20070825 Ver 1_Major Variance_20070514

~ OFFICE USE ONLY: Date Received Request # _ ~
~,
State of North Carolina
Department of Environment and Natural Resigu~cesr ~ ,;
Division of Water Quality
"General" Major ~tariance Application Form -
From the Neuse and 1'ar-Pamlico Ri~a~°ian Buffer Protection Rules for residential structures
on existing lots mithin 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.
^ 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 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.)
cant's name (the
2
individual, etc. who owns the property):
Print Owner/Signing Official (person legally res
Name: c fi 1~ S- J_..__~.1_._..~L
Title:
Street address:
City, State, Zip
Telephone:
Fax:
3. Contact person who can answer
Name: ~ ~
Telephone: ~~S ~ _,_~/~~
f
Fax: ±:_._;1.~°~;5:5
Email: 0;~.~:L~a,,.. ~
"General" Variance Application Form
Version 1: May 2001
ble fqr the property and its compliance)
ns about the proposed project:
5

4. Project Name (Subdivision, facility, or establishment name -consistent with project name on
pla 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 copy of the portion
of the USGS topographic map indicaating the location/ j~f the site
~:.°rt rl ;.~ '? ~ r ~o c '~t o+'~ . ~,~ f-€ '..:.~ ~+ .'~ (~ ~ ~' I -i l..:r~!` S ~ r ^. ; 4.~,G'n'~-~ ~~ C~,T f,"s 7L:~ ~.X..
Il.~ . J a f / ~ n~ ~-n Fix ., l'c ~l~i,! ~ S ~~-~ ~-r.. /.~(/??. c x ~ ~J ~ 1 ~' [T !'~ / f7 ~/.~
7. Stream to be impacted by the proposed activity:
Stream name ~or unnamed streams label as "UT" to the nearest named stream):
~~i f _ ` ~ ____' ~ ~ iL____.._._.____.__~____. _______...__~.__...._...__
Stream classification [as identified within the Schedule of Classifications 15A NCAC 2B
.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: Date received: Permit Type:
CAMA Major
_ CAMA Minor
ti' _ ~ 401 Certification/404 Permit
~ ~__ ~_ On-site Wastewater Permit
_~_~ ~ 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.)
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
~ .r., _.,
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 huffpr impact in ftZ

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y li ~""•t i~~~_Y,~ k I j 'R SLr v'• ~ >J c 1 't' ~ u •Y\ '+1'1:i.. ~ ,, - ~t ., , U `~ '~ ' I t1(~_ 11'; I v L ~, ) (~ ~ ;
__._ 2,~ _-_ --~ ~~~•V~ J
r~l~,(;;.~/~. JL'-4>~ „lrv;1'~•'+~' ~.il~~'%~- -~~\~. ~ yt~~'~Q11 <~~',~o~. ,l.l~~ J1J1-'~ ;fit-''1'. i~-c~~v.1..
QOJV_~h a~'1. {~-1 ~ ' ~,~,.1~ w`~Q~ l'J2 fli.Qta ~:.~ tlv:r,~~.~. "%~~ ~l>-^~s:~,'v~ ~:n 'r ~ 1."~;~.t~, ,~~
..;~~ _
'., :~11;,pai d~ .a./9- 11niV-~ ~,_„r- 1 ~c~it'x.N ` _ _
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 vegetation, etc.): , ~ _
~~ ~_~~~ L-~i 1 t~~ ~_ C 7~-1~ 1.>~`ct,~- _,.1~~~ J`~+~ ~ - ~ t~._._..~~Y~_-_l~r 2-~~)~~_
4. Please provide an explanation of the following:
(1) The practical difficulties or hardships that would result from the strict application of this
Rule. +
~~u l~_ ~(~. i ~..! V r=~„ ~ _-- ~ ~~x.. ~V ~ >v~ .1.ik1.ll(~. ~~L11.J. ~C.i ~` ~ ~'•~ ~ ?t~~.t~..i~~..!('~'._. _! I~J',1~-~ -
(2) How these difficulties or hardships result from conditions that are unique to the property
involved.
. ~ ~ ~ ,,
~L~.Lz.:~"4=.i1`1~ 1 (fir'+~.'~ k?_l-L~-T__~+_1~ _t,l~? 4 '~ ~~.!~i.~_ ~ n L_ ll.`_11C~_lf~ ~'~ l -">_.S~ .~~:_~`.s.~11:
~;1 S (1-1J ~_Y]_ ~ ~. T! Vi_. ~1? 'i~~,1-{,,.~t u'l `Sl -tie,.--- - - _ _ _ _ -- - --------- - ------
(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. ,
--'.. ~y~(-`- ~'co( - 1G~~C~ ~_t~Sl't VJ~¢.. Ji.~f1, ~f,~ t,,;;~0 ~l~ ~II.~LI?lL ~?_-.~.,. ~_4_~ ~4'~ Lr~~~v',+2, it'~~-~-.
~(~!' it 1i.~~.~ ~ ;SGj(_t1'1 l~ ~'~' ~~ ~"ty '.~.-~,x._ .7.1taP.,.t.~JL_!~ ~tiy:~_K!t~ Zi\-~1
---
_~ _
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

