New Submission

A. General Project Information

For instructions on how to fill out this form, see the Major and Minor Variance Help Document posted on DWR’s 401 & Buffer Permitting page.
Please note: fields marked with a red asterisk * below are required. You will not be able to submit the form until all mandatory questions are answered.
1a. Is this a transportation project?*field type radio button
1a. Is this a transportation project?YesNo
1b. Is this an NCDOT Project?*field type radio button
1b. Is this an NCDOT Project?YesNo
1c. TIP#:field type single line
Input blocked. Maximum character limit of 4000 characters reached.
1d. WBS#:field type single line
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C. Applicant/Owner Information

Who is submitting the application:*field type checkbox
Who is submitting the application:OwnerApplicant other than OwnerAgent
Check all that apply.
Is there an agent working on the project but not submitting it?*field type radio button
Is there an agent working on the project but not submitting it?YesNo
Primary Contact:*field type single line
This is for who should be notified if a payment is required.
Input blocked. Maximum character limit of 4000 characters reached.
Primary Contact Email:*field type email
1. Property Owner:
×
- 1a. Name:*field type single line
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- 1b. Title:field type single line
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- 1c. Mailing Address:*field type address
  Street Address
  Address Line 2
  City
  State / Province / Region
  Postal / Zip Code
  Country
- 1d. Telephone:*field type single line
  Input blocked. Maximum character limit of 4000 characters reached.
- 1e. Email Address:*field type email
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2. Applicant Information (if different from owner):
×
- 2a. Name:*field type single line
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- 2b. Company Affiliation:field type single line
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- 2c. Mailing Address:*field type address
  Street Address
  Address Line 2
  City
  State / Province / Region
  Postal / Zip Code
  Country
- 2d. Telephone:*field type single line
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- 2e. Email Address:*field type email
- 2f. Attach a signed and dated copy of the authorization granting the applicant owner approval. An agent authorization form is acceptable.field type file upload
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3. Agent Information:
×
- 3a. Name:*field type single line
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- 3b. Company Affiliation:*field type single line
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- 3c. Mailing Address:*field type address
  Street Address
  Address Line 2
  City
  State / Province / Region
  Postal / Zip Code
  Country
- 3d. Telephone:*field type single line
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- 3e. Email Address:*field type email
- 3f. Attach an agent authorization form.*field type file upload
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D. Project Information

1. Project Name:*field type single line
(Subdivision, facility, or establishment name)
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	2. County(ies)*field type drop-down
Row 1×	2. County(ies)*field type drop-down	×

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3. Property Location:

3a. Property Address:*field type address
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Country
3b. Latitude:field type single line
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3c. Longitude:field type single line
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3d. Attach an 8 ½ x 11 excerpt from the most recent version of the USGS topographic map indicating the location of the site.field type file upload
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* USGS Topo look up
3e. Attach an 8 ½ x 11 excerpt from the most recent version of the published County NRCS Soil Survey Map depicting the project site.field type file upload
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Link to Soil Surveys for North Carolina Counties. (Please see instructions in the Help Document to determine the most recent published version.)

4. Property Information:

4a. Parcel Identification Number (PIN)field type single line
Row 1× 4a. Parcel Identification Number (PIN)field type single line
Input blocked. Maximum character limit of 4000 characters reached.
×
Add another id number
4b. Date Property Purchased:field type date
mm/dd/yyyy

	4a. Parcel Identification Number (PIN)field type single line
Row 1×	4a. Parcel Identification Number (PIN)field type single line Input blocked. Maximum character limit of 4000 characters reached.	×

4c. Type of Book	Book#field type single line	Page#field type single line
Deed	Book#field type single line Input blocked. Maximum character limit of 4000 characters reached.	Page#field type single line Input blocked. Maximum character limit of 4000 characters reached.
Map	Book#field type single line Input blocked. Maximum character limit of 4000 characters reached.	Page#field type single line Input blocked. Maximum character limit of 4000 characters reached.

