,[,-„j feet NGVD (or other FIRM datum-sea Section B, Item 7).
(c). FIRM Zone A (without BFE). The floor used as the reference level from the selected diagram is UJ.U feet above ? or
below El (check one) the highest grade adjacent to the building.
(d). FIRM Zone AO. The floor used as the reference level from the selected diagram Is (,..,j feet above ? or below 0 (check
one) the highest grade adjacent to the building. If no flood depth number Is available, is the building's lowest floor (reference
level) elevated in accordance with the community's Doodplain management ordinance? ? Yes ? No ? Unknown
3. Indicate'the elevation datum system used in determining the above reference level elevations:,Q'NGVD'29 ? Other (describe
under Comments on Page 2). (NOTE. If the elevation datum used In measuring the elevations is different than that used on
the FIRM [see Section B, Item 4 then convert the elevations to the datum system used on the FIRM and show the conversion
equation under Comments on Page 2.) ?.,/
4. Elevation reference mark used appears on FIRM: ? Yes 93 No (See Instructions on Page 4)
5. The reference level elevation Is based on: ©'acitial construction ? construction drawings
(NOTE. Use of construction drawings is only valid if the building does not yet have the reference level floor in place, In which
case this certificate will only be valid for the but7ding during the course of construction. A post-construction Elevation Certificate
will be required once construction is complete.)
6. The elevation of the lowest grade Immediately adjacent to the building is: I 1 I 13J.Ll feet NGVD (or other FIRM datum-see
Section B, item 7).
. •r
SECTION D COMMUNITY INFORMATION
1. It the community official responsible for verifying building elevations specifies khat the reference level Indicated in Section C. Item 1
Is not the "lowest floor" as defined In the community's Doodplain management ordinance, the elevation of the building's "lowest
floor" as defined by the ordinance is: [ L 1 1 I U feet NGVD (or other FIRM datum-see Section B. Item 7).
Jate of the start of construction or substantial Improvement
FEMA Form 81-31r MAY 90 REPLACES ALL PREVIOUS EDITIONS SEE REVERSE SIDE FOR CONTINUATION
. SECTION E CERTtFICATtON
)A
This certification is to be signed by a land surveyor, engineer, or architect who is authorized by state or local law to certify elevation
Information when the elevation information for Zones Al-A30, AE, AH, A (with BFE),V1-V30,VE, and V (with OFE) is required.
:ommunity officials who are authorized by locai.law or ordinance to provide floodplain management Information, may also sign the
certification. In. the case of zones AO and A (without a FEMA or community issued 8FE), a building official, a property owner, or an
owner's representative may also sign the certification.
Reference level diagrams 6, 7 and 8 - Distinguishing Features-if the certifier Is unable to certify to breakaway/non-breakaway wail,
enclosure size, location of servicing equipment, area use, wall openings, or unfinished area Feature(s), then fist the Feature(s) not
included In the certification under Comments below. The diagram number, Section C, Item 1, must still be entered.
I certify that the Information In Sections 8 and C on this certificate represents my best efforts to Interpret the data available.
i understand that any false statement may be punishable by fine or Imprisonment under 18 U.S. Code, Section 1001.
CE TIFIER'S NAME LICENSE NUMBER (or AMix Sea!)
73
TITLE 1 ,. ra -270
__,..... Qa,V V1V uc irraaia W ui13 l.6r11I1CaTe Tor: 1) community ofitcial, 2) insurance agent/company, and 3) building owner:
COMMENTS:. ?ce Ahe Cly'rGr'!? ? /U C (o S ?/lJt!/I7?'/1/J" I `?i?l?r 32 !•

+. J.
fji... ,
oil'
ON
SLAB
! = wWmw
' f ' BASEMENT
?•;?.. A
ZONES
own
The diagrams above illustrate the points at which the elevations should be measured in A ?..ones and V Zones.
Elevations for all A Zones should be measured at the top of the reference level floor. KI.
+e:l,
Elevations for all V Zones should be measured at the bottom of the lowest horizontal structural member.:.
w
Page 2 •
ADDRESS
CITY
ON PILES,
PiRM. OR COLLIMINS
A -v
ZONES ZONES

State of North Carolina
Department of Natural Resources and Community Development
Northeastem Region
1424 Carolina Avenue, Washington, North Carolina 27889
James G. Martin, Governor l mard D. Moye, Jr.
S. Thomas Rhodes, Secretary September 24, 1985 Regional Manager
LETTER OF APPROVAL
Mr. Janes B. Cox, Jr.
P.O. Box 246
Bayboro, North Carolina 28515
RE: Land-Disturbing-Activities Adjacent to
Chapel Creek
Pamlico County
Dear Mr. Cox:
We have reviewed the erosionlsedinentation control plan for the above
referenced project and are approving the plan for construction.
Approval of the plan is subject to satisfactory performance of the
measurers indicated under actual field conditions. Should any of the measures
indicated fail to provide adequate control, this office may require additional
measures.
If additional development related to this site is to occur, arAndments
must be submitted to reflect the changes'or additions.
If you should have any questions, feel free to call; otherwise, we will
be making periodic inspections.
Sincerely, 1
F1oyd.R. Williams, C.P.G.S.
Regional Engineer
Division of Land Resources
Land 'Quality Section
FRWIRAS:mgr

Pn Box 1SO7, \Vkddroon, North CardW 2768 IS07 Tdq*one 91944660