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FRAZIER HOME DESIGN, LLC.
900 RIDGEFIELD DRIVE, SUITE 170
RALEIGH, NC 27609
0: (919)-424-7255

DWR
State of North Carolina
Department of Environmental Quality
Division of Water Resources Division of Water Resources
15A NCAC 028 .0233 (8)(b), .0243 (8)(b), .0250 (11)(b), .0259 (8)(b), .0267 (11)(c), .0607 (e)(2) - Buffer Authorization
FORM: BA 10-2013
Riparian Buffer Authorization Form
A.
Applicant Information
1 •
Project Information
1a. Name of project:
B i e/4,t`i7 O LVV.
(i/ag A [ . J 6,0
1 b. County:
6
1 c. Nearest municipality:
1 d. Subdivision name:
�-FlT /aY
rAP- K
1 e. Is the project located in any of North Carolina"S
If es, answer 1f below.
twenty coastal counties?
Yes No
1f. Is the project located within a NC Division of Coastal
Environmental Concern (AEC)?
Management Area of
❑ Yes No
2.
Owner Information
2a. Name on Recorded Deed:
W i Lyk1k J-(Y-fa J_OW _ I of4&y
OFFy,N L&,l R 1
2b. Deed Book and Page No.
1
jj D
2c. Map Book and Page No.
(include a copy of the
recorded map that indicates
when the lot was create :
2d. Responsible Party
for Co orations :
t,41kt
2e. Street address:
X " L
2f. City, state, zip:
'6 LLY
5 P rV N. L.
5-,vV
2g. Telephone no.:
-
o y - 6c1 -P-
2h. Fax no.:
-
2i. Email address:
S
l"E?1r/I evil/
Q ' Ca:
3.
Applicant Information (if dill t from owner)
3a. Applicant is:
Agent
Other, specify:
3b. Name:
3c. Business name
if applicable):
3d. Street address:
3e. City, state, zip:
3f. Telephone no.:
3g. Fax no.:
3h. Email address:
4.
Agent/Consultant Information (if applicable)
4a. Name:
4b. Business name
i if applicable):
_
4c. Street address:
4d. City, state, zip:
4e. Telephone no.:
4f. Fax no.:
4g. Email address:
FORM: BA 10-2013 Page 1 of 4

