20080475 Ver 1_Minor Variance_20080312

OFFICE USE ONLY: Date Received Request #
State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
Variance Request Form - for Minor Variances
Protection and Maintenance of Riparian Areas Rules
NOTE: This form may be photocopied for use as an original.
Please identify which Riparian Area (Buffer) Protection Rule applies.
Li 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)
o Catawba River Basin: Protection and Maintenance of Existing Riparian
Buffers (15A NCAC 02B.0243)
Part 1: General Information
(Please include attachments if the room provided is insufficient.)
1. Applicant's name (the corporation, individual, etc. who owns the property):
2. Print Owner/Signing Official (person
Name: t3cWaNml
Title:
Street address: Q -l- F-
City, State, Zip:
Telephone: (Z-
Fax: 3. Contact person who can an
Name: _
Telephone:
Z)_
Fax:
Email
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4. Project Name (Subdivision, facility, or establishment name -consistent with project name on
plans, specifications, letters, operation and maintenance agreements, etc.):
107- 2:?l , P60_340_6 __M4
nsible for the property and its compliance)
questions about the proposed project:
Version 2: November 2002
5. Project Location:
Street address:
City, State, Zip:
County:
Latitude/longitude:
6. Directions to site from nearest major intersection (Also, attach an 8 % x 11 copy of the USGS
topographic map indicating the location of the site):
ro-vi -Ur- r,? r? ? r,? ? AO t_d s i4wv J71'r 4J j4,Kih,? PpeAc w AD.
7. Stream to be impacted by the proposed activity:
Stream name (for unnamed streams labjel as "UT" to the nearest named stream):
Stream classification [as identified withh the Schedule of Classifications 15A NCAC 26
.0315 (Neuse) or.0316 (Tar-Pamlico)]: .0310 - L- C.u
/AID itX ©P 27_6:*)
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 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:
r
Variance Request Form, page 2
Version 2: November 2000
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
-
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.):
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4
(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 (indi)
Mailing address:
City, State, Zip:
Telephone:
Fax:
Email:
Part 5: Applicant's Certification
L41
UN
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Variance Request Form, page 3
Version 2: November 2000
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
i nvnlvpd _
I, Q ? A l? g, (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:
Title:
Variance Request Form, page 4
Version 2: November 2000
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PRELIMINARY PLAT; NOT FOR RECORDATIOt
CONVEYANCES, OR SALES
ADJOINER'S ??- ?1?
EXISTING
BULKHEAD
54, PROPERTY LINE FROM
s' F DEED AND MAP
PROPOSED BULKHEAD CONNECTING
ADJOINER'S BULKHEADS
TOP OF BANK &
SHORE LINE +/- 51
PROPOSED DECK & SCREENED PORCH
ENCROACH INTO RIPARIAN BUFFER TO
PROVIDE 5' BUFFER TO EXISTING SEPTIC
TANK
? R/P,yp,Wy BUfF?
2.9 LAVE PROPOSED
PROPOSED DECK SCREENED
50 37.0' PORCH - -
23 0'
PROPOSED DWELUNG
W
n
N 18.0' C
e 60.0'
PORCH 29.7'
2
EXISTING
SEPTIC TANK
Li
3.7'
ADJOINER'S
EXISTING
BULKHEAD
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