20021310 Ver 1_Complete File_20020819

Michael F. Easley
Governor
William G. Ross, Jr., Secretary
Department of Environment and Natural Resources
Alan W. Klimek, PE, Director
Division of Water Quality
January 9, 2003
(Replaces Approval issued on November 8, 2002)
DWO Project #02-1310
Hyde County
. Page 1 of 2
Laura B. Barabas
c/o: Mr. David L. Miller
P.O. Box 1111
Ocracoke, NC 27960
Subject Property: 76 Elizabeth Lane, Ocracoke, NC 27960
Pamlico Sound [03-03-08; 29-(40.5); SA HQW (high quality)]
APPROVAL for the use of the "General" MAJOR VARIANCE; From the Tar-Pamlico 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 Ms. Barabas:
You have our approval, in accordance with the conditions listed below, to impact approximately 1,400 square feet of the
protected riparian buffers for the purpose of constructing a single family home on the subject property as described within
your application dated August 14, 2002 and depicted on the attached site plan initialed by DWQ staff on January 9, 2003.
This letter shall act as your approval for the use of the "General" Major Variance; From the Tar-Pamlico 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 as approved by the Water Quality
Committee (WQC) of the Environmental Management Commission (EMC) on May 10, 2001. In addition, you should get
any other required federal, state or local permits before you proceed with your project including (but not limited to)
Sediment and Erosion Control and CAMA permits. This approval shall expire when the variance expires on April 11, 2006
unless it is renewed before that time by the EMC. This approval replaces the approval issued on November 8, 2002.
This approval is only valid for the purpose and design that you described in your variance request. If you change your
project, you must notify us and you may be required to send us a new request for approval. If the property is sold, the
new owner must be given a copy of this approval and is thereby responsible for complying with all conditions. For this
approval to be valid, you must follow the conditions listed below.
Conditions:
The home shall not be placed closer than ten (10) feet to the CAMA coastal wetland and no clearing of
vegetation shall occur within 10 feet of the CAMA coastal wetland (except for "exempt" uses identified
within 15A NCAC 02B .0259(6).
2. All new stormwater drainage shall be directed to vegetated areas as diffuse flow at non-erosive velocities
prior to entering the protected riparian buffers as identified within 15A NCAC 2B .0259(5). No new
ditching or piping of stormwater through the protected buffers is allowed.
3. You are required to mitigate for impacts to Zone 1 of the protected riparian buffers. The required area of
mitigation to compensate for impacts to Zone 1 of the protected riparian buffers shall be 430 square feet
as required under the "General" Major Variance for Coastal Counties. The DWQ has determined that
planting additional trees or woody shrubs within the protected buffer on the property will satisfy this
mitigation requirement. The preferred number of individual plants shall be such that there are at least 320
trees or shrubs per acre at maturity within Zone 1 and shall not be less than nine (9) new, individual trees
or woody shrubs. These plantings shall occur no longer than one year after construction of the home has
been completed. This office shall be notified in writing that the plantings have been installed within one
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), http://h2o.enr.state.nc.us/ncwetlands/
Page 2 of 2
month of the installation of the plantings. You are required to ensure survival of these plants for a period
of five (5) years from the date of their installation. You are required to replace any plants that do not
survive within this five-year period.
Deed Notifications
Deed notifications or similar mechanisms shall be placed on all retained jurisdictional wetlands, waters
and protective buffers in order to assure compliance for future wetland, water and buffer impact. These
mechanisms shall be put in place prior to impacting any wetlands, waters and/or buffers approved for
impact under this Certification Approval and Authorization Certificate.
If you do not accept any of the conditions of this approval, you may ask for and adjudicatory hearing. You must act within
60 days of the date that you receive this letter. To ask for a hearing, send a written petition that conforms to Chapter
150B of the North Carolina General Statutes to the Office of Administrative Hearings, 6714 Mail Service Center, Raleigh,
NC 27699-6714. This approval and its conditions are final and binding unless you ask for a hearing.
