20070276 Ver 1_Minor Variance_20070214

:~
` OFFICE USE ONLY: Date Received Request #
State of North Carolina
Department of Environment and Natural Resources 2 Q Q 7 Q 2 7 (~`
Division of Water Qualit-
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.
~t~ Neuse River Basin: Nutrient Sensitive Waters Management Strategy
`'~ Protection and Maintenance of Riparian Areas Rule (15A NCAC O2B
.0233}
Tar-Pamlico River Basin: Nutrient Sensitive Waters Management
Strategy Protection and Maintenance of Riparian Areas Rule (15A
NCAC O2B .0259)
Catawba River Basin: Protection and Maintenance of Existing Riparian
Buffers (15A NCAC O2B .0243)
Part 1: General Information
(Please include attachments if the room provided is insufficient.)
1. Appli is name (the corporation, individual, etc. who owns the pro erty):
2. Print QwnerlSignirtg Offjcial (person legally responsible for the property and its compliance)
Name: -~~ c Ni9,~J _ ~-' _ ___ /1.~~ E1~~~//a1
Title: _ _
Street address: c/5/DDS _ ~f~Li iU~ S G T
City, State, Zip: /7G7G~- y Ja°t~, nl~ s , /Ur ~ .~ 7 j Qa0
Telephone: `~ / r 5~5 ~" =~7~ Z- _ _
Fax: ~~/`'~ 5~ 7- 37~~-
__
3. Contact person who can a wer questions abo}~t the proposed project:
Name: ~<~FI ~'' ~.~ _ /V ~ ~ ~t~~~
Telephone: ~ 1 ~~ 7 - 3'7G, z_
Fax: ~/`j SS 7- ~7~-Z
Email: ~°~~~4~1~ic,.fc ~ }~~/-E~~.. C'~'. _
4. Project Name (Subdivision, facility, or establishment name -consistent with project name on
plans, specifications, letters, operation and maintena ce agreements, etc) .~ . -- ;
.-c ~,
__.. ,r
ry ',I
Version 2: November 2002 ~- %~,' ! `u ~-
4 ~~ ~ ' 6t
t~'q'~ig AY4 . , .

5. Project Location: ..- ~ ~
Street address: ~ f~~ ~/~~-//~~ ~
.. / _.
noun tate, Zip: ~,,4Kt ~/~'1.1G ~. ~ !lf~ ... ~?7~.~~.
tY~
Latitude/longitude: __ __ _ _ __
___
6. Directions to site from nearest major intersection (Also, attach an 8'h x 11 copy of the USGS
p p g site}.
to o ra hi ~ a Sin~c~~ s he I~ocation~~ th ~ ~~ L / ti~r('~ c ~~tdd~ - ~7- U~/ S A-c.~ ~
~- c~c..~ .. ..
~~J~~- .y •vr c ac.3_ ~.~l:T1t ~.~ TV~.i.__ - ~T- ~ ~ .SeF ~.i~i~S Cr-
_ ___ _ __
7. Stream to be impacted by the proposed activity:
Stream name (for ~pnamed streams label as UT" to the nearest named stream):
Stream classification [as identified within the Schedule of Classifications 15A NCAC 2B
.r?315 (Neese) or.tT346 (Tar-Pamlico)]: /5 !~_ /lJ'C!4,~,' `~ T3 , rj-z. ~~~ _
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/4Q4 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 ft2.]:
~X~AN~ ~~c ~.~-~ o ~v_ ~~ ~~ of l-~v~tE
__ __ _ _ _
__ _ _ _ _ _.
2. State reasons why this plan for the proposed activ~y cannot be practically accomplishers,
reduced or reconfigured to better minimize or eliminate disturbance to the riparian buffers:
__ _ 7f~E C~ u r~,e c ~ T ~~..c K °6-. I -~c~.u s~ _.~~s ~.
~/ T/ft~EN =~0 FT p F G~EE~I , .f~l , ~R~ ~'N7~"//~1~ f~ll~ ~J
_ . __ - .,. m _ _..._ ., - ,~ _.....R... _ _ r . _.... _ .~ _ __.
~F~A1 ~7~~rti~FiG~..~~~5 Tc~ ,STAN ~1~7"~i~ ~F ~- ~~Fr' gcr.~f~,~-
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 surtaces 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.
~/i((~/LQJ.~r?c.~: _.~.~1~7._.L~li-e~'-../2~~._._J~/.~../~~...-~.1-t~-...1"12.~~1~~~ll/T~.~.~'1~,
{2) How these difficulties or hardships result from conditions that are unique to the property
(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 shaft 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

L- • il./~~~/f '/ rint ort e name of erson
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: ,~~~,zao ~.
Title:
Variance Request Form, page 4
Version 2: November 2000

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Norfh Caroli\`,``o~>Ij)l~~` hake Co.
I, Daniel ~ tify that this plat was drawn
under my ° actual surve= made under my
aupervis 2 2 ); that the boundaries
not ~; ash as'SiasLsd lines; that the ratio
of9~p ~ ted ;s 10000 ; t t this plat
wj~ a ce;Wi the Stand da of Practice.
gais~;q~ ~ >~ registra oa nu-sber d
s cj~ e ~Y~• '
°' o ~' ~ Y ~ 44;0 O S
b Daniel ,V'. ~ '"8 ~~~~
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r ., ~` 1
+ 4 ~' ;
k.1. .... .~\. hr
~f`f"~., .1~
< 'tn. ~
Tha property (f~ is not) n an area '
designated as havia al flood
hazards as of this date.
3 7 1 8 30066 O E X
FEMB MSP ~ ZONE
Effective Date: March 3, 1992
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t3ENERAL NOTES
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Order Entry Report
.~~~!{{ U91d~~' CtJi"`!S$CUCtIOCI. Quote #: S2-Q777
Norma Adachi
Tysoft
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USA
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Summary: 9/19 Rick test 2 Vantage 6
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