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Home My WebLink About20061881 Ver 1_Minor Variance_20061206OFFICE USE ONLY: Date Received _ __ Request # _ __- State of North Carolina ~ A ~ g Department of Environment and Natural Resources ~! ~ 8 8 t Division of Water Quality 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 026 .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) Part 1: General Information ~ ~~ "~ ~~~ D (Please include attachments if the room provided is insufficient.) p E C 6 2006 1. Aonlicant's name (the corporation, individual, etc. who owns the property): n ~ DENR • VYATER QUALITY _- ~~ ~,~~ fV"t~-~-t ~D~.__--=-Iv C~,ru~~i~~'~ _N~~:rrilc<~;c ~-r~~.~~;~sa~a~ra~w~t~~aNC~+ 2. Print Owner/Signing Official (person legally responsible for the property and its compliance} Name: Ntc~l~._ S~~~LC . ;,- C~'rt~~~~sz t~'ta.-~<<<,~~_r-r~~~;-z.->;- `. Title: ~~ - ~~,_~nrn~,~n~.r~-- F'tc";-d~' __ _ __ _ ____ - ~ __ ._ _ Street address: n"' ~'>- ~~.~ :?E-t'~ '~' _ __ ___ -_ -- - - __ -- _ __ - City, State, Zip: _~~-t` 21 1'~?f_ 3? ~r ~3~ ~ ____ _ __-- _ _-- -- __-- _ - --_-----__-_ Telephone:(1t~O ~t~ ~ 3i:~;~~-, ____ __ Fax: ~t~~ )~_~~' t~-f~---------_---__-----------------_--------- 3. Contact person who can answer questions about the proposed project: Name: '~~ Fi nr ~~ V- ~~_-----_____-- _ _ - Tele hone: ~ p ~.~1-~-)._~_x~ -1~~-_- ---------------- -_ --------------------- --- - Fax: { ~ t c~ }, ~(c.. ~ - i~ t y_L? ------------ -- Email: 4. Project Name (Subdivision, facility, or establishment name -consistent with project name on plans, specifications, letters, operation and maintenance agreements, etc.): --~_1~~~__ n_`L~ I _~ ~~_----L~1a sf."~t.~: Ct ,cc~ ~ _I ~'~-c<s.~~r~~~_~i- 1~~-~'~-F _-- Version 2: November 2002 5. Project Location: Street address: 1`~~ -i ~~ __i21 ~~~ ~t~ir~~ __iUY ____ Ciry, State, Zip: ~~a:k c~-~i- y ~ ~t- --'~=-----_d~l_____ _ _-- County: (,~k~-u--C%_ _ _ __ _ _ _ --- -_ _ _ ---- --- __ Latitude/longitude: - ~-,c~,~._ ~ ~_~~-14 Z_'~~'~_~ . ___ Lvr'1___-7~a-~~'~C-~>~---- -------- 6. Directions to site from nearest major intersection (Also, attach an 8'/z x 11 copy of the USGS topographic map indicating the location of the site}: ~~L~u~ In o n 1~=~z i,~~ c.,~. til~,~~~_ ~Y . -~t r~G~1;t- c ~ i2i ~.~ I~.~, ~ 7. Stream to be impacted by the proposed activity: Stream name (for u named streams label as "UT' to the nearest named stream): Stream classification [as identified within the Schedule of Classifications 15A NCAC 26 .0315 (Neuse} or .0316 (Tar-Pamlico)]: __ __~-_ 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 - __ X_ ~~ 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.) 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 ftz.] ~ Vl ~;f/~~ t i rlt~1 ~_ ~ f;~ (,ti... ' '~ ~ t'l. Z ` X j L~` X ~ `~_ (,~.~~'1_ 2 Variance Request Form, page 2 Version 2: November 2000 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: 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.): "~Q-~ w~l t ._._G~~'?-~.~)-- ~'..7~-- _~ ~~~~r _~ XC_~L'c~k~ `~"1 _C~u~~~ Gi _`~t (-~.---- ------ -- - - 4. Please provide an explanation of the following: (1) The practical difficulties or hardships that would result from the strict application of this Rule. ~~ ~-r~~ ..~ P~ h r~. S~,I ~ tc~-- -rye ~~c2Lelc~-~ r ~~ '~ ~ (2) How these difficulties or hardships result from conditions that are unique to the property involved. ~-~LSiL~~ t<ll~~ CCc.F..~t`~P~ 'Chi i--~~~~t~1i~ irn~C~ _ t.~~ ~ l t~ ~r~f C~ cc m ~ r~ i rYl (_l i~v~ f~ C,c ~' ~^ ~m rv-- '?~c-["'~- - (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. F neor~~ ~<~ a~ v-ti~r ~ iDt,~ etas ~~_ ~ t'r,[2/~ ~ ~ .~ s~ ~ ~~, 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: - ----- ------------ ------ Variance Request Form, page 3 Version 2: November 2000 Part 5: Applicant's Certification 1, ~1Gi.1bk-G J-'l l-<<~C~S _ ______ (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: ~Ol-r~ ~- Variance Request Form, page 4 Version 2: November 2000 \ `, ~ \~\ I _ / ~ ~ 1 ~ ~ ~ s V f '~ ~ ~ Z.~~r ~. 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