This letter completes the review of the Division of Water Quality under the Tar-Pamlico River Riparian Buffer Protection
Rules (15A NCAC 2B.0259 (9)(b)): Please call Mr. Bob Zarzecki at 919-733-9726 or Ms. Deborah Sawyer at 252-946-
6481 if you have any questions or require copies of our rules or procedural materials.
cc:
Tom Steffens, DWQ Washington Regional Of
Terry Moore, DCM Washington District Office
File copy
Central Files
DWQ021310
January 9, 2003
bz
Sincerely,
Dec 16 02 03:47a LIELEVEN SHRDES'N MOVIES, ?-5z-azti-auuu
P•1
HYDE COUNTY HEALTH DEPARTMENT SITE PLAN
LAURA BARABAS & DAVID MILLER
PERMIT #10202-1

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OFFICE USE ONLY: Date Received
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State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
"'General" Major Variance Application Farm -
the Neuse and Tar-Pamlico Riparian Buffer Protectioit Rules for residential structures
From
on existing lots within the coastal counties as defined by the Coastal Area Commission on 5/9/2001)
A
•
(As approved by the Water Quality Committee of the Environmental Management
Please identify which Riparian Area Protectioh Rule 'applles:'
a°
l?Neuse River Basin: Nutrient Sensitive Waters Management Strategy
Protection and Maintenance of Riparian Areas Rule (15A NCAC .0233)
14 Tar-Pamlico River Basin: Nutrient Sensitive Waters Management
Strategy Protection and Maintenance of Riparian Areas Rule (15A
NCAC.0259)
i -
NOTE:
To constitute a complete applicatlon, all of the information requested In this form
must be provided, incomplete applications will be returned to the applicant. The
original and two copies cf the completed "General" Variance Application Form and
any attachments must be sent to the DWo 4611wetlands Certification unit, 1650 Mail
Service Center, Raleigh, NC 27699-1650, 919-733-1786 to constitute a complete
submittal. This form may be photocopied for use as an original. F15 -?3 ? " S7L6
c
eLi3t fn,•df`
Part 1: General information
(Please include attachments.if the room provided Is insufficlent.)• our 15
1. Applicants name Lthe orpor d n, individual, etc. who owns the property):
2.
Print Owner/Signing
Name:
Title:
Street address:
City, state, Zip:.
Telephone:
Fax:
Fax:
(person i Sally responsible for the property and its compliance)
3. Contact person who can answer questions about the proposed project:
Name: Akav - or flay i,d ?. OX
Telephone: f2..)4t9_- A'ooa
tmau: ._
"Generar Variance Application Form
Version 1: May 2001
4. Project Name (Subdivision, facility, or establishment name - consistent with project name on
j,,,?
plans, specifications, letters_o isr tlon amaintena L r? men , etc.):
? t ? ?.. '' w .? ,pv, V ?"r. ? •. ;?2 t....:+t. ..? A- . a . ?s M r '; •: 7 t ?.. '? r ? ?y
rc..?$ L K ?.t-f M BYO' .• + ..}• ?1'. ' Y? L..T •. • _ Y.. `a aK? • •
,5. Project Location: r d h , -
... Street address: 7.3 Sim-c'
City, State, Zip:;s-:
County: :t . ., ,.
Latitudetlongitude:
8: Qtrecttoris to site from nearest major Infersectlon (Also; 'attach an 8'fs x 11 copy of the portion
of the .US.GS topograp
-,.A a A a I a 0'r1i"; 'w&Jv 's a . 2- it 4?-nf '?ao A ;1 hic.m indicating the location of the site). Q
W AdF -An .4V AM_
7. Stream to beIm acted by the p or posed actIvif
9
Stream name (for unnamed streams 1 el as?y: UT" to the nearest named stream):
,Ma.r?h
Stream classification [as identified within the Schedule of Classifications. 15A NCAC 2B
.0315 (Neuse) or .0316 (Tar-Pamlico)]: . nes
s. Which of the following permitslappmvals will be required or have been received already for
this project?