4d. Attach a copy of the recorded map that indicates when the lot was last platted.field type file upload
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4e. Is your project in one of the 20 Coastal Counties covered under the Coastal Area Management Act (CAMA)?*field type radio button
4e. Is your project in one of the 20 Coastal Counties covered under the Coastal Area Management Act (CAMA)?YesNo
4f. Is the project located within a NC DCM Area of Environmental Concern (AEC)?*field type radio button
4f. Is the project located within a NC DCM Area of Environmental Concern (AEC)?YesNoUnknown
4g. In which AEC do you fall?*field type radio button
4g. In which AEC do you fall?30 ft75 ft
4h. What is the total percent of impervious cover that you have proposed within the AEC?*field type single line
Input blocked. Maximum character limit of 4000 characters reached.
4i. Directions to site from nearest major intersection:*field type multi line

5. Stream associated with riparian buffer to be impacted by the proposed activity:

	Namefield type single line	Water Quality Classificationfield type single line
row 1	Namefield type single line Input blocked. Maximum character limit of 4000 characters reached.	Water Quality Classificationfield type single line Input blocked. Maximum character limit of 4000 characters reached.

6. Goose Creek Only: Is the buffer in the 100-year floodplain?field type radio button
6. Goose Creek Only: Is the buffer in the 100-year floodplain?YesNo

7. List any permits/approvals that have been requested or obtained for this project in the past.

	Date Appliedfield type date	Date Receivedfield type date	Permit Typefield type single line
Row 1×	Date Appliedfield type date	Date Receivedfield type date	Permit Typefield type single line Input blocked. Maximum character limit of 4000 characters reached.	×

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E. Proposed Activity

1. Provide a detailed description of the proposed activity including its purpose:*field type multi line
2. Attach a site plan as applicable to the project:field type file upload
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** Below is a link with instructions on what you will need to show on your site plan.
http://edocs.deq.nc.gov/WaterResources/0/doc/402224/Page1.aspx

F. Proposed Impacts and Mitigation Information

1. Individually list the square footage of each proposed impact to the protected riparian buffers:

	1a. Site# - Reasonfield type single line	1b. Buffer Impact*field type drop-down	1c. Stream Namefield type single line	1d. Mitigation Required?field type drop-down	1f. Zone 1field type number	1g. Zone 2field type number	field type number
B 1×	1a. Site# - Reasonfield type single line Map label (e.g. Road Crossing 1) Input blocked. Maximum character limit of 4000 characters reached.	1b. Buffer Impact*field type drop-down	1c. Stream Namefield type single line Input blocked. Maximum character limit of 4000 characters reached.	1d. Mitigation Required?field type drop-down	1f. Zone 1field type number Square Feet	1g. Zone 2field type number Square Feet	field type number	×

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1h. Total Zone 1 Impacts:field type number
1i. Total Zone 2 Impacts:field type number
1j. Total Buffer Impacts:field type number
1k. Comments:field type multi line

Calculated Mitigation

1l. Zone 1

	Total Impactfield type number	Multiplierfield type number	Required Mitigationfield type number
Zone 1	Total Impactfield type number Square Feet	Multiplierfield type number	Required Mitigationfield type number Square Feet

1l. Zone 1 - Catawba Only

	Total Impactfield type number	Multiplierfield type number	Required Mitigationfield type number
Zone 1 - Catawba Only	Total Impactfield type number Square Feet	Multiplierfield type number	Required Mitigationfield type number Square Feet

1l. Goose Creek Only

	Total Impactfield type number	Multiplierfield type number	Required Mitigationfield type number
Zone 1 - Catawba Only	Total Impactfield type number Square Feet	Multiplierfield type number	Required Mitigationfield type number Square Feet

1m. Zone 2

	Total Impactfield type number	Multiplierfield type number	Required Mitigationfield type number
Zone 1	Total Impactfield type number Square Feet	Multiplierfield type number	Required Mitigationfield type number Square Feet