Fax:
Email:
Part 5: Applicant's Certification
I, .~.`~~``~ ~ ~~~~~ ~lt~oc~G\r ~ (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
rnnriitinnc
Signature:
Date:
Title:
NC Division of Water Quality {DWQ}
401 Wetlands Certification Unit
2321 Crabtree Blvd. {LOCATION}
1650 Mail Service Center (MAIL.ING ADDRESS}
Raleigh, NC 2"1699-1650
(919} 733-977.6 {phone}
http: //h2o. en r. state. nc. us; ncwetlandsl
RALEIGH REGULATORY FIELD CJFFICE
US Army Carps of Engineers
6508 Falls of the Neuse Raad. Suite 120
Raleigh, Nar~#h Carolina 27615
General Number: {919} 876-8441
http:/(v+rww.sawa.usace.army.miltwetlandstregtaur.htm
WASHINGTON REGULATORY FIELD OFFICE.
US Army Carps of Engineers
Post Office Elax 1000
Washington, North C<~ralina 27889-1000
General Number; {252} 975-1616
http://wvaw.savr.usace.army.mil/wetlandslregtaur.htm
Washington District Office
Division of Coastal Management
943 Washington Square Mall
Washington; NC 2"7889
phone: [phone]
Morehead City District Office
Division of Coastal Management
151 _t3 Highway ?_4
Morehead City, NC 28557
phone: [phone]
"General" Variance Application Form, page 4
Version 1: May 2001

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1

PAMLICO COUNTY HEALTH DEPARTMENT
P.O. BOX 306
BAYBORO, N.C. 28515
IMPROVEMENT PERMIT
.- ,~ ;t j ~ (valid 5 ears) ~~
Owner.Ansela Cahoon ~ ~ :~ ~ ~' ~'
- .-- -
Own_er Address:2740 Scotts Store Roads ~ _,~ ~ ~
Owner Address(2):Grantsboro, NC 28529 ~ Q ~ ~,
Owner Phone #:[phone] ~ ~ ~ ~ ~
Property Address:Biards Creek S/D ~'~ ~ ~' ~
Property Address(2): Parsons Road ~ ~ ~ ~ "~< -~
~°:~ (~ ~
Record: LOT # 5 ,~
Establishment Type:Hom ~ ~
T e of Well:Public Well ~Ip
YP "
_Design Flow (GPD):480i ~ „~ •~`~
~= a- ~~
~yn= ~,
Initial Site - ~ *~"
- -- ~ .
Wastewater System:Disposal Beds ~ ~' w
~~~~
Long Term Acceptance Ftate(GPD/SQF :0.8 `~ ~ ' - ~ *~.r
Trench Width:3 FT ~'~ r ,' ' ,,,,,, ~ ,~ ~ ~;
Trench Spacing (OC):3 FT, r ,~ ~ ~~~~ j~
Trench Bottom From NGL.r24 IN ~' ~~ v ~, ~'~+~
Septic Tank Volume:1000 GAL ~~ ~. '~'~~'`'~
Place soil cloth over rock ~ ~~4 ~ ,~
;50.00 feet~~ -~ _ . _ ~ "" "9
~'rniNal(18' X ity' -~ .repair (78 X 50~
...,.
it ~ ~~{~ .. ~1
~Repair Site` . `~,h ~ " ~, N+~ ~'OAl~ ~''~`` ~ --. c~~fl~) w..~
~1/Vastewater System.Disposal Bed ~E _,Q
Long Term Acceptance Rate(GPD/SQFT)_ 0.8~-----~..,~
Trench Width:3 FT ~ ' '' RR11~,q ~~
,.
~--- - - Eta Eqo
`Trench Spacing (OC):3 FT ----= _ ,~
Trench Bottom From NGL.-24 IN :,-~..._. o
.Septic Tank Volum~00 GAL ' "`-"" ~ - ~_
a; jj ~ o. ~ Zi ~ a, %~
t a ~ ~ o :~~ ~ ~ 5
,..
...
AN AUTHORIZATION TO CONSTRUCT MUST BE OBTAINED AND
ALL FEES PAID PRIOR TO WASTEWATER SYSTEM INSTALLATION.
THE PAMLICO CO. HEALTH DEPARTMENT RESERVES THE RIGHT
TO REVOKE THIS PERMIT IF THE SITE IS ALTERED, INTENDED
USE CHANGED, OR ANY INFORMATION IS FALSIFIED.
ANY CHANGES TO THIS PERMIT WILL REQUIRE A REDESIGN
PERMIT AND SUBSEQUENT FEE.
Authorized
Date 9!1 /2005