20070405 Ver 1_Major Variance_20070308

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.
^ 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 maybe 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, ir~dividual, etc. who owns the property):
2. Print Owner/Signing Official (person legally~esponsible for the prope~and its compliance)
Name: C~_~ wFul~ o~/~C ~'t/,A~'y5'
Title: Oi~N~' 2
Street address: ~ ~~ CFA f},Q ~12 ~ ~. !~ c X ~ q 3
City, State, Zip: UC ~ q~alCr ~ C Z'lct 6 ~ __
Telephone:~~~- ©'6 E~
Fax: } ^~ ~q-
3. Contact person who can answer questions about the
Name: f!.'~'.~4w~oQD ~~NQa~ ~
Telephone: ~2_S_~) 5~b'' UaE y
Fax: f } ~v/f~
Email: nr/a ___
"General" Variance Application Form
Version 1: May 2001

/~ ~~aQPRTY ~~~JNbf~IC S, SEPTIC SySiCM , r4NJ >7o5rT~~N
_._.! ko t~iTc~, ~~~E~¢ ?~ ~UlLD A- J+o~sE= JS
MIN/!'1 12 ~~
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.):
i'`'© ~.i:SJ1:~16 N'avs'~7 O~}~.oQ~ q.'v~ S/tF/~ ~ECC /3F Q_F~i a v~ A . SF/~2hi
-TRi=~~ f~4v~ gF~v ~C~NTED , Nu ~~iSri,ur ~~s wr[c /sue ~'i~M2~d
A-!vb (~/2~~5 W±GL ~N ~L~A/7't4 ON tA/~-2/= AOaPEQtY.
4. Please provide an explanation of the following:
(1) The practical difficulties or hardships that would result from the strict application of this
Rule.
EnC- i~Df/~~ S/~tFLy SE Ndwh~E/~F Tc~ g~lC~ /kjrSFLF ff-
(2) How these difficulties or hardships result from conditions that are unique to the property
involved.
~E %'Ic-S~lTy bl tC~ ~~5 /~,/~!I/~,4ai= !:^~ rrfi ya 5 { rly Fyn off/ /~/~~~/f -/tST 5i~
o~ DITc/~ (S v~13vi~t~~4-gc~ ~!{E oNCY .~-QFA- Tv ~SvPtO ~¢ N~~sF !S g~11•~1
~JC(57'rN6 SEnrlC ST~.^- .gJlr~ 1J! tCN-
(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: 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:
N~~7-
"General° Variance Application Form, page 3
Version 1: May 2001

Fax:
Email:
Part 5: Applicant's Certification
~'Q'"~~"OA ~~N~p~ ~~~~ ~ (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 wilt be recorded with all required permit
conditions.
Signature:
Date:
Title:
,~
Z-~~-G
Gt,~N~2
NC Division of Water Qua':ity (DWO)
401 Wetlands Certification'Jr:it
2321 Crabtree Blvd. (LOCAT!CNl
1650 tVlaii Service Center (aVi.h;l_ING ADDRESS;
Raleieh, NC 2?699-1650
(9191733-9726 (phone)
~ttp !!h2c.enr.state.nc.usLncWetiands!
Rfi'_EiGR R;=GULATCRY LI=~r~ O~ FICB
CS Arr?y Corps of Engineers
6508 ~al!s of the Neese Road. Suite 120
Raleigh, North Carolira 27615
General Number (9191 876-8441
^tC,~i`:!/~,~,~,vw.saw.usace.army.mi~lWetlanUSl!eytOUr. i^i~ i ~
'.NASH';NG ~ ON REGUL.ATOR`.' =!ELD O=-ICE
US Army Corps of Engineers
Post Office Box 1000
`~ Washington, North Caro'ina 27889-1000
General Number: (252; 975-1616
:'1tt[J:!!Vi/WtN. S2W. USace. arr?y.,i.I~!LNet~andS!regtCU(. ht.%~
'J'~.'ash~ngton District Office
Division of Coastal 11~anaaement
943 l~~ashington Square P~iall
Washington, NC 27889
ahone:252l946-6481
~J!crehead City District Office
Division of Coastal':Uanagement
151-8 ~'ighway 24
r`~!}orehead City, NC 28557
phone: 252!808-2808
"General° Variance Application Form, page 4
Version 1: May 2001

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HYDE COUNTY HEALTH DEPARTMENT SITE PLAN
CRAWFORD M. EVANS, III
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HYDE COUNTY HEALTH DEPARTMENT
P.O. BOX 100 SWAN QUARTER, NC 27885
{252)926-4380
AUTHORIZATION FOR CONTINUED USE OF AN
EXISTING SEPTIC TANK SYSTEM
FOR
Crawford M. Evans, III
An existing system inspection was performed on your property located at
203 British Cemetery Road, Ocracoke. The system can accommodate a 2
bedroom house and 1 camper trailer. On the date of the inspection, February
8,20078 there was no evidence of failure.
This authorization shall in no way be taken as a guarantee or warranty
that the existing wastewater system will function in a satisfactory manner for any
given period of time.
Due to the development of clogging mats which adversely impact the life
expectancy of normally functioning ground absorption sewage treatment and
disposal systems, and variables influencing systems function which are beyond
the scope of the Laws and Rules for Sewage Treatment and Disposal Systems,
no guarantee or warranty is implied or given that the existing system on the
properly will function in a satisfactory manner for any specific period of time.
Hugh Watson, RS
Environmental Health Specialist

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Tax Lot No. 203 British Cemeta Road ~'
V ~/ .Ocracoke Parcel Identifier No.
erified by 200821
County on the day of 20
by
Prepared by: Casey, Grimsley ~ Ragaller, PLLC
Return To: Dan Merrell & Assoc., P.O. Box 270, Kit Hawk, NC 27949
Brief Description for 203 British Cemetarv Road
the index
Ocracoke
THIS DEED of TRUS'
NORTH CAROLINA DEED OF TRUST
made
GRANTOR
Crawford M. Evans, III,
Unmarried
P.O. Box 793
Ocracoke, NC 27960
and
TRUSTEE
Dan Merrell
P.O. Box 270
Kitty Hawk, NC 27949
BENEFICIARY
Nathaniel Jackson
P.O. Box 2734
Manteo, NC 27954
Enter in appropriate block for each party: name address, and, if appropriate, character of entity, e.g.
orporation or partnership
The designation Grantor, Trustee, and Beneficiary as used herein shall include said parties, their heirs,
successors, and assigns, and shall include singular, plural, masculine, feminine or neuter as required by context.
W ITNESSETH, That whereas the Grantor is indebted to the Beneficiary in the principal sum of Sixty Thousand
Dollars ($60,000.00), as evidenced by a Promissory Note of even date herewith, the terms of which are
incorporated herein by reference. The final due date for payments of said Promissory Note, if not sooner paid, is
June 14, 2031
NOW, THEREFORE, as security for said indebtedness, advancements and other sums expended by Beneficiary
pursuant to this Deed of Trust and costs of collection (including attorneys fees as provided in the Promissory Note)
and other valuable consideration, the receipt of which is hereby acknowledged, the Grantor has bargained, sold,
given and conveyed and does by these presents bargain, sell, give, grant and convey to said Trustee, his heirs, or
successors, and assigns, the parcel(s) of land situated in Ocracoke Township, Hyde County, North Carolina, (the
"Premises") and more particularly described in Exhibit A attached hereto and incorporated herein by reference.

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North Carolina Environm al
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910-346-3107 28540
DATE: ~-1a91o5
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