20050490 Ver 1_Major Variance_20050220

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=`~, pFFiCE USE ONLY: date R,> clued ------ Request #~
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State of North Ceraiina
Department of invironment and Natural Rasoui~ces
t7'svision of Water Quality
`jGen~x~l" M.~~r ~'~t~~~nce Appl~ca~ion Firm
Frorn the.lVeuse and Tar Pamlico Riparian 13ufferProtection Rules for residential structures`
on exc~^ting Tats within the coastal counties as defrned by the G'oastal Area ManagementAct
(As approved by the Water Quality Committee of the Em~ironmental Management Commission on 5/9/2001 }
Please identify vrlhich Riparian Araa Protection Rule applies.
cs' Net~s® River basin: Nutrient Sensitive Waters Management Strateg~-
Protection and Maintenance of Riparian Areas Ruts ('iSA NGAG A233)
a Tar-Pamlico River Basin: Nutrient Sensitive V~~ters Management
Strategy Protection and Maintenanc® of Riparian Areas Ruts (~15A
Ncac .~2~~~
NCaT~;
To constlfute a complete application, all of the Informaflon requested In this form
;trust be pra~rlded, incomplete appiicatlons wJ/! b®returnerl fo the appfdcsnt; The
ori~inai and' two copies of the completed "General" Variance Application Form and
any atiachmants rrocast.be sent to th®DfWQ 401/Wetdands Certification Unit, 1850 ANail
Service Center, Raleigh, NC 2P999-1850, 919-7'3.3-1TB6 to consfltute a complete
submittal. This form may ba photocopied for use as an original.
part 1: den®rat tnforrnation
Please includ® attaehmenfs if the room provided is insufficient.
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1. Applicant's. name (the corporation, Mdiv~ual, etc, who owns the property):
~tz~ ~~o tzr~i*~ ~~~~~
Print Owngr/Signing Official (person legally responsible for the property and its compliance}
dame: ~EP ~a!-f~S~r~-~1
Title:
Street:<address: fa - _ , ~- . Wiz', .
City, State, Zip:.
Telephone:
Fax:
3'' Contact person who cart~.answer questions about the proposed project:
1 Name: ~ ~ ~';z~~ ~1o~~sz~~
~ Telephone: (2) ~ ~'`t r - `~ ~ ~~-.
,Fax: ~,w..~:.sm~..~" ~ ~ _ -
~Generai" VariaOoe AppFication i=orin '°
Version 1: May 20A1

~. Email: ) ~ )
4. project Name {Subdlvisian, facility, or establishment name - consistent with project name an
plans, specdfications, letters, operation and maintenance agreements, etc,:
5, Project Location:
Street address: d-~ ~ ~~t~~ ~LvF~ ~cz~,-~L
City, State, Zip: ~ N ~~~ ~-~~- 4 ~ C.
County: Pn~, ~~ ~-~
Latitude/longitude: `3 ~° ~~' S 3" IJ ~ ~ ` so ' ~ s ' ` W
B. Directions to site from nearest major intersection (Also, attach an 8'/ x 11 copy of the portion
of the USOS tapagraphic map indicating the location of the site):
~fZUM ~G ~~`{ ~~ 'T~~ ~F'CL~~-`1 t~.l,_-~-7~t~ t, - T~g-.~ tz~., ou'-co ~ ~ i ~Z\
~~tz~ 't?'Z• ~zo 51~ 11`ZZ 'T~ '~-~• t5r~ =~r~r~~ F~L.vFF ~,•
7. Stream to be impacted by the proposed activ'~ty.
Stream name (for unnamed streams label as "l~T'` to the nearest named stream):
Stream dassiilcation has identified witzhin the Schedule of Classifications Z 5A NCAC 2B A315
(Meuse) ar .p316 (Tar-Pamlico)]: 1~~~5~" -- ~~ ~ S;~ ~ i..~s~
~~tz~l G.v-c - SG; Sw, Usw
5. Which of the following permitslapprovais will be required or have been received already for
this project?
Required: Received: date received: Permit Type:
,_,_ CAAAA Allajor
LAMA Minor
~v . 401 Certificationl404 hermit
~/ °I z/l }~ ~~ On-site Wastewater Permit
____~, ______ ~ ~~si Active Connection to Sanitary Sawar System
NPDES Permit (including stormwtater)
_____ ~lon-discharge Permit
Water Supply 1Natershed Variance
Others (specify)
,. .
Part 2: Proposed Activity
Please include attachmenfs it' the room provided is insu~cianf.)
Description of proposed activity tAlsa, please aftach 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
assodatsd with the activity, and the extent of riparian, buffers on the land. inc{ude the area
ot` buffer Impact In tt~.:

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°Gonerat" l~ariance Appliaatian Form, page ~