B. Project Information and Prior Project History
1 • Property Identification
la. Property identification no. (tax PIN or parcel ID):
7DN,, ii j - 7 7 -- q,7S- -
1b. Site coordinates (in decimal degrees):
Latitude"3,J'0yV /D,5y Longitude:-7�'j8 J
1 c. Property size: q `Z _
acres
2. Surface Waters
2a. Name of nearest body of water to proposed project:
1.4 EaN acw S 11114,4C.Jy
2b. Water Quality Classification of nearest receiving water:
2c. River basin:
AJ EV 5
3. Project Description
3a. Describe the existing conditions on the site and the general land use in the vicinity of the project at the time of
this application: 6 vc 3 rr A16 40 44f- W AH< ;L Mo ✓ruO , V,,46^ -,� 'r 4--O °r Nat✓ -
oT SL01C5 ?o (S IC 0/- P/t0P&27w
3b. Attach an 81/ x 11 excerpt from the most recent version of the USGS topographic map indicating the location
of the site
3c. Attach an 8'/2 x 11 excerpt from the most recent version of the published County NRCS Soil Survey Map
depicting the project site
3d. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property:
3e. Explain the purpose of the p roposed project: my W I 0 z t4KF- TNf- ®r7//YFW lwip
' 9dri'Lt Ca -,V � TD.t 1.AJV 'rO L I VF_ JU 4E W 1 J&V S/"Cp
3f. Describe the overall project in detail, including the type of equipment to be used:
Al Ew C67V S IPW C7r W 01- <'fW64-15- r-iC!Lows '6A4'W/Kf_ RA 03A-fir M-F
4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations by
the Corps or State been requested or obtained for this
property/ project (including all prior phases). in thepast?
4b. If yes, who delineated the jurisdictional areas?
Name (if known):
LJ Yes ❑ No 2rOnknown
Comments:
Agency/ Consultant Company:
Other:
4c. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach
documentation.
5. Project History
5a. Have permits or certifications been requested or obtained
for this project(including all priorphases) in thepast?
I ETYes No F1 Unknown
5b. If yes, explain and detail according to "help file" instructions.
6004-l1 ton/ If7mli aeo +- w O e Pkdmtr
6. Future Project Plans
6a. Is this a phased project? El Yes ONO
6b. If yes, explain.
C. Proposed Impacts Inventory
1. Buffer Impacts
1 a. Project is in which protected basin?
�9 Neuse L] Tar -Pamlico ❑ Catawba
❑ Randleman ❑ Jordan ❑ Goose Creek
1 b. Individually list all buffer impacts below. If any impacts require mitigation, then you MUST fill out Section D of
this form.
Buffer impact I Reason for Type of impact I Stream name i r Buffer I Zone 1 1 Zone 2
FORM: BA 10-2013 Page 2 of 4
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number —
Permanent (P)
or Temporary
impact
(exempt, allowable,
allowable w/
mitigation)
mitigation
required?
impact
(sq ft)
impact
(sq ft)
B1 ❑ P ❑ T
❑ Yes No
B2 0 P ❑ T
Yes No
3
B3 P ❑ T
El Yes No
64 7P ❑ T
Yes No
135 177 L T
L Yes L1 No
136 ❑ P ❑ T
❑ Yes M No
Total buffer impacts
1 c. Comments:
D. Impact Justification and Mitigation
Avoidance and Minimization
la. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction
techniques.
2. Buffer Mitigation
2a. Will the project result in an impact within a protected riparian buffer that LJ Yes No
requires buffer mitigation?
2b. If yes, then identify the square feet of impact to each zone of the riparian buffer that requires mitigation and
calculate the amount of mitigation required in the table below.
Zone Reason for impact Total impact Multiplier Required mitigation
s uare feet (square feet
Zone
1 3 (2 for
1
I Catawba)
Zone
1.5
2
Total buffer mitigation required:
2c. If buffer mitigation is required, is payment to a mitigation bank or NC DMS Yes No
proposed?
2d. If yes, attach the acceptance letter from the mitigation bank or NC DMS.
2e. If no, then discuss what type of mitigation is proposed.
2f. Comments:
E. Diffuse Flow Plan
All buffer impacts and high ground impacts require diffuse flow or other form of j_; Diffuse flow
stormwater treatment. Include a plan that fully documents how diffuse flow will be ❑ Other BMP
maintained. If a Level Spreader is proposed, attach a Level Spreader Supplement Form.
If due to site constraints, a BMP other than a level spreader is proposed, please provide a
plan for stormwater treatment as outlined in Chapter 8 of the NC Stormwater BNi
Manual and attach a BMP Supplement Form.
F. Supplementary Information
FORM: BA 10-2013 Page 3 of 4

1. Environmental Documentation
la. Does the project involve an expenditure of public (federal/state/local) funds or the El Yes No
use of public (federal/state) land?
1 b. If you answered "yes" to the above, does the project require preparation of an El Yes No
environmental document pursuant to the requirements of the National or State (North
Carolina) Environmental Policy Act (NEPA/SEPA)?
1c. If you answered "yes" to the above, has the document been finalized by the State ❑ Yes No
Clearing House? (If so, attach a copy of the NEPA or SEPA final approval letter.)
2. Violations
2a. Is the site in violation of DWR Wetland Rules (15A NCAC 02H .0500), Isolated ❑ Yes No
Wetland Rules (15A NCAC 02H .1300), DWR Surface Water or Wetland Standards,
or Riparian Buffer Rules (15A NCAC 02B .0200t?
2b. Is this an after -the -fact permit application? Yes No
2c. If you answered "yes" to one or both of the above questions, provide an explanation of the violation(s):
)�,Itc-um SnAm) L. " ()%, —),
Applicant/Agent's Printed Name pplicant/Agent's Signature _
(Agent's signature is valid only if an authorization letter from the applicant is provided.) Date
Send 3 complete sets of this form and accompanying documents to the following:
For government transportation projects sent For government transportation projects sent by
by First Class Moil via the US Postal Service: delivery service (UPS, FedEx, etc.):
NC DWR, Transportation Permitting Unit OR NC DWR, Transportation Permitting Unit
1617 Mail Service Center 512 N. Salisbury Street
Raleigh, NC 27699 - 1617 Raleigh, NC 27604
For all other projects sent by First Class Mail via For all other projects sent by delivery service
the US Postal Service (UPS, FedEx, etc.):
Karen Higgins Karen Higgins
NCDWR — 401 & Buffer Permitting Branch OR NCDWR — 401 & Buffer Permitting Branch
1617 Mail Service Center 512 N. Salisbury Street
Raleigh, NC 27699 - 1617 Raleigh, NC 27604
FORM: BA 10-2013 Page 4 of 4

