20081202 Ver 1_Minor Variance_20080806

OFFICE 'JSE ONLY: Date Received

State o" N :).th Carolina Q 8 2 0 2
Depart'ne i+, of Environment and Natural Resources
Division a Water Quality

AU G 6 -2008
WETLANDS AND TTORMWA R BRANCH
Variance Request Form - for Minor Variances
ProtFactiion and Maintenance of Riparian Areas Rules
NOTE l t is form maybe photocopied for use as an original.

Please i4entify which Riparian Area (Buffer) Protection Rule applies.
}t, Noose River Basin: Nutrient Sensitive Waters Management Strategy
Prw,ection and Maintenance of Riparian Areas Rule (15A NCAC 02B
.02%1' 13)
o Tar• Pamiico River Basin: Nutrient Sensitive Waters Management
Strategy Protection and Maintenance of Riparian Areas Rule (15A
U!'#'AC 02B.0259)
o Catawba River Basin: Protection and Maintenance of Existing Riparian
Buf^ors (15A NCAC 02B .0243)

Part 1: General Information
(Plea !;e include attachments if the room provided is insufficient)
1. Applicant's name (the ooU)o?rat`i`on, individual, etc. who owns the property): ?1 G
t n, ( k
2. Print Owner/Signing Official (person legally i;esponsibie for the property and its compliance)
Niim o?u Tit e: St,ee t address: '7 1 ?? ?.,,., S .
Ci-,y, State, Zip: na. /o:. ArC, X76 0 l
Telephone: q <q ; It I I? ? Y / l
Fei x:
3. CvnU,-,t person who can an wer quespflpns,?bot the proposed project:
Neim,.: V ou3 l-? l -!
Telephone:
Fa x:
Er sail: D??? 1^n? l k e. 6 A r1 . G oY?--'
4. Praject Name (Subdivision, facility, or establishment name -consistent with project name on
phnns, specifications, lette operation and maintenance agree Tts, etc.):
13 P19
J
Versior, 2: November 2002
5. Projac Location: ?? rryl? y
Street address: r A
City S tate, zip: JQ- L z? 6 t?
COUntit:
Lati{uc ey/longitude: 3 S" #4 ' JQ5 `? hJ '7
36' 9q" W
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):
?•ycaY?'?., In TerS?rG'L„ d ? S' ? ? V ? /' ` ??
1. o C_ Q40 yr y.
3,..e we' i-0 rywood ? Qt an.'4d h'10L 16OL,,
7. Stre=ari to be impacted by the proposed activity:
Streari name (for unnamed streams label as "UT" to the nearest named stream):
VT
Stre;avi classification [as identified within the Schedule of Classifications 15A NCAC 2B
.03'= 5 O leuse) or .0316 (Tar-Pamlico)]: _ 01 I $
8. Whic!" of the following permits/approvals will be required or have been received already for
this project?
Rec;ui - d: 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
(Pleasca :'riclude attachments if the room provided is insufficient.)
1. Description of proposed activity [Also, please attach a map of sufficient detail (such as a plat
main of site plan) to accurately delineate the boundaries of the land to be utilized in carrying
out th 3 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 9xiler impact In fe.]: A 14-or, I& I
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:
NouS yy? ;ti ; »1 z?
".??9' .f?4G F / ?S 440, 1,,_ e d- 4' CO.-J t& k l a-
{L ,,C,?f It S I'r1, Ci T tti CL p r, 1--Y
G,r X0.1-_ 6vWa/ Iq,wIf I
Variance F f! quest Form, page 2
Version 2: November 2000
3. Des hi)-kion of any best management practices to be used to control impacts associated with
the prc posed activity (i.e., control of runoff from impervious surfaces to provide diffuse flow,
re-piar ting vegetation or enhancement of existing vegetation, et/c.):
Qa-co•nv-+?? dr.riww...? ?a Q.`B t'? yag?...?ror.
X r.av-? 1 0 ?r a b • J
4. Please provide an explanation of the following:
(1) `I'hi i practical difficulties or hardships that would result from the strict application of this
Rulo. worn ?C 4 ab
j-61" `° vY S o? ?? q c t el t dL r G? 8'-iI'? L
l
(2) ;Aonr these difficulties or hardships result from conditions that are unique to the property
invvIved. J 1
._d- r ?r a? h? l to V to S
(3) If ex,onomic hardship is the major consideration, then include a specific explanation of the
ecc iornic hardships and the proportion of the hardship to the entire value of the project.
Part' I: Deed Restrictions
By your stnature in Part 5 of this application, you certify that all structural stormwater best
managerr e:nt practices required by this variance shall be located in recorded stormwater
easernaw s, that the easements will nm 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 ar y lot.
Part 4: Agent Authorization
If you wis-i to designate submittal authority to another individual or firm so that they may provide
informatiofi on your behalf, please complete this section:
Desigr,atod agent (individual or firm):
Mailing address:
City, Si.at), Zip:
Telept or e :
Fax:
Email:
Part Vii: Applicant's Certification
Varianca Eequest Form, page 3
Versior 2: November 2000
I D at/l r ?, b k (print or type name of person
listed in l"art I, iterri-), 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 rr: sirictions in accordance with Na of this form will be recorded with all required permit
condition: .
Signat.u,EDate: 6 / 1? 0e
Title: m
3r
Variance; F quest Form, page 4
Version 2: November 2000
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Page Last ModifiNI::iiune 8, 2008

http://store.us ys.?,ovfb2c_usgs/usgs/maplocator/(layout=6_1_61 48&uiarea=2&ctype=are... 6/17/2008
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