Required:; Received: Date received: Permit Type:
CAMA Major
p v,? CAM Minor
401 Certification/404 Permit
On-site Wastewater Permit
Active Connection to Sanitary Sewer System
NPDES Permit (Including stormwater)
Non-discharge Permit
AOL Water Supply Watershed Variance
9% of Others (specify)
Part 2: Proposed Activity
(Please include attachments if the room provided is insufficient)
1. Description of proposed activity [Also, please attach a map of sufficient detail (such as a plat
map or site plan) to accurately delineate the boundaries of the land to be utilized In carrying
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
2. State reasons why this plan for the proposed activity cannot be practically accomplisnea,
reduced or reconfigured to better minimize or eliminate disturbance to the riparian buffers:
"General" Variance Application Form, page 2
Version 1: Mav 2001
r
3.
oaM tilt
4. Please provide an explanation of the following:
(1) The practlcal difficulties or hardships that would result from the strict application of this
(3) if economic hardship is the major consideration, then include a specific explanation of the
economic hardships and the proportion of the hardship to the entire ft 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 will 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
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
Mailing address:
City, State, Zip:
Telephone:
"General" Variance Application Form, page 3
Version 1: May 2001
Description of any best management practices to be used to control impacts assoclated with
the proposed activity (i.e., control of runoff from impervious surfaces to provide diffuse flow,
re-planting vegetation or enhancement of existing vegetation, etc.): >?J
•.1(?LO ?S ?I?s'!? ?fZi S•la/IA -'?'r?L . , ? ? •1?. I.,r,e a fw.r
rat Mnw these difficulties or hardships result from conditions that are unique to the property

Fax:
Email:
Part 5: AppilcanVs Certification' ' . _
1*a?: ba:?" (print or type name of person
listed In Part 1, Item 2), certify that the information included on this permit application forrh 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.. ... _ _ . - - - _ .... _ .. r:
Signature:
Date:
Title:
,le NC Division of Water Quality (DWQ)
401 Wetlands Certification Unit
2321 Crabtree Blvd. (LOCATION)
1650 Mail Service Center (MAILING ADDRESS)
Raleigh, NC 27699-1650
[phone] (phone)
http:l/h2a.enr.state.ne.ustnewatlands/
RALEIGH REGULATORY FIELD OFFICE
US Army Corps of Engineers
6508 Fails of the Neuse Road, Suite 120
Raleigh, North Carolina 27615
General Number. [phone]
http:!/www.saw.usace.army.mlVwetlandslregtour.htm
WASHINGTON REGULATORY FIELD OFFICE
US Army Corps of Engineers
Post Office Box 1000
Washington, North Carolina 27889-1000
General Number. [phone]
http:/Avww.saw.usace.ormy.m!Vwetiands/regiour.him
Washington District Office
Division of Coastal Management
943 Washington Square Mali
Washington, NC 27889
phone: [phone]
Morehead City District Office
Division of Coastal Management
151-B Highway 24
Morehead City, NC 28557
phone: [phone]
"General" Variance Application Form, page 4
Version 1: Mav 2001
December 5, 2002
DWQ Project #02-1210
Hyde County
Bob Zarzecki
DWQ 401/Wetlands Certification Unit
1650 Mail Service Center
Raleigh, NC27699-1650
Dear Bob:

u V ?S
DEC 1 0 2002
. _ aown ?
Please find enclosed the original "General" Major Variance Application Form. In
response to our conversation on Tuesday, December 3, also find enclosed the new
building envelope and plan for our house. Laura Barabas and myself are asking for
approval from the Division of Water Quality to impact an additional 30 feet into Zone 1
of the buffer zone. After further investigation of the property, we find this new plan to
be the least harmful to the vegetation. Also, our new house plan is approximately 300
square feet smaller than the original plan we submitted with the application in August
2002.
I hope this information to be helpful regarding your decision. We are requesting a rush
on this revision due to the circumstances that occurred with our original application.
If I can be of further assistance, please feel free to contact me at [phone] or (304)
389-4446.