H I\LVIJGLJ IVI/Nl L-C, LV 1 ZI
o REVISED AUGUST 13, 2019
30 15 0 30 60
F_� --
-- I
SCALE 1 "=30'
ADDRESS
(BICKETT BLVD)
DISTANCE FROM
RIGHT OF WAY
AVERAGE HEIGHT
1621
24.8'
14.03'
1624
20.5'
10.18'
1626
24.3'
8.11'
1630
23.6'
9.00,
1632
23.3'
9.32'
1634
23.2
9.75'
NOTE: \
REVISED DATE OF \
AUGUST 13, 2019
IS TO ADD NEUSE RIVER BUFFER. \
BEIB
- BENT IRON BAR
CM -
CONCRETE MONUMENT
EPK
- EXISTING PK NAIL
SPK
- SET PK NAIL
NIP -
NEW IRON PIPE SET
R/W
- RIGHT OF WAY
CAN
- CABLE TV BOX
EB -
ELECTRIC BOX
TEL -
TELEPHONE PEDESTAL
PP -
POWER POLE
OHL
- OVERHEAD LINE
LP -
LIGHT POLE
WM -
WATER METER
GIRD
- GROUND ELEVATION
CO -
SEWER CLEAN -OUT
54 /
QD5.4'
�2� 5 �°
1's��
o s B IP 53
sr ra �F
F
/i 16.0�/ tS jO 0 NIP
TIE TO G THE INTERSECTION
OF BICKETT BLVD
PROPO D
AND W AYCOCK ST \G
T � DISTURBED A 4
4.9' q3% \ =4,4 4 S.F.
\ 50.0' NEUSE
_ _ �y RIVER BUFFER�s�\ IB
01 gZ0
n � q�2 �9 - - ��'' r 52
/ w
V. 9%.4 GRAVEL\ I h2 El / / - �E P 2g DRIVEWAY `` ) 6� 1,14'BNORTH OF
CPO 18 0 - DWELLING 6 i \ PROPERTY LINE\
BOtp.
oA> / 124 12 3
Nam, \� �p2BZg1g FENC CORNER IS 8�575 S.F.
N 0.4' NORTH OF
THE PROPERTY LINE 0. 197 AC.
0.- �5
El P 11
FENCE CORNER IS
(� 0.6' NORTH OF IMPERVIOUS SURFACE TABLE
P THE PROPERTY LINE
HOUSE
913 S.F.
DRIVEWAY 1,252 S.F.
SIDEWALKS 64 S.F.
RETAINING WALLS 53 S.F.
MISC/UTILITIES_ _ 4 S.F.
LL TOTAL IMPERVIOUS AREA 2,286 S.F.
TOTAL LOT AREA 8.575 S.F.
PERCENTAGE OF IMPERVIOUS AREA 26.66%
LINE TABLE
NOTE: LINE BEARING DISTANCE
-REVISION ON MAY 29, 2019 ONLY L-1 S 29'24'43" E 24.01'
REFLECTS A CORRECTED NAME. L-2 S 43'15'01" E 28.31'
I DECLARE THAT THIS SURVEY COMPLIES WITH THE NORTH
CAROLINA STANDARDS OF PRACTICE FOR SURVEYING, %%.A Cq p$�,O
(SECTION 1600) FOR CLASS A SURVEYS AND THAT THE �%% I`
CALCULATED RATIO OF PRECISION BEFORE ADJUSTMENTS
CAWTHORNE, MOSS IS 1:10,000+. FURTHERMORE, PROPERTY CORNERS SHOWN $$ /
2 O
ARE PRI NTROL MONUMENTAITON FOR THE RE-
& PANCIERA, P.C. ESTA .MEF PROPERTY CORNERS IN THE ABSENCEa
Professional Land Surveyors OF 901D MONU ENTS AND OTHER SUBDIVISION PROPERTY - e s
C-1525 CO NERS. THI SURVEY IS NOT TO BE RECORDED WITH- = 1- L"31
3335 .�
0 THE WRI TEN AUTHORIZATION OF THE SURVEYOR. ' -V
333 S. White Street
Post Office Box 1253R�
� '�,��''�„ 3U
Wake Forest, N.C. 27588 """'"' _p�
[phone] ROFESSIONAL LAND SURVEYOR L— ,,���''PAS

ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
S. DANIEL SMITH
Director
William and Mary Lowell
204 Holly Green Lane
Holly Springs, NC 27540
NORTH 'CAROUNA
Environmental Quality
March 20, 2020
Subject: Buffer Determination Letter
NBRRO #20-064
Wake County
Determination Type:
Buffer I intermittent/Perennial
® Neuse (15A NCAC 2B .0233)
❑ Tar -Pamlico (15A NCAC 2B .0259) ❑ intermittent/Perennial Determination (where local buffer
ordinances apply)
❑ Jordan (15A NCAC 2B .0267)
(governmental and/or interjurisdictional
projects)
Project Name: 1628 Bickett Blvd.
Address/Location: 1628 Bickett Blvd., Raleigh, NC
Stream(s): Pigeon House Branch
Determination Date: March 19, 2020 Staff: Vanessa Manuel
Stream
VIM*
Not Subject
Subject
Start@
Stop@
Soil
SGo
Survey
Feature A
✓
✓
*EIIIP = Ephemeralllntermittent/Perennial
Explanation: The stream(s) listed above has been located on the most recent published NRCS Soil Survey of Wake
County, North Carolina and/or the most recent copy of the USGS Topographic map at a 1:24,000 scale. Each
stream that is checked "Not Subject" has been determined to not be at least intermittent or is not present. Streams
that are checked "Subject" have been located on the property and possess characteristics that qualify it to be at least
an intermittent stream. There may be other streams located on the property that do not show up on the maps
referenced above but may be considered jurisdictional according to the US Army Corps of Engineers.
This on -site determination shall expire five (5) years from the date of this letter. Landowners or affected
parties that dispute a determination made by the DWR may request a determination by the Director. An
appeal request must be made within sixty (60) days of date of this letter. A request for a determination by the
4 North Carolina Department of Environmental Quality I Division of Water Resources
Raleigh Regional Office 13800 Barrett Drive i Raleigh, North Carolina 27609
NORTH (:.AR A INA ��
m�� r 919.791.4200

1628 Bickett Blvd
Wake County, NC-DWR Project # 20-064
NRCS Soil Survey Sheet 49��Ea
dxi
Wake CO., NC 1970 Locations are approximate
Legend: and are provided for refer-
ence only :: nn
-project boundary '� �;� A`1

1628 Bickett Blvd
Wake County, NC-DWR Project # 20-064
Feature A —Not depicted
n
USGS Topographical Map
Mwxi�
Raleigh West Quadrangle 2019 Locations are approximate
Legend: � �;.
-: and are provided for refer-
ence only::
-Project boundary �.�,

ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
LINDA CULPEPPER
6. Has anyone from DWR visited the
site?
NORTH CAROLINA
Environmental Qaalit
N Staff
I I Name I VA1W A-* ![ L f Date of Visit?I mgf'y '-kog X'?V
DWR Use Only: Project #
Date Received — L —
Buffer Determination Request Form
Property Owner Information
1. Owner Information
Ia. Name(s) on Recorded Deed
lb. Responsible Party (for LLC)
lc. Mailing Address
dq AOLLY C46W /-/Wx f(©ay Ir/. G ' Zrylb
1 d. Telephone Number
1 e. Email Address
Address of Property:
Project Description (attach plan if available): 6 k / //(J --,Ao 0/'�
a,IL tl & 0CCE F,4 11 c4 KLrY /It 5/4im c c .41-
Consultant/Agent Information
4. AgentXonsultant Information
4a. Name, Company
4b. Mailing address
4c. Telephone no.
4d. Email address
5. Project and Site Information
5a. Name of project
5b. County
5c. Nearest Named Stream
5d. River Basin
Attach a map of the site indicating project boundaries on the USGS 1:24,000 Topo and/or NRCS Soil Survey.
Please return form Rick Trone
to: 1628 Mail Service Center
Raleigh, NC 27699-1628
Email: [e-mail]
Please contact the Raleigh Regional Office at [phone] if you have any questions.
-`
NOFiH "AkOLIl:ADq-/l'
.MJ�m a aim!
North Carolina Department of Environmental Quality I Division of Water Resources
Raleigh Regional Office 1 3800 Barrett Drive I Raleigh, North Carolina 27609
919.791.4200

