20090275 Ver 1_Minor Variance_20090318

OFFICE USE ONLY: Date Received _ ____ Request
State of North Carolina
Department of Environment and Natural Resources F B MAR Division of Water Quality oQ
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 Protection Rule applies.
? Neuse River Basin: Nutrient Sensitive Waters Management Strategy
Protection and Maintenance of Riparian Areas Rule (15A NCAC .0233)
a' Tar-Pamlico River Basin: Nutrient Sensitive Waters Management
Strategy Protection and Maintenance of Riparian Areas Rule (15A
NCAC .0259)
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 gfficial (person legally responsible for the property and its compliance)
Name:
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Title: p Pe f?
Street address: i
,
City, State, Zip: sX
Telephone:
Fax:

3. Contact person who can answer questions about the proposed project:
Name: !1 t?C>_ ??
Telephone: ``
Fax:
Email:
4. Project Name (Subdivision, facility, or establishment name - consistent with project name on
plans, specifications, letters, operation and maintenance agreements, etc.):
5. Project Location:
Street address:
City, State, Zip:
County:
Latitude/longitude:
Version 1: February 2000

6. Directions to site from nearest major intersection (Also, attach an 8'/2 x 11 copy of the USGS
topographic map indicating the location of the site):
L ! N 1. L,'.. '? - I? L
7. Stream to be impacted by the proposed activity:
Stream name (for unnamed streams label as "UT" to the nearest named stream):
Stream classification [as identified within the Schedule of Classifications 15A NCAC 2B
.0315 (Neuse) or .0316 (Tar-Pamlico)] c,.C --?e I`
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 Variance
Others (specify),_ 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 impact in fts.:
?......... -
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.):
Variance Request Form, page 2
Version 1: February 2000
4. Please provide an explanation of the following:
(1) The practical difficulties or hardships that would result from the strict application of this
Rule.
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(2) How these difficulties or hardships result from conditions that are unique to the property
involved.
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(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:
Fax:
Email:
Part 5: Applicant's Certification
1, (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 3
Version 1: February 2000
HYDE COUNTY HEALTH DEPARTMENT
P.O. BOX 100 SWAN QUARTER, NC 27885
[phone]
AUTHORIZATION FOR CONTINUED USE OF AN
EXISTING SEPTIC TANK SYSTEM
FOR
Smithwick Properties
An existing system inspection was performed on your property located at
G-11 on Robin Lane, Riverside Campground, Belhaven. The system can
accommodate a 2 bedroom cabin and a 2 bedroom mobile home. On the date of
the inspection, January 28, 2009 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
property will function in a satisfactory manner for any specific period of time.
Hugh Watson, RS
Environmental Health Specialist
HYDE COUNTY HEALTH (DEPARTMENT
P.O. Soot 100 Sudan Quarter, NC 277
Pimmre # (252) 92SAM
APPLICATION FOR AUTHORMTION TO CONSTRUCT
AWkmt: C.
Phone #; Lot #': - 1c>?,.i =1
Original Owner: ?%yLt ??. li ?.... ?? s ? ? .....?
Directions to propr i ty: 1? i C'C vc?G? ?_ - L (1;?
.? l?i `".•k..?.- t->ie? ??''i+(- t ! ti AC
k
No. of bedrooma. _ .., ? Business t # of people)
Water source:

Comrtrunity Private well-
1. The applicant *Al notify the Hyde County Health Department of
any designated wetlands on this property/ C 404 or CAMA ) prior
to a sibs Visit.
2. The owner shall identify all lest lines and corm.
I dedare all the information given in this applicaton is true and x
hereby authorize the Hyde County Health Department personnel
to go on said properly to perfa m the necessary evaiua*NL
Owner/Authorrxed Agent Date
HYDE COUNTY SITE/SOIL EV.?UATIDN
wrier/App Applicant:
late of Eval.: Evart!
,st imated Flow ?Resi entilal ?-.
SLOPE
T-15%
15-30%
30%
FACTORS ? PROFILE 1'RQPILE PPOF?LB PROF?I,E PROFILE

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,, - s a.nd
is - loamy sated
sl - sandy loan,
I - loam
wi. - salt
sit - silt loam
sicl - silty clay loam
cl clay loam
scl - sandy clay loam
sc - sandy relay
sic - silty clay
r. - clay

Permit 0 on by : Auger boring
ComerCial
-TERM ACC
STRUCTURE
cr - C rmb gsanulax
bk - blocky
(peds :'1 in.)
(pods al
pi - platy
pr - prismatic
eg - single grain
m - massive
CONSISTENCE
-- Moist
fx - friable
fi - firm
loo - loose
Wat
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s - sticky
np - non-plastio
P - plastic
MIk?j;-?OGY
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