20110724 Ver 1_Minor Variance_20110808

AG Y1
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NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins Dee Freeman
Governor Director Secretary
201 10T24
Variance Request Form
Catawba River Basin: Nutrient Sensitive Waters Management Strategy
Protection and Maintenance of Riparian Areas Rule (15A NCAC 02B.0243)
NOTE: This form may be photocopied for use as an original.
Part 1: General Information (Please include attachments if the room provided is insufficient.) AUG 8 2011
Applicant's name (the corporation, individual, etc. who owns the
L m v- om 4,- e a ?J P_ ./ e fl n m e vl t C n rr? .a mot. &,,,I
2. Print Owner/Signing Official (person legally responsible for the property and its compliance)
Name: _Q1..1^ k..........._L'. Q_G k.?Kh ...................................... _._......... ................................. .__....__...__................... .............
..._.._...
Title:
Street address:
City, State, Zip:
Telephone:
Fax:
Contact person who can answer questions about the proposed project:
Name:
mar ...... Lock._,?,? ,_.
Telephone: (10t) 7
.....?f 6."..3 S_6
Fax: )Q?) 6......25 ............ ....
Email: ?'?'? a, r4 .. L.o..c.1? w?._M,_ .......Q _I%4.ng._"_+^4 s......o? "-.._K?? ...__.c. rr
4. Project Name (Subdivision, facility, or establishment name - consistent with project name on
plans, specifications, letters, operation and maintenance agreements, etc.):
.. _ ........
Project Location:
Street address:
City, State, Zip:
County:
Latitude/longitude:. 3.0 - ? 5 q ...... ?.1 '' Al '......._a p ° S / .... ...`? ?• 1.-7 " LY...........
6. Directions to site from nearest major intersection (Attach an 8 '/z x 11 copy of the USGS
topographic map indicating the location of the site).
Version 2: March 2009
(70.0) ........... G.zs 1/1.5
Stream to be impacted by the proposed activity:
Stream name (for unnamed streams label as "UT" to the nearest named stream):
4kG Oat, Ct sOr f/ &R_ke- ww ?rC( K
Which of the following permits/approvals will be required or have been received already for this
project?
Required: Received: Date received: Permit Type:
401 Certification/404 Permit
On-site Wastewater Permit
NPDES Permit (including stormwater)
Non-discharge Permit
Water Supply Watershed Variance
Erosion/Sedimentation Control
Others (specify) !' 0 k1 e.
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 in Adobe (pdf) format) 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 W.:
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2. Fill in the table below to identify the square footage of impact to Zones 1 & 2 in the protected
riparian buffers and the required mitigation (Fill in the impacts portion of the table, even if
mitigation is not required):
Buffer Impact
Zone of Impact in Number Purpose for
Multiplier Required
Impact Square Feet (Indicate on the Impact Mitigation
Plan Sheet)
Zone 1 5 p 2 0-0
Zone 2 1.5
Total 100
*For the Catawba River mainstem, zone 1 extends out 30 feet perpendicular from the most landward limit of the top of bank
or the rooted herbaceous vegetation; Zone 2 extends an additional 20 feet from the edge of Zone 1. For mainstem lakes,
Catawba Variance Request Form, page 2
Version 2: March 2009
Zone 1 begins at the most landward limit of the full pond level and extends landward 30 feet. Zone 2 extends an additional
20 feet from the edge of Zone 1.
3. 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:
4. 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 vegetation, etc.):
5. Please provide an explanation of the following:
(1) The practical difficulties or hardships that would result from the strict application of this Rule.
(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
economic hardships and the proportion of the hardship to the entire value of the project.
Part 3: Stormwater
Provide a description of all best management practices (BMPs) that will be used to control
sedimentation impacts associated with the proposed activity. Please ensure to include all
applicable operation & maintenance agreements and worksheets for the proposed BMPs. Also,
include the BMPs on your plan sheets.
