20110074 Ver 1_General Major Variance_20110124

State of North Carolina I i
Department of Environment and Natural Resources
Division of Water Quality y. L 4 Z0 1
"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.
u Neuse River Basin: Nutrient Sensitive Waters Management Strategy
Protection and Maintenance of Riparian Areas Rule (15A NCAC .0233)
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 fonn
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/Wetiands Cerarication 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)
1. Applicant's name (the corporation, individual, etc. who owns the property):
2.
3.
Print Owner/Signing Official (person legally responsible for the property and its compliance)
Name: w i mn m t A. 3e-
LL-Title:
Street address:
City, State, Zip:
Telephone:
Fax:
Contact person who can answer questions about the proposed project:
Name:
Telephone:
Fax:
Email:
"General" Variance Applics
Version 1: May 2001
714 u,?
l4e3te2 ?,
4. Project Name (Subdivision, facility, or establishment name - consistent with project name on
plans, specifications, letters, operation and maintenance agreements, etc.):
N?
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 copy of the portion
of the USGS topographic map indicating the location of the site):
7. Stream to be impacted by the proposed activity:
Stream name (for unnamed streams label as "UT" to the nearest named stream):
U T +o rN_YhV; D R k v er
Stream classification [as identified within the Schedule of Classifications 15A NCAC 2B
.0315 (Neuse) or .0316 (Tar-Pamlico)]: SC-, N S U
8. Which of the following permits/approvals will be required or have been received already for
this project?
Required: Received: Date received: Permit Type:
CAMA Major
CAMA Minor
401 Certification/404 Permit
On-site Wastewater Permit
N 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.)
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
n of buffer impact in ft2.:
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
-19 D4 X 106. 6- X 1?) • 0-1
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,
replanting vegetation or enhancement of existing vegetation, etc.):
n_ t ., .- n r n . ,, _r -._-
rlin?
4. Please provide an explanation of the following:
(1) The practical difficulties or hardships that would result from the strict application of this
Rule.
V1
(2) How these difficulties or hardships result from conditions that are unique to the property
involved.
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Part 3: Deed Restrictions
N?
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
?de
tea'}
deleted without concurrence from the State, and that the easements will be rerded?ort the
sale of any lot. lacicL t` A4 oo- a, I Aro LVtne S`Vq`Fe meA +; T l?'
"t f A-Vve- prO pet--}-1 of W1 ttianl 3et1 15 501d 'fh??ewiporar`, 5tv uclvre WI It 10e- t',emUPe?
Part 4: Agent Authorization J1V-rO V- -k-e C !5at'e e>-q -1'•v- Xcr+.
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:
"Generar Variance Application Form, page 3
Version 1: May 2001
Designated agent (individual or firm):
Mailing address:
City, State, Zip:
Telephone:
_.(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.
Fax:
Email:
Part 5: Applicant's Certification
W ? ?,1mnn &L'L (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://wvAv.saw. usace. army.miI/wetlands/eegtour.htm
WASHINGTON REGULATORY FIELD OFFICE
US Army Corps of Engineers
Post Office Box 1000
Washington. North Carolina 27889-1000
General Number: [phone]
httpi//4vwv-i.saw.usace,army.mil/wetiands/regtour.htm
Washington District Office
Division of Coastal Management
943 Washington Square Mall
Washington, NC 27889
phone: 252,946-6481
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
C?O6=Lr
BK1140PG369
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:!STATE OF NORTH CAROLINA
11 COUNTY OF BEAUFORT
PREPARED BY:
RODMAN, HOLSCHER, FRANCISCO
G PECK, P. A., Attorneys at Law
320 N. Market Street, P. O. Box 1747
Washington NC 27889
Telephone: [phone]
THIS DEED, made and entered into this the 1L? day of June,
1999, by TILLIE MAYO (formerly TILLIE MAYO TODARO), unmarried,
Grantor, to WILLIAM M. BELL, JR., unmarried and ELISE D. BELL,
un-arried, of 216 Fort Shores Drive, Chocowinity NC 27817,
Grantees;
W I T N E S S E T H:
That the Grantor, in consideration of the sum of Ten and '
no/100 Dollars ($10.00) and other good and valuable considera-
i'c tions to her paid by the Grantees, the receipt whereot is
0 w y acknowledged, has given, granted, bargained, sold and does hereby
x convey unto the- said Grantees: WILLIAM M. BELL, JR., his heirs,
cc LIJ
t( and assigns, a one-half (31) undivided interest; and
,successors
ELISE D. BELL, her heirs, successors and assigns, a one-half J%)
1
i undivided interest, in and to that certain tract or parcel of land
} = lying and being in Chocowinity Township, County of Beaufort, State
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° O of North Carolina, more particularly described as follows:
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LD TT BEING all of Lot No. Fifty Three (53) as shown on a subdivision map of Old
Fort River Shore Development, recorded in the Register of Deeds office of Beaufort
County, North Carolina, in Map Book 15, Page 39, and being the same property
ROD7-1AN. conveyed to Thomas J. Todaro and wife, Tillie M. Todaro (now Tillie Mayo) by
FRANC1_=1 F .?:.•;. a-A. Deed dated June 22, 1984 and recorded in Book 837, Page 168, Beaufort County
Registry. See also Deed to Tillie Mayo Todaro, said Deed being recorded in Book
860, Page 321, Beaufort County Registry. Reference is made to said Deeds and
12 v_' 9::?JI ?_
Fax 12921 9?1-31i5 map and the same are incorporated herein for a more complete and adequate
BEAUFORT COUNTY LARD RECORDdescription.