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www.frazierhometlesign.com
LOWELL RESIDENCE
FRAZIER HOME DESIGN, LLC.
�
900 RIDGEFIELD DRIVE, SUITE 170
RALEIGH, NC 27609
0:(919}424-7255

State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
15A NCAC 02B .0233 (8)(b), .0243 (8)(b), .0250 (11)(b), .0259 (8)(b), .0267 (11)(c), .0607 (e)(2)
Protection and Maintenance of Riparian Areas Rules - Variance Application
FORM: VAR 10-2013
PLEASE IDENTIFY WHICH RIPARIAN AREA PROTECTION RULE APPLIES:
Neuse River Basin (15A NCAC 02B.0233)
❑ Major Variance Y Minor Variance
❑ Catawba River Basin (15A NCAC 02B.0243)
❑ Randleman Lake Water Supply Watershed (15A NCAC 02B.0250)
❑ Major Variance ❑ Minor Variance
❑ Tar -Pamlico River Basin (15A NCAC 026.0259)
❑ Major Variance ❑ Minor Variance
❑ Jordan Lake Water Supply Nutrient Strategy (15A NCAC 02B.0267)
❑ Major Variance ❑ Minor Variance
❑ Goose Creek Watershed (15A NCAC 02B.0606 & 15A NCAC 02B.0607)
A. General Information
1. Applicant's Information (if other than the current property owner):
Name:
Title:
Street Address:
City, State & Zip:
Telephone:
Email:
1. Property Owner/Signing Official (person legally responsible for the property and its compliance):
Name: UJj LOAV4 9`d
Title: Q` co n +cT-O/L—
Street Address: ZT " y 14 P L L Y cR rcf 11) L-AN Er
City, State & Zip: U l- 5 PILt Vv 6 ` �' l �-v
Telephone: fC 1 1 l f® r 4
Email: `T 1 i5 � e (l VICI re d1 �Q) S d` �1 [11/( �1 1 • t! O �'I
FORM: VAR 10-2013

2. Agent Information:
3a. Name:
Company Affiliation:
Street Address:
City, State & Zip:
Telephone:
E-mail:
3b. Attach a signed and dated copy of the Agent Authorization letter if the Agent has signatory authority for the owner.
3. Project Name (Subdivision, facility, or establishment name):
4. Project Location:
5a. Street Address: �('O ,7� LJ cKk T f� L v o
City, State & Zip: ✓L) • c ,
5b. County: rz- COA 0 T
5c. Site Coordinates (in decimal degrees): � % J 0• �yo8 Latitude j� ;"OVILongitude
5d. Attach an 8 % x 11 excerpt from the most recent version of the USGS topographic map indicating the location of the site.
— 5e. Attach an 8 % x 11 excerpt from the most recent version of the published County NRCS Soil Survey Map depicting the
project site.
5. Property Information:
6a. Property identification number (parcel ID):
j ®q, II - � � -q � 5�)-
6b. Date property was purchased: oac6o,15&L & i
6c. Deed book ` and page number it
Q �
6d. Map book ? and page number U .S
6e. Attach a copy of the recorded map that indicates when the lot was last platted.
7. Is your project in one of the 20 Coastal Counties covered under the Coastal Area Management Act (CAMA)?
❑ YES p NO
7a. if you answered yes above, in which AEC do you fall (30 ft or 75 ft)?
7b. If you answered yes above, what is the total percent of impervious cover that you have proposed within the AEC?
FORM: VAR 10-2013 Page 2 of 6