Catawba Variance Request Form, page 3
Version 2: March 2009
2. Attach a description of how diffuse flow will be maintained through the protected riparian
buffers. Please ensure to include all applicable operation & maintenance agreements and
worksheets for the proposed diffuse flow measure(s). Also, include the diffuse flow measure(s)
on your plan sheets.
3. Attach a detailed plan for all proposed structural stormwater BMPs.
Drainage
basin Size of
drainage
basin
ac Post-development
sediment loading
rate without BMPI
Ibs/ac/ r BMP sediment
removal
efficiency5
% Final
sediment
loading rate
Ibs/ac/ r
1
2
3
4
S
Totals' ------ ------
Attach calculations and references.
Attach calculations and references.
Part 4: Water Quality Protection, continued
4. Attach all applicable supplement form(s) and Inspection and Maintenance (I&M) Form(s) to this
completed application. The applicable supplemental form(s) and I&M form(s) for the proposed
BMPs noted in your application can be downloaded from the following website:
http://h2o.enr.state.nc.us/su/bmp_forms. htm
Part 5: Proposed Impacts and Mitigation
Provide a description of how mitigation will be achieved at your site pursuant to 15A NCAC
213.0244.
If buffer restoration is the method you are requesting, be sure to include a detailed planting plan
to include plant type, date of plantings, the date of the one-time fertilization in the protected
riparian buffers and a plan sheet showing the proposed location of the plantings. A guide to
buffer restoration can be downloaded at the following website:
http://www.nceep.net/news/reports/buffers.l)df
If payment into a buffer restoration fund is how you plan to achieve your mitigation requirement,
then include an acceptance letter from the mitigation bank you propose to use stating they have
the mitigation credits available for the mitigation requested.
Part 6: 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,
Catawba Variance Request Form, page 4
Version 2: March 2009
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 7: Applicant's Certification
(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: $ J ,
Title: Se ?-1 i car
Part 8: Plan Sheets
Be sure to include a copy of all of your completed application form, plan sheets and maps in Adobe
(pdf) format on a CD or floppy disk.
Part 9: Checklist
A complete appplccation submittal consists of the following components. Incomplete submittals will
be returned to the applicant. The complete variance request submittal must be received 90 days prior
to the EMC meeting at which you wish the request to be heard. Initial below to indicate that the
necessary information has been provided.
Applicant's Item
Initials
._...._...... •
Original and two copies of the Variance Request Form and the attachments
listed below.
• A vicinity map of the project (see Part 1, Item 5)
?i
• Narrative demonstration of the need for a variance (see Part 2)
• Calculations supporting sediment loading estimates (see Part 4)
• Calculations and references supporting sediment removal from proposed BMPs
(see Part 4)
IVA • Location and details for all proposed structural stormwater BMPs (see Part 4)
a •
IVA Three copies of the applicable Supplement Form(s) and I&M Form(s) for each
-- BMP and/or narrative for each innovative BMP (see Part 4)
• Three copies of plans and specifications, including:
0 Development/Project name
0 Engineer and firm
0 Legend and north arrow
0 Scale (1" = 50' is preferred)
0 Revision number & date
0 Mean high water line (if applicable)
0 Dimensioned property/project boundary
0 Location map with named streets or NC State Road numbers
< < 0 Original contours, proposed contours, spot elevations, finished floor
elevations
Catawba Variance Request Form, page 5
Version 2: March 2009
0 Details of roads, parking, cul-de-sacs, sidewalks, and curb and gutter
_ WA-- 0 Footprint of any proposed buildings or other structures
IY-A- _. 0 Wetlands delineated, or a note on plans that none exist
NA 0 Existing drainage (including off-site), drainage easements, pipe sizes,

WA runoff calculations
0 Drainage basins delineated
!!Y`/ 0 Perennial and intermittent streams, ponds, lakes, rivers and estuaries
0 Location of forest vegetation along the streams, ponds, lakes, rivers and
-- - estuaries
Catawba Variance Request Form, page 6
Version 2: March 2009
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