LR - FORM001 #
ACCEPTED ?6t
o FEB ?
Land Records Official Date
BK1140PG371
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IN WITNESS WHEREOF, the Grantor has hereunto set her hand and
adopted as her seal the typewritten word "Seal" appearing beside
her name, this the day and year first above written.
(Seal)
ILLIE MAYO
STATE OF NORTH CAROLINA
COUNTY OF BEAUFORT
Before me, the undersigned Notary Public in and for the State
and County aforesaid, this day personally appeared TILLIE MAYO,
unmarried, and acknowledged the due execution by her of the
foregoing instrument for the purposes therein expressed.
WITNESS my hand and Notarial Seal, this the A day of June,
1999.
I! My Commission expires
V, 1. TO( f,
NOTARY PUBLIC
Il- 02.,7- ?° AO ! NOTARY
PUBLIC
sF ` AV
OPT CQ%

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North Carolina
Beaufort County
The f egoing certificate of
Notary Public/Nota.rie Public is/are certified to be o¢rrect
This day of ?H 19 at o'cloc . :n4,
D. Jennifer I,er?I?p.tt Bye
.?
RODMAN. HOLSCHER. Register of Deeds
+tDprnatp RPgi?t?r ?f D?^??
RA NGISCU 3 PECK. P.A. ii
ATTORNEY`AT LAA li
P. O. ?O\ 1747
WASHINGTON. NC Deeds: udi 1-2 to ea, sgl to mul/tt 6-9-99
12521 U.16.3122
FAX [phone]
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I
Environmental Health Section
N2 1111625 Beaufort County Health Department
220 N. Market St.
Washington, North Carolina 27889
[phone]
Date:
O New Construction
0 Repair
O Flow Addition
OPERATION PERMIT
This permit guarantees only materials used and method of installation and that it meets all state regulations for new constructions.
Owner:
Address:
Phone:
Lot Number:
State Road Number: Type Structure:
Septic Tank I.D. Pump Tank I.D.
Installer: 10-DIGIT PIN
System Type: Specific System Installed
Additional for all systems: Landscape system area for surface water runoff and grass.
Do not place drive or any building over the system area or repair area.
Remarks:
Authorized State Agent:
White Owner/Contractor Yellow - Health Deoartment Pink Building Inspections
- - - - - - - - - - - - - - - -
. AII?HQRQATIOM'TO CPNSTRUCT
? . S .
DATE' _._ I i ??12v o
PERlM 11 • I ((,? 7 '1!87
1M C?tilweltra Aul?ItMier to aen?
Mtt'190iI 0MtMp it a e#M„ U eemership
IMPROVEMENTS PERMIT
*Improvements permit is valid for five years from
Owner. t 1 { ,I ?n !S f C?t Phone: 0'
Address: 7 1;,. F, sff",•1 tt IVZ Ll. n<t>tUl a, If'l r hC Z q?.t
Subdivision: ?. A Lot Number: r /.l
State Road Number: l -7 Directions 11 1 L C? +Yt UL,'} zj S (? ?, n- ?t ;??
10-DIGIT PIN _"? 6- + ? v
Property Size: Type Structure: r4" a . s c
- - - -
Design Flow: C1 No. Bedrooms No. People: /, A )c
Water Supply: 0 Public 0 Private (Maintain minimum ! p feet separation
T' L -Itea ((-Z' from any part of septic system and repair area.)
Classification: -La-Suitable- O Provisionally Suitable O PS with fill
Additional Drainage: i_ ,j t„, S ?• ;1 AA cry < 4< S t.« r'q e` ri r
Seasonal Wetness Condition: Soil Type 717 System Type
Septic Tank: E o D gal. Pump Tank: N (4 gal.