8. Directions to site from nearest major intersection:
Vr P0/,417-5 /12rra/�CL��c�.uaoV,�iJ
RA/ GV . 41W l TAAM `rylU 1ZJ6Y, 0/l1
9. Stream associated with riparian buffer to be impacted by the proposed activity:
Name
Water Quality Classification��]
A/ or�'v f 7/0G�� 4,14,V z
9a. For Goose Creek only: is the buffer in the 100-year floodplain? ❑ YES ❑ NO
10. List any permits/approvals that have been requested or obtained for this project in the past (including all prior phases).
Date Applied
B. Proposed Activity
Date Received:
Permit Type:
1. Project Description
la. Provide a detailed description of the proposed activity including its purpose:
L ,WC
114e d- j 0C 4 SI w61 E 1 4W,l r
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52 . f Go V Mfi k , / Y !r/foe�C
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()w- lt�op-4-7t VV// ✓ / _ li✓,�y
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- .So VI-' M-r✓ 10�Lc Oar low To J;r
1b. Attach a site plan showing the following items as applicable to the project: -'P,
0 Development/Project name
0 Revision number & date
0 North arrow
0 Scale (1" = 50' is preferred)
0 Property/project boundary with dimensions
0 Adjacent streets and roads labeled with names and/or NC State Road numbers
0 Original contours and proposed contours
0 Perennial and intermittent streams, ponds, lakes, rivers and estuaries
0 Mean high water line (if applicable)
0 Wetlands delineated, or a note on plans that none exist
0 Location of forest vegetation along the streams, ponds, lakes, rivers and estuaries
0 Extent of riparian buffers on the land including Zone 1 and Zone where applicable
0 Location and dimension of the proposed buffer impact (label the area of buffer impact in Won the plan)
0 Details of roads, parking areas, cul-de-sacs, sidewalks, and curb and gutter systems
,,Or- Ad d {�e�►—
FORM: VAR 10-2013 Page 3 of 6

0 Footprint of any proposed buildings or other structures
0 Discharge points of gutters on existing structures and proposed buildings
0 Existing drainage (including off -site), drainage easements, and pipe dimensions
0 Drainage areas delineated
C. Proposed Impacts and Mitigation
1. Individually list the square footage of each proposed impact to the protected riparian buffers:
Buffer Impact
Number, -
Permanent (P) or
Temporary (T)
Reason for Impact
Buffer
Mitigation
Required
❑ Yes ❑ No
Zone 1 Impact Zone 2 Impact
(square feet) (square feet)
Bi - ❑ P ❑ T
B2 - P ❑ T
❑ Yes# No
-5 _
B3 - P EJ T
❑ Yes ❑ No
Total Buffer Impacts
%la' 4,-
'Label on site plan
2. Identify the square feet of impact to each zone of the riparian buffer that requires mitigation from the table above. Calculate
the amount of mitigation required.
Required
Zone Total Impact Multiplier Mitigation
(square feet) (square feet)
Zone 11 A/10 A/3
(2 for Catawba only)
Zone 2 1.5��
Total Buffer Mitigation Required:
'For projects in the Goose Creek Watershed, list all riparian buffer impacts as Zone 1
and use Zone 1 multiplier.
3. Provide a description of how mitigation will be achieved at your site pursuant to the mitigation requirements of the applicable
river basin/watershed.
3a. Is buffer restoration or enhancement proposed? ❑ Yes XNo
If yes, 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.
3b. Is payment into a buffer restoration fund proposed? o Yes y No
If yes, attach an acceptance letter from the mitigation bank you propose to use or the NC Ecosystem Enhancement
Program stating they have the mitigation credits available for the mitigation requested.
FORM: VAR 10-2013 Page 4 of 6

D. 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.).
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Ia. Show the location of diffuse flow measure(s) on your site plan.
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1b. Attach a completed Level Spreader Supplement Form or BMP Supplement Form with all required items for each proposed
measure.
1c. Attach an Operation and Maintenance (O&M) Form for each proposed level spreader or BMP.
2. For Major, Catawba, and Goose Creek variance requests, 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.
2a. Show the location of BMPs on your site plan.
2b. Attach a Supplement Form for each structural BMP proposed.
2c. Attach an Operation and Maintenance (O&M) Form for each structural BMP proposed.
E. 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 fro the term of the applicable Buffer Rule that sh II make reasonable use of the property possible.
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FORM: VAR 10-2013 Page 5 of 6

2xplain 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).
3.,,—Explain how the hardship results from physical nature of the property, such as its size, shape, or topography, which is different
from that of neighboring property.
Explain whether the hardship was caused by the applicant knowingly or unknowingly violating the applicable Buffer Rule.
For Neuse, Tar -Pamlico, Jordan Lake and Goose Creek only: Did the applicant purchase the property after the effective date of
the applicable Buffer Rule and then request a variance?
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6. Explain how the hardship is rare or unique to the applicant's property, rather than the result of conditions that are widespread.
F. Deed Restrictions
By your signature in Section G 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.
G. Applicant's Certification
1, �LI 1 LL IIM 11 (print or type name of person listed in Section A, ltem 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 Section F of this form will be recorded with all required permit
conditions.
Signature: ��/ / �j�//
Date: ��I_Z_6 Zo
FORM: VAR 10-2013 Page 6 of 6