HYDE COUNTY HEALTH DEPARTMENT SITE PLAN
LAURA BARABAS & DAVID MILLER
PERMIT ##10202-1
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HYDE COUNTY HEALTH DEPARTMENT SITE PLAN
LAURA BARABAS & DAVID MILLER
PERMIT #10202-1
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Alan W. Klimek, PE, Director
Division of Water Quality
November 8, 2002
Laura B. Barabas
c/o: Mr. David L. Miller
P.O. Box 1111
Ocracoke, NC 27960
Subject Property: 76 Elizabeth Lane, Ocracoke, NC 27960
. Pamlico Sound [03-03-08; 29-(40.5); SA HQW (high quality)]
DWO Project #02-1310
Hyde County
Page 1 of 2
APPROVAL for the use of the "General" MAJOR VARIANCE; From the Tar-Pamlico 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 Ms. Barabas:
You have our approval, in accordance with the conditions listed below, to impact approximately 470 square feet of Zone 2
of the protected riparian buffers for the purpose of constructing a single family home on the subject property as described
within your application dated August 14, 2002. This letter shall act as your approval for the use of the "General" Major
Variance; From the Tar-Pamlico 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 as approved by the Water Quality Committee (WQC) of the Environmental Management Commission
(EMC) on May 10, 2001. In addition, you should get any other required federal, state or.local permits before you proceed
with your project including (but not limited to) Sediment and Erosion Control and CAMA permits. This approval shall
expire when the variance expires on April 11, 2006 unless it is renewed before that time by the EMC.
This approval is only valid for the purpose and design that you described in your variance request. If you change your
project, you must notify us and you may be required to send us a new request for approval. If the property is sold, the
new owner must be given a copy of this approval and is thereby responsible for complying with all conditions. For this
approval to be valid, you must follow the conditions listed below.
Conditions:
1. No impacts (e.g., filling, grading, clearing of vegetation, etc.) shall occur to Zone 1 of the protected
riparian buffer, except for activities classified as "exempt" uses within the buffer rule (15A NCAC 02B
.0259) or otherwise approved in writing by the DWQ. No new impervious surfaces (including but not
limited to patios, gazebos, decks, etc.) shall be placed within Zone 1 unless otherwise approved in writing
by the DWQ.
2. All new stormwater drainage shall be directed to vegetated areas as diffuse flow at non-erosive velocities
prior to entering the protected riparian buffers as identified within 15A NCAC 2B .0259(5). No new
ditching or piping of stormwater through the protected buffers is allowed.
If you do not accept any of the conditions of this approval, you may ask for and adjudicatory hearing. You must act within
60 days of the date that you receive this letter. To ask for a hearing, send a written petition that conforms to Chapter
1508 of the North Carolina General Statutes to the Office of Administrative Hearings, 6714 Mail Service Center, Raleigh,
NC 27699-6714. This approval and its conditions are final and binding unless you ask for a hearing.
This letter completes the review of the Division of Water Quality under the Tar-Pamlico River Riparian Buffer Protection
Rules (15A NCAC 2B .0259 (9)(b)). Please call Mr. Bob Zarzecki at 919-733-9726 or Ms. Deborah Sawyer at 252-946-
6481 if you have any questions or require copies of our rules or procedural materials.
Michael F. Easley
Governor
William G. Ross, Jr., Secretary
Department of Environment and Natural Resources
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), http://h2o.enr.state.nc.uslncwetiands/
Page 2 of 2
't
cc:
Sincerely,
Deborah Sawyer, DWQ Washington R?gional
Terry Moore, DCM Washington District Office
File copy
Central Files
DWQ021310
November 8, 2002
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'HYDE COUNTY HEALTH DEPARTMENT SITE PLAN
LAURA BARABAS & DAVID MILLER
PERMIT #10202-1
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HYDE COUNTY HEALTH DEPARTMENT SITE PLAN
LAURA BARABAS & DAVID MILLER
PERMIT #10202-1
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Barabas021310
Subject: Barabas021310
Date: Wed, 25 Sep 2002 16:43:43 -0400
From: Bob Zarzecki <bob.zarzecki @ncmail.net>
Organization: Division of Water Quality; 401 Certification Unit
To: "Deborah Sawyer (WaRO)" <[e-mail]>
Deborah:
We need WaRO comments for this variance. David Miller called me and
said that they are proposing a variance for the entire lot with a house
in the area that said "This Area Clear". It'-s not very clear what
they're asking for. Please work with him. I'll put a copy of this
email in the file and put it back On Hold. Let me know WaRO comments as
soon as possible. Thanks. It's only been a little over a month, but it
would be nice to get something back to him within 60 days.