2. Mitigation Information

2a. What is the mitigation plan proposed for this project?*field type checkbox
2a. What is the mitigation plan proposed for this project?Payment to private mitigation bankPayment to Division of Mitigation (DMS)Permittee responsible mitigation
2b. Provide a description of your mitigation plan.field type multi line
2c. Attach a detailed planting plan to include plant type, date of plantings, the date of the one-time fertilization in the protected riparian buffers, and a plan sheet showing the proposed location of the plantings.*field type file upload
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2d. Attach statement of availability from mitigation provider.*field type file upload
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2e. Attach your reservation letter from DMS.*field type file upload
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2f. Comments:field type multi line

G. Stormwater

1. Provide a description of how diffuse flow will be maintained through the protected riparian buffers (e.g., re-planting vegetation or enhancement of existing vegetation, gutter splash pads, level spreader to control of runoff from impervious surfaces, etc.).*field type multi line
2. Show the location of diffuse flow measure(s) on your site plan.field type file upload
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3. Attach a completed Level Spreader Supplement Form or BMP Supplement Form with all required items for each proposed measure.field type file upload
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4. Attach an Operation and Maintenance (O&M) Form for each proposed level spreader or BMP.field type file upload
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5. For Major, Catawba, and Goose Creek variance requests
×
- 5a. Provide a description of all best management practices (BMPs) that will be used to minimize disturbance and control the discharge of nutrients and sediments from stormwater.*field type multi line
- 5b. Show the location of BMPs on your site plan.field type file upload
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- 5c. Attach a Supplement Form for each structural BMP proposed.field type file upload
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- 5d. Attach an Operation and Maintenance (O&M) Form for each structural BMP proposed.field type file upload
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H. Demonstration of Need for a Variance

The variance provision of the riparian buffer rules allows the Division or the Environmental Management Commission to grant a variance when there are practical difficulties or unnecessary hardships that prevent compliance with the strict letter of riparian buffer protection.

1. Explain how complying with the provisions of the applicable rule would prevent you from securing a reasonable return from or make reasonable use of your property. Merely proving that the variance would permit a greater profit from the property shall not be considered adequate justification for a variance. The Division will consider whether the variance is the minimum possible deviation from the terms of the applicable Buffer Rule that shall make reasonable use of the property possible.*field type multi line
2. Explain how the hardship results from application of the Buffer Rule to the property rather from other factors such as deed restrictions or other hardships (e.g. zoning setbacks, floodplains, etc).*field type multi line
3. Explain whether the hardship was caused by the applicant knowingly or unknowingly violating the applicable Buffer Rule.*field type multi line
4. Explain how the hardship results from physical nature of the property, such as its size, shape, or topography, which is different form that of neighboring property.*field type multi line
5. Explain how the hardship is rare or unique to the applicant’s property, rather than the result of conditions that are widespread.*field type multi line
For Neuse, Tar-Pamlico, Jordan Lake and Goose Creek only:
×
- 6. Did the applicant purchase the property after the effective date of the applicable Buffer Rule and then request a variance?*field type multi line
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I. Sign and Submit

Deed Restrictions
By your signature of this application, you certify that all structural stormwater BMPs required by this variance shall be located in recorded drainage 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.
Applicant’s Certification
I, 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 will be recorded with all required permit conditions.
*field type checkbox
By checking the box and signing the box below I certify that:
By digitally signing below, I certify that:
- I have given true, accurate, and complete information on this form;
- I agree that submission of this form is a “transaction” subject to Chapter 66, Article 40 of the NC General Statutes (the “Uniform Electronic Transactions Act”)
- I agree to conduct this transaction by electronic means pursuant to Chapter 66, Article 40 of the NC General Statutes (the “Uniform Electronic Transactions Act”);
- I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written signature; AND
- I intend to electronically sign and submit this form.
Print Name:*field type single line
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Signature*field type signature
Submission Date:field type date
Automatically filled in

Buffer Variance Application