2, State reasons why this pan for the proposed activity cannot be pra.;c~caily accomplished,
reduced or reconfigured to better minimize or eliminate disturbance to the riparian buffers:
~jlJPjp1~3 i~1r;tJ ~, ~ b1Z1 ~ M,L^i ~T~~16~ ~591J to ~(~~
~ y , „ ,. „ . ~., ., Lh.m.,,,-t ~ W N L R"~ W Owl t U E, 'T --~ G
~>J~ ~'~ u ..~
--~`+- /
3, nescription 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 ficaw,.
re-planting vegetation or enhancement of existing vegetationT etc.}: ca ~T(v~
~.QIJ~--~'T ~i L.J4N~7~J-~4'P~ ~ZD~*~'(`~ ~"' ,,~..e_,.,mc~, Aa.,~ DI~~~ -
~c. t"j '1~ LL 1J~ ~ iSiTLG v c
~. Please provide an explanation of the following:
(1}The practical difficulties or hardships that would result from the strict application of this
Rule. . _ _ _ 2. _,~ .--~-~
:.,~: - --
(2} How these difficulties or hardships result from conditions that are unique to the property
invalved.
AFT'~__ ~~~>;e l~E~i~v~~l~~..> '--' ~Tn~'Flt,1'QS ~D __'~±?_
2 t~ w~ ~ ti ~ ~'D5
(3} if economic hardship is the rna]or consideration, then include a specific explanation of the
economic hardships and the praport]on of the hardship tv the entire value of the protect.

Park 3: Dead R®strictian~
By your signature in Part 5 of this application, you certify that ail structural stormwater best
management practices required by this variance shall be located in recorded stormvvater
easements, that the easements wiA run with the land, that the easements cannot be changed or
de{eted without concurrence frtim the State, and that the easements wiq be recorded prior to the
sale of any lot.
Rare 4: Ag~nit ~-u~harizaticn
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 (indi~
Mailing address:
"General" Vseriancs Application Form, page 3
~~;s-
~rn~~

T !~ f-`t I
City, StSte, Zip:
Telephone:
Fax:
Email:
Part. S: Applicanir's Gerdflcat~arr
{print or type name of person
i ~~> ~~-~-~~.1 ttoation form is
tilted in Part 1, item 2), Cart ~ tc~nstruCted incortformance with the app oved plans and that the
Correct, that the project w 1
deed restriction accords ce wi art 5 of this form will be rerarded wtth aft required permit
Conditions. ~~
Slynature; ~ ~. - --__-
Date: °z- ~zr~ ~^'.
Title:
NC pivision of Water Quality (DWQ}
401 Wetlands Certification t)nit
2321 Crabtree Blvd. (LOCATi~N)
1650 Mail Service Center (tViplLtNG A6DRE5S)
Raleigh, NC 27699-1650
(915} 733-9726 (phone)
http:J/h2a.enr.sta4e.nc.uslnc~xetiands/
F2ALElGH REGIfLATORY Fii3L0 OFFICE
U5 Army Corps of Engineers
8508 Falls of the Nauss Road; Suite 120
Raleigh, North Carolina 27815
Genera! Nurciber: [phone]
http: J~riww. saw. u sacs, army.mll/wets and slregtour. htm
WASHINGTON REGt.lLAT~RY FIELD OFFICE
US Army Corps of Engineers
Post Off-ce Box 1000
Washington, North Carolina 27889-1000
General Number: [phone]
http:lJwww.saw.usace. am7y.millwatlandsJregtour. htm
Washington District Q#fice
Division of Caasta4 Management
943 Washington Square Mail
Washington, NC 27689
phone: [phone]
Morehead City District Office
Division at Coasts! Management
151.8 Highway 24
Morohead Glty, NC 28557
phone: [phone] -
"General" Variance Application Form, page 4

Page 1 of 1
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IMPROVEMENT PERMIT
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~Owner:Fred Johnson ~ (j'y
jOwner Address:P.O. Box 887 z ~
Owner Address(2):Oriental, N.C. 28571+'
Owner Phone #:(252} 249-3045
Property Address:lndian Bluffs-Minnesott
~PI N : F094-75-3-2
~ Establishment Type: Home ~~`-~ ~..~,,,,~ ~ ~ ~
Type of V11elI:Public Well ~ ~ ~`~
Design F I ow G P D) .360,"`•-----~..r.,.,.,,~, ~
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A r.-
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} ~ a (/~, RePair area
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40.00 feet
1 :480

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Initial Site. ~ „~' .: ~.. ~ _
Wastewater System:Conventional Pipe..
Long Term Acceptance Rate(GPD_/SQFT):0.8
Trench Width:3 FT~~"}'~
Trench Spacing (OC):9 FT .
Trench Bottom From NGL:-24 IN
Septic Tank Volume:1000 GALS` ~ ~ ,. -
Place soil cloth overr ro~. ~`--'~ ~ ~"'-
Repair will require use of innovative system with either setback or system size reduction
Site plan must be submitted prior to Authorization to Construct being issued

1
Authorized Agent:
Date 2!14/2003

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