- Bob
Bob Zarzecki
NC DENR/DWQ 401 Wetlands Certification Unit
919-733-9726
1 of 1 9/25/02 4:44 PM
Date: °
To: ?RRO
?FRO
,ETWaRO
?WiRO
?WSRO
?ARO
?MRO
If
Steve Mitchell
Ken Averitte
Deborah Sawyer
Joanne Steenhuis
Jennifer Frye
Mike Parker
Pete Colwell
Project Name ??+??? 69r
DWQ Project Nu ber d i 3i0
County.
From: v6otin ^'.?°ss? Telephone (919) 733- -
The file attached is being forwarded to you for your evaluation. Please call if you need
assistance.
? Stream length impacted
? Stream determination
? Wetland determination and distance to blue-line surface waters on USGW topo maps
? Minimization/avoidance issues
? Buffer Rules (Neuse, Tar-Pamilco, Catawba, Randleman)
? Pond fill
? Mitigation Ratios
? Ditching
? Are the stream and or wetland mitigation sites available and viable?
? Check drawings for accuracy
? Is.the application consistent with pre-application meetings?
? Cumulative impact concems
- -Comments ..... t/4-cl L - - - - - -
A
[OFFICE USE ONLY: Date Received Request #
State of North Carolina
Department of Environment and Natural Resources AUG
9
Division of Water Quality
"General" Major'V aiat Applica ion'r'""&n -
From the Neuse and Tar-Pamlico Riparian Buffer Protection Rules for residential structures
on existing lots within the coastal counties as defined by the Coastal Area Management Act
(As approved by the Water Quality Committee of the Environmental Management Commission on 5/9/2001)

Please identify which Riparian' Area Protection Rule applies:
qNeuse River Basin: Nutrient Sensitive Waters Management Strategy
Protection and Maintenance of Riparian Areas Rule (15A NCAC .0233)
AS 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 copies of the completed "General" Variance Application Form and
any attachments must be sent to the DWQ 401/Wetlands Certification Unit, 1650 Mail
Service Center, Raleigh, NC 27699-1650, 919-733-1786 to constitute a complete
submittal. This form may be photocopied for use as an original.
Part 1: General Information
(Please include attachments if the room provided is insufficient.).
2.
3.
1. Applicant's name (the corporation, individual, etc. who owns the property):
?Gl t,?r a 8• ?GL,y'CL? S
Print Owner/Signing Official (person legally responsible for the property and its compliance)
Name: 444A_rt
Title:
Street address:
City, State, Zip:
Telephone:
Fax:
Contact person who can answer questions about the proposed project:
Name: ? -_ 0- or
Telephone: S2 )42-9- 9000
Fax: (251) q2Q• quo!
Email:
"General" Variance Application Form
Version 1: May 2001

4. Project Name (Subdivision, facility, or establishment name -consistent with project name on
plans, specifications, letters, operation an maintenance agreements, etc.):
PPrrn&MAri.l. M a lnla A!/ -ior k" P& GL AOAS ahd !?avid Adler
5. Project Location: "
Street address: tllo
City, State,
County:...
Latitude/longitude:
6.` 'Directions to site from nearest:major intersection (Also, attach an 8'/2 x 11 copy of the portion
of the.USGS topographic .map indicating the location of the site). ; _ _ .k_ _
'A.4 24 ho
•??
e?i Ma-S S r f. 's ¢ last !e?
jq k+, Across -Prom kca&1&3 A4'dld -
7. StreTam to be impacted by the proposed activity:
Stream name (for unnamed streams I bel as "UT" to the nearest named stream):
Me .rah In.hd , 010A -r 4he VLiM11*4eo -TOL4. nd - -
Stream classification [as identified within the Schedule of Classifications. 1 5A NCAC 2B
.0315 (Neuse) or .0316 (Tar-Pamlico)]: . b'S( [e
8. Which of the following permits/approvals will be required or have been received already for
this project?
