20110262 Ver 1_General Major Variance_20110321

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OFFICE USE ONLY: Date Received Request #
State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
"General" Major Variance Application Form -
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.
o Neuse River Basin: Nutrient Sensitive Waters Management Strategy
Protection and Maintenance of Riparian Areas Rule (15A NCAC .0233)
Li 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 4011Wetlands 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.)
Applicant's name (the corporation, individual, etc. who owns the property):
Print Owner/Signing Official
Name:
Title:
Street address:
City, State, Zip:
Telephone:
Fax:
ri legally responsible for the property and its compliance)
Contact person who can answer questions about the proposed project:
Name:
Telephone: ()_
Fax:
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 and maintenance agreements, etc.):
5. Project Location:
Street address:
City, State, Zip:
County:
Latitude/longitude:

6. Directions to site from nearest major intersection (Also, attach an 8'/2 x 11
of thenUSGS topographic map I icating the location of;.the site): j?
//V/PrfJ
t fJ?
{J
copy of the portion
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7. Stream to be impacted by the proposed activity:
Stream/narge (for unnamed streamsJabel a? "UT" to the nearest named stream);
Stream classification [as identified within the S ed le of Classifications 15A NCAC 2B
.F
.0315 (Neuse) or .0316 (Tar-Pamlico)]:
8. Which of the following permits/approvals will be required or have been received already for
this project?
Required: Received
1? ?
Date received: Permit Type:
CAMA Major
CAMA Minor
401 Certification/404 Permit 4
,•. r On-site Wastewater Permit C
Active Connection to Sanitary Sewer System
NPDES Permit (including stormwater)
Non-discharge Permit
Water Supply Watershed Variance
Others (specify)
Part 2: Proposed Activity
(Please include attachments if the room provided is insufficient.)
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
of buffer impact in ft2.:
0'y C
X6. /6 :
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;K ,
"General" Variance Application Form, page 2
Version 1: May 2001
Fax:
Email:
Part 5: Applicant's Certification
I - (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)
http://h2o.enr state.nc.us/ncwetlands/
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://wmnv.saw. usace. army.miI/wetlands/regtour.htm
WASHINGTON REGULATORY FIELD OFFICE
US Army Corps of Engineers
Post Office Box 1000
Washington, North Carolina 27889-1000
General Number: [phone]
http://www,SaW.LJsace.army,mil/wetlands,/regtour.htm
Washington District Office
Division of Coastal Management
943 Washington Square Mall
Washington, INC 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: May 2001
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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,
re-planting vegetation or enhancement of existing v getation, eXc ): ,
-
: „3 r..:• a ,t'.;; ..E.: ?. r
' #i" / trJ J'_`: P` e"?? S ,d"" r" CY " ?r
S c,
4. Please provide an explanation of the following:
(1) The practical difficulties or hardships that would result from the strict application of this
Rule, ' f
(2) How these difficulties or hardships result from conditions that are unique to the property
involved
(3) If economic hardship is the major consideration, then include a specific explanation of the
econo iq, hardships and the proportion of the hardship to the entire value of the project,;
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Alt lEk<^iG,&. K _. f. f L. ?vd
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 (individual or firm):
Mailing address:
City, State, Zip:
Telephone:
"General" Variance Application Form, page 3
Version 1: May 2001
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MAR. 17. ? O 11
Form: HB-296
MUD
OWNED:
?;?4PM
CARTERET CO HEALTH DEPT
NO 2985 P 2
(T
u.
ENVIRONMENTAL HEALTH DIVISION
CARTER9T COUNTY HEALTH DEPARTMENT

(Ground Absprption Sewage Disposal System - GS Cha
?r 130 - Article 1.3c)
Alves t?Li.r,n R? rwl.r DATE COMPLETED; 41,11711 t/?,7
Notice- This certification of completi6n in no way binds the Public Health Sanitation Division of Carteret County, rt
health Department nor Implies a guarantee that this system will function in all eircum$tances, but that the, system is
pxop.erly insfalled in accordance, with applicable rules and regulations of the Carteret County Health Department and
can reasonably be expected to perform properly under normal conditions of use and maintenance.
By' P
Xy4N?`.,Y1??E ' '
?1VEMENT ' PERMIT
OWNS
EUVIRONMENYAL HEALTH DIVISION
CARTEI.IET COUNTY HEALTH DEPARTMENT
PHONE: 7)4
4 F
r?
-? n
PROPERTY LOCATION: ~r 6v`1
'TYPE S R[IX~ RE.'?11
NO. REDROOMS: r"
NO, BATHS;
WATER SOURCE: 45-
GARBAGE CRINbER. YES ( ) NO (•.?}
AUTO DISHWASHER: "YES (-T- NO(
)
AUTO WASMNG MACHINE? YE5 (-j`_N0 ( )
Pere. Rage (ii applicable):
SIZE OF 'TANK,.
NO. LINES:" WIDTH: r
TOTAL: SQ. FT. -77 TOTAL LENGTH: r •.
HORIZONTAL DISTANCE FROM WELL: FT.
NOTICE: Cansttuctior! must comply with all state
and local regulations. Do not install well until
well site has been approved. Do not cover any
portion of system until approved on final inspection.
IMPROVE TS Fl r MIT,$Y;
t 711
' gent
ENVIRONMENTAL HEALTH DIVISION
CARTERET COUNTY HEALTH DEPARTMENT
` BEAUFORT, N.C. 28516
wcnwca P91NY1nc cc.,, woncncwc CITY, M, F_
4 A
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ST FAM9yP' ? I
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VICINITY MAP(not to scctle)
N 03°56'00"W 0 R/W
100.00' E I R
C, SEA GATE DR. 50 R/W
Ri ?br
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76
..........
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AZ' S 03°56'00"f
Zo?2 A?,.?
52
INTRACOASTAL WATERWAY
I certify that on/a_ 3/__ 19l 7_. 1
supervised the survey of the property (shown on
this plat; that the Property lines and location
of all structures are accurately shown hereon;
that the structure locatltl
t"'I IMhIN %"Per t y
DOESiDOES NOT encroach,t
0 e t
or property and th`?% Lapee't•profiOyl??
DOES/DOES OT encw. a .? j?m 'S, urv4
•
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JOHN W. 1 L C4R ?.ko .
?, y? • , 8UR q-
COVL'???.
010
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41"

CHIP IN SEA WALL
REF: LOT 74, BLOCK H
SEA GATE S/D
MB. 8 PG. 90"D"
MAC JOHNSON
HARLOWE T.S. CARTERET CO. NC
SCAL E
I " = 30' JOHN W. COL L I ER, R, L. . S.
DATE 408 Arendell Street, P. D. Box 3460
10 31 _97 Morehead Ci ty, N. C. 28557
FILE (?,qC (9/9? 726-1464
D _ I _ J N. C. TOLL FREE - (800 ) 682-4.3 J 6