Pump Required DYes M No O May be required based upon final location & elevation of facilities
Nitrification Field: © square feet trench bottom
Trench Depth: 1 ? Fill Depth: / t I' c u cJ C 12
Comments: -.{ - -1 n ulc 11, 1 ,'.l 4-1t ,
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i-T 0t,U61P"if (- A,4 ". i p rA; t /ir itS
- LrS;. ?otl <+r?il.i /1 i1,? /, i ('`•?_:?{ L,?pF''ri c
Date:
O New Construction
0 Repair
0 Flow Addition
CANAL
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??- - 3 ry
Site Plan
The issuance of this permit by the Health Dept. in no way guarantees the issuance of other permits. The permit holder is responsible for checking with appropriate
governing bodies in meeting their requirements. This permit is subject to revocation if the site plan, plat, or the intended use changes, or site alterations occur. The Improve-
ment Permit shall not be affected by a change in ownership of the site. This permit is subject to compliance with the provisions of the Laws and Rules for Sewage Treatment and
Disposal and to conditions of this permit.
Additional for all systems: Landscape system area for surface water runoff and grass. Do not place drive or any building over the system area or repair area. Observe all proper
setbacks (15A NCAC 18A .1950). Do not work Soil 0 stall system i wet conditions. This permit must be on site during installation and inspection. /
Authorized State Agent: / Lei' %'?' /? n?tA• f r S ?7n1;
Owner/Contractor Yellow - Health Department
Environmental Health Section .
Beaufort County Health Department
220 N. Market St.
Washington, North Carolina 27889
[phone] / Fax [phone]
r
of issue.
' AP G1 i
II.INp t
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Pink Building Inspections
THE PRINTERS - ingalls & associates 252-975-2056
12/06/2010
To whom this may concern,
I am writing on behalf of my patient, William Bell, to require the necessity of hydro-therapy for
the treatment of arthritis in his knees, hypertension, and depression. This letter documents the
medical necessity for this therapy.
William Bell is a 51 year old male with a diagnosis of arthritis in his knees, hypertension,
hypercholesterolemia, depression, and sleep apnea. I have treated Mr. Bell since 1998.
Mr. Bell is currently using his personal pool for additional treatment for arthritis in his knees,
hypertension, and depression. Mr. Bell is overweight consequently `land' exercises aggravate his
knee pain. Therefore, he is required to avoid high-impact exercises and replace it with more low-
impact exercises such as swimming. Mr. Bell uses swimming as his therapy for the arthritis in
his knees due to pain that he endures during `land' exercises. Mr. Bell has minimized or non-
existence of pain while exercising in his pool. He also has no complaints of his knee joints
swelling after exercising in his pool. Swimming is an excellent no-impact exercise. Regular'land'
exercises can also be done underwater. The buoyancy of the water supports most of his body's
weight while the resistance of the water makes his muscles work harder to perform movements.
Water exercise is an excellent way for those with arthritis to build up strength, ease stiff joints
and relax sore muscles. It is a necessity for Mr. Bell's health to continue his hydro-therapy.
Mr. Bell also uses swimming to help treat his diagnosis of hypertension. Water aerobics provides
a low-impact cardiovascular workout that uses all muscles in the body, making it an ideal routine
for weight loss and fitness. When swimming he is engaging nearly every muscle in his body.
This calls for a regular supply of oxygen, hence Aerobic Exercise. Swimming exercise improves
his body's use of oxygen without overworking his heart. Water is denser than air; therefore it
provides a cooling effect to regulate overexertion and overheating. Swimming improves
cardiovascular conditioning by lowering both systolic and diastolic blood pressure significantly
and it will stay down if his hydro-therapy is continued.
Mr. Bell also uses swimming as time to lessen his anxiety and depression. Exercise has shown itself
to be even more potent than a drug therapy. Exercise affects neurotransmitters such as serotonin
that influence mood and produces ANP, a stress-reducing hormone, which helps control the
brain's response to stress and anxiety. Swimming serves to offer excess fight-or-flight stress
hormones, converting free-floating angst into muscle relaxation. It can even promote so-called
"hippocampal neurogenesis" - the growth of new brain cells in a part of the brain that atrophies
under chronic stress. Mr. Bell uses swimming as his only source of exercise and also swims to
reduce his stress level. Mr. Bell mediates as he swims. He refers to this as "clearing his mind".
He would be unable to continue his mediation to reduce his depression if he had to attend a
public pool year round. During the winter months, he is forced to use a public pool, but it is not
as effective.
I recommended and now I am requiring for William Bell to continue his hydro-therapy in his
personal pool. If you have any questions, feel free to contact me at Pamlico Internal Medicine
(252-946-2101) to discuss.
Sincerely,
(;P,164'4v? v Richard Young, M ?/' 7 lRe'
Pamlico Internal Medicine,
Washington NC

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