Required: Received: Date received: Permit Type:
rialt CAMA Major
A10- CAMA Minor
401 Certification/404 Permit
_ On-site Wastewater Permit
Active Connection to Sanitary Sewer System
A of NPDES Permit (including stormwater)
Y% 01 Non-discharge Permit
rA of Water Supply Watershed Variance
V% 0+ Others (specify)
Part 2: Proposed Activity
(Please include attachments if the room provided is insufficient.)
1.
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:
"General" Variance Application Form, page 2
Version 1; May 2001
a
Description of proposed activity [Also, please attach a map of sufficient detail (such as a plat
map or site plan) to accurately delineate the boundaries of the land to be utilized in carrying
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

3. Description of any best management practices to be used to control impacts associated with
the proposed activity (i.e., control of runoff.from impervious surfaces to provide diffuse flow,
9-planting vegetation or enhancement of existing vegetation, etc.):
aS F»anw LK;S+nd -K-GGSJSr c?.`g DJSi ?'?.
• 1:ra ?t t ai Il . o:fe?? a-rsM Id.n•,d- .t s i Id /:-A-- - by k ecD lm o
s ..Vy- ma-rs a.r im -f• »
- 4. Please provide an explanation of the following:
(1) The practical difficulties or hardships that would result from the strict application of this
1
(3) If economic hardship is the major consideration, then include a specific explanation of the
economic hardships and the proportion of the hardship to the entire 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 will 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
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:
?e
Designated agent (individual or firm): _ n, IA
Mailing address: p• 0 . SDX as
City, State, Zip: k g - 41 At e- 7 0
Telephone: 11W G 2! -'1oy.? C ;rAx- Z S2- 429- 1002
"General" Variance Application Form, page 3
Version 1: May 2001
(2) How these difficulties or hardships result from conditions that are unique to the property
Fax:
Email:
Part 5: Applicant's Certification'
I, &A& r& 8. gar 1" far - (print or type name of person
listed in Part I, Item 2), certify that the information included 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:
NC Division of Water Quality (DWQ)
401 Wetlands Certification Unit
2321 Crabtree Blvd. (LOCATION)
1650 Mail Service Center (MAILING ADDRESS)
Raleigh, NC 27699-1650
[phone] (phone)
h.ttp://h2o.enr.state.nc.us/ncwetiands/
RALEIGH REGULATORY FIELD OFFICE
US Army Corps of Engineers
6508 Falls of the Neuse Road, Suite 120
Raleigh, North Carolina 27615
General Number: [phone]
http://www.saw.usace.army.miVwetlands/regtour.htm
V WASHINGTON REGULATORY FIELD OFFICE
US Army Corps of Engineers
Post Office Box 1000
Washington, North Carolina 27889-1000
General Number: [phone]
http://www.saw.usace.army.miVwetlands/regtour.htm
Washington District Office
Division of Coastal Management
943 Washington Square Mall
Washington, NC 27B89
phone: [phone]
Morehead City District Office
Division of Coastal Management
151-B Highway 24
Morehead City, NC 28557
phone: [phone]
"General" Variance Application Form, page 4
Version 1: May 2001

me: Owner - Contractor: ??%LT !Jl t? ??'?r'
Hyde COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT
Dats: l? House Mobile Hom ?.
Location: ,,*C D_sA t Awl Address: /)? Pd!/.-TV4
9usiness F-
State Road No.
Lot No. Lot Size . Ft No, oom No. Baths
Washing Machine: Dishwasher: Garba a Disposal:
Tank Size: Nitrification.Field S Ft. Water S 1 :
Percolation Rate: Plot Plan
Soil Condition:
Water Table:
Remarks: ? 5
? 0
Improvements Permit B : t o • f?
Name: Owner - Contractor,
: ALZL2 '?? b &.t I Permit No.t
y Y
Hyde COUNTY HEALTH nEPARTMENT rnmoi rT.Tnm rrDTTrTrATr- /
Distance - Nearest Pollution:
Plot Plan
3D
Date: )2-<-- 7 Location; Cs ., ;z Address: f
Lot No. Type D sllin . / (L o. e oo : No. Baths: Washer: G
Dishwasher:: Garba a Disposal: Water Su 1 -Source _6 r e Well:
Certificate of Com
tion By:
5?