20071305 Ver 1_Minor Variance_20070730

OFFICE USE ONLY: Date Received ____ __ Request #
State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality ~ 7- 1 3 0 5
Variance Request Form -for Minor Variances
Protection and Maintenance of Riparian Areas Rules
NOTE: This form maybe photocopied for use as an original.
Please identify which Riparian Area (Buffer) Protection Rule applies.
~/Neuse River Basin: Nutrient Sensitive Waters Management Strategy
Protection and Maintenance of Riparian Areas Rule (15A NCAC 02B
.0233)
^ Tar-Pamlico River Basin: Nutrient Sensitive Waters Management
Strategy Protection and Maintenance of Riparian Areas Rule (15A
NCAC 02B .0259)
^ Catawba River Basin: Protection and Maintenance of Existing Riparian
Buffers (15A NCAC 02B .0243)
._ - _ ;y
Part 1: General Information
(Please include attachments if the room provided is insufficient.) ~ - -- °~ '~' ~u`'
1. Applicant's name (the corpo ation, individual, etc. who owns the property): ,. , :> *~
-, ::
~ llq erne S~.~eetw
a
2. Print Owner/Signing Official (person legally responsible for the property and its compliance)
Name: ~(.,~.~j~~ne SG~.IP~~
Title: <J
Street address: ~ Q a ~ t~C~-~lc, tJ C
City, State, Zip: ~y10 l5 V ~ L l e., N L d 75~CD
Telephone: ~ l°f fo5~ '' L')Ocl
Fax:
3. Contact person who can nswer questions about the proposed project:
Name: t°IrIC SC~P~('Nc~
Telephone: ~j l ~S ~ - ~'70~
Fax:
Email: ~j SQ.,_~pr1~f Q ~ NG- IZ2, C-U N~
4. Project Name (Subdivision, facility, or establishment name -consistent with project name on
plans, specifications, letters, operation and maintenance agreements, etc.):
Version 2: November 2002

5. Project Location: o
Street address: ~.C~~ ~. T7V ?~S ~N ~ Dry
City, State, Zip: G° 19rLY _. N(- 2'? Sl3 _ _
County: W Gc~KP-..
_ __
Latitude/longitude: ~~ 5~ ~~ ~ ~~ ~`'~ ~~~
6. Directions to site from nearest major intersection (Also, attach an 8'h x 11 copy of the USGS
topographic map indicating the location of the site):
7. Stream to be impacted by the proposed activity:
Stream name (for nnamed streams label as "UT" to the nearest named stream):
_ _ ~s _-__~ __ _ _ _
Stream classification [as identified within the Schedule of Classifications 15A NCAC 26
.0315 (Neuse) or .0316 (Tar-Pamlico)]: a~ -33 - (,t~ _ _
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
NPDES Permit (including stormwater)
_ _ __
Non-discharge Permit
Water Supply Watershed Varian
~ Others (specify) ~..pp4y____r~~t~b/
y(ar4ov~k~a-
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
of buffer"mpact in ft2.]:
~.~9< 3 S L+~ Fri" _ - /k ~ l~ i h (M ~. = l 2s S ~, Fc ~ 'I ~,~ /k,!" A-Q.2, SUn21/~e~ ~~
_ _ h~~t ~v~ Z y 7 6-. ~ N L-e~LtJ~w
__ _ _ __
2. State reasons why this plan for the proposed activity cannot be practically accomplished,
reduced or reconfigured to better minimize or el'minate disturbance to the ri avian buffers:
~s~v~ _ .~Y ~2k r~4 . ~!~-^~ _`~~ _.. __ ,l~ b_~-(K ~S t Diu
_ _ ~ GIn nr~_ e ~1 ~A~*~~._~~._ a ..ate .~+c~.~-~i,,~ wc~-
_ _ _ _
Variance Request Form, page 2
Version 2: November 2000

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.):
_. _._
_ _
4. Please provide an explanation of the following:
(1) The practical difficulties or hardships that would result from the strict application of this
Rule. t I.
~~ ~jct-.ca.~l- `~_ _ ,C~r~ v~Uc~2a2__ eA= AJV1~~L..
~~r
.~~~
__
__ __
(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 he 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: _ _
Fax:
__
Email:
Part 5: Applicant's Certification
Variance Request Form, page 3
Version 2: November 2000

I, ~~.-_~,}~v~~ -_~~ ~~N~ __ (print or type name of person
listed in Par't'l, 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: '"I j 5 t ~ ~l
Title: ~J /U U w~
Variance Request Form, page 4
Version 2: November 2000

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