20080331 Ver 1_Initial Interest_20080222

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INITIAL INTEREST IN PARTICIPATION IN THE EXPRESS REVIEW PROGRAM
WITHIN THE 401 OVERSITE/EXPRESS PERMITTING UNIT
October 1, 2006
Version 4
Applicant Name: Gr~C ~~ (.,av~n,Gut~diCx .r`
Applicant Address: ~/~ /''1 ~ c,17~ e { ~ KG,,, ¢ F'C
51 1~~(n~~u ~s .17,~-tee S„:d-~ L~3 C~~ NC27Sf(
r
Applicant's phone number: 9/9 - ~/8l - 67 ~(~ Fax number: `~(`J- yY/ • ~Z`j J
Applicant's email address: ~ {~a-, z ~ ad v~~c¢.~~c. v. fd e s~ ~~T . <<:.,
-.>
Consultant Name (if applicable): 1~~G~~{- '~ r.,6..1L, F,~,,.,:,,,,~.. ~.~ •t~>r ,,~ ,_~ ~~ .
Consultant address (if applicable): S Zy .~ N. pw a-l~o~ (~'
(~..! Lt'~• 1, N ~ 27 G v `'(
Consultant's phone number: `l l ~ • L l Z - 1760 Fax number: `/(9-Z/2 - / 7017
Consultant's email address: /'~'u~~bct (f(}~ s ;nc • ec
Type of action requested under the Express Review Program (check all that apply):
^ 401 Water Quality Certification
^ Isolated Wetland Permit
^ Riparian Buffer Approval
^ Riparian Buffer Minor Variance
Stream Origin Determination
~# of Determinations Requested
^ Inteimittent/Perennial Determination
# of Determinations Requested
^ Coastal General "Major" Variance ^ Isolated Wetland Determination
linear feet or acres
^ Stormwater Management Plan (this fee is not additive when approval is combined with 401 Cert.)
# of Drainage Areas/Project Site
Name of Project: •arne.,.¢e~ Pry>~~, County: l.~«ke_
Total project acreage: y . 3 S (acres) Total built out impervious area: ^- ~. S (acres)
Nearest Namned stream + River Basin (from USGS to o map):
~~~~u C~rarr~ a- Moc~is (~~a,~~.~. + ~r1.-e ~PQn
Please provide a~brief description of this project (attach site plan if available):
11\ L rA c i ~ h c r/h a~ n /'e 7' ~c~ ar `~-~ J' r r'Ujoa J e. e~
Cx+~UelaOMevtJ' P~~~f n.I•G Gta~lCv~oW~'I ova' ~cf J '~iiht -

Please attach a map of site location using USGS 1:24,000 map and county soil survey.
Location of project site -please include reference to the county, nearest name town and highway number:
? ~~ !S I~GC-~tC~ ~I~ Cap ~- ,F- ~
!~ // /~ // ~l ~~) f ~//O dt~ e w t ~ ~•'~l v ~,-,y~+ ~Mre c7 ~, .e ~ ~ ~
. ~uf"n a-bK /t.Jc1 [~ •S/~ ~t)GS _f~~!e.YiMa f~-~h, K /~'~~ /C7 J ~iLN7 S~~'~ of / /T!`/~ J 4~ //`C
Proposed impacts:
Nlk
Acres of 404/401 wetlands
Acres of isolated wetlands
Linear feet of streams
Linear feet of isolated streams
Square feet of protected stream buffers
Has consultaL}nt or applicantlattended any DWQ-sponsored training sessions in the past two years? If so, please list
which ones. IBS, P:-1"GI+Nial_~•,y„+tr~t,~}kt.{ f~Y[c,..y:12c,•J~•(.Cal,Dn.~-I,`t'.•r~' ~~ / p
- _ _. ~ln f•C (:` Li I ~e-C~t~M Pr"8ry C.a IS . F_,.t^o: e. J f lUIMI
~,InYNU.~n
Has any DWQ staff visited the site? , if yes, please provide DWQ staff name,
date of visit:
.,.;~~ J
and
Which other environmental permits from other agencies will be needed for this project? Please list the permits and
issuing agencies below:
~lC,in.o w n at ~t~,j- -~, n,
Does this project require approval under the State Environmental Policy Act or National Enviraunental Policy Act?
N~
Is this project an After-the-fact application oi• leas this project received a previous Notice of Violation from DWQ?
N~,
Does this project require approval of a Variance from the NC Environmental Management Commission? lv a-
Are you aware of any local controversy concerning this project? If so, please describe the controversy and any
measures that have been taken with respect to public involvement.
~r.
This form must be submitted via email (c/o 401express(a~ncmail.net), faxed (919-733-6893) or hand-delivered to the
Parkview Building, 2321 Crabtree Blvd. Suite 250, Raleigh, NC 27604. Applicants who are selected to participate in
the Expeess Review Program will be notified via fax within 2 days. 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 orr the next busifress day).
Please contact Cynthia Van Der Wiele at 919-715-3473 if you have any questions regarding this form.

TopoZone -USGS Green Level (NC) Topo .Map
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Page 1 of 1
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http://~~vw.topozone.con~/print.asp?lat=35.8321 &lon=-78.9021 &size=l&u=5&layei=DR... 2/22/2008

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