20100854 Ver 1_Initial Interest_20101015

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I Print Form..
Form Version 6.2
June 29, 2009
INITIAL INTEREST IN PARTICIPATION IN THE EXPRESS REVIEW PROGRAM
wITHIN THE 401 0VFRSIGHT1EXPRESS PERMITTING UNIT
A. Applicant Information
1. Processing
E] 401 Water Quality Certification (List NW(s) or GP# verified by Corps:
© Non-404 Jurisdictional Permit
n Riparian Buffer Authorization
1a. Type(s) of actions Riparian Buffer Minor Variance
requested: Coastal General "Major" Variance
(Check all that apply) Stream Determination: 1 # Streams
Non-404 Weiland Determination: # Wetlands
n Stormwater Management Plan Review (fee not additive if combined with 401):
of Drainage Areas/Project Site
2. Project Information
2a. Name of project: Veteran's Freedom Monument
2b. County: Wake
2c. Latitude/Longitude: Lat: 35.8206 Long: -78.7717
2d. River Basin: Neuse
2e. Tax PIN or Parcel ID: 0765735674
2f. Nearest Named Stream: Crabtree Creek
2g. Water Quality Classification of Nearest Named Stream: C: NSW
2h. Total project acreage (Stream or wetland determinations may omit this item): (acres)
2i. Total Built Out Imperviousness (Stream or wetland determinations may omit this item): %
2j'. Provide a brief description of this project (attach a site plan):
'
s freedom park, and associated parking for vistors coming
The proposed project will include a monument for the veteran
to the site.
2k. Provide directions from the nearest named town, including street names and/or highway numbers:
From 140 take exit for Harrison Ave. Go south on Harrison toward Cary/Morrisville The site is on the right between
Beechtree St and Cary Parkway (Directly across from Cary Academy).
Please attach a map of the site location using USQS 1:24,000 topographic map and a copy of the latest bound
and published County soil survey with the project/site boundaries delineated. A site plan should also be included
for all projects other than stream and wetland determinations.
Initial Interest Form v6.2 Cont.
.
3. Applicant Information
3a. Applicant is: ? Owner ? Agent © Other:
3b. Name: Joseph Puckett
3c. Business name (if applicable): Stewart Engineering, Inc
3d. Street address: 421 Fayetteville St
3e. City, State, zip: Raleigh, NC 27601
3f. Telephone no.: 919-866-4829 3g. Fax no.: 919-380-8752
3h. Email address: [e-mail]
4. Agent/Consultant In formation (if applicable)
4a. Contact Name:
4b. Company Name:
4c. Street address:
4d. City, State, zip:
4e. Telephone no.: 4f. Fax no.:
4g. Email address:
5. Proposed Impacts (include both temporary and permanent) (Determination requests may omit this item)
5a. Total 4041401 wetland impacts: 0 (acres) 5b. Total non404/401 wetland impacts: 0 (acres)
5c. Total 404 stream impacts: Intermittent: 0 (linear feet) Perennial: 0 (linear feet)
5d. Total non404 stream impacts: Intermittent: 0 (linear feet) Perennial: 0 (linear feet)
5e. Total riparian buffer impacts: Zone 1: 0 (sq. feet) Zone 2: 0 (sq. feet)
6. Project History and Additional Information
6a. Has any DWQ staff visited the site? ? Yes ® No
If yes. provide staff name: and date of visit:
6b. Does this project require a Stormwater Management Plan (SMP)7 ® Yes ? No ® Unknown

6c. Who will be responsible for the review of the SMP? ® Certified Local Gov't: Cary
? DWQ Stormwater Program
? DWQ 401/Express Review Unit
6d. Does this project require approval under SEPA or NEPA? ? Yes ? No ?x Unknown
6e. Is this project an after-the-fad application or has a DWQ notice of violation been issued? ? Yes ® No
6f. Does this project include buffer impacts that are "prohibited" in the DWQ "Red Rule Book"? ? Yes Q No
6g. If you are aware of any local controversy concerning this project, provide details in a cover letter. Describe the
controversy and any measures that have been taken with respect to public involvement.
This form must be submitted via email (do Lia.M.Gillesk0nodenr.aov), faxed (919-733-6893), or hand-delivered to:
Parkview Building, 2321 Crabtree Blvd. Suite 250, Raleigh, NC 27604. Applicants who are selected to participate in the
Express Review Program will be notified via email or fax. Successful applicants will then be instructed regarding detailed
procedures for full application (Note: Submittals of the review packages on Friday after 12:00 pm will be stamped as
received on the next business day).
Please contact Lie Myott Gilleski or Joseph Gyamfi at 919-733-1786 If you have any questions regarding this form.
2
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Print Page - NC Areas Subiect to Phase 11 Post-Construction & Other Stonnwater ... Page I of* I
NC Areas Subject to Phase 11 Post-Construction & Other Stormwater Program Requirements
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