HomeMy WebLinkAbout20080333 Ver 1_Initial Interest_20080222~XP ~$" ° 3 33
INITIAL INTEREST IN PARTICII'ATION IN THE EXPRESS REVIER' PROGRAM
WITffiN THE 401 OVERSITE/EXPRESS PERMITTING UNIT
October 1, 2006
Version 4
Applicant Name: ~~ a,o ~ ~~~~ ~~~.~T~ l l ~ VDl`~ r ~~~ r ~VGi /t C, I~t S 5~
Applicant Address;~~ ~ ~LLI S ~~~.~~ e • Z.77 03
Applicant's phone number: 5(~.. ~-~+?f Z~ _ Fax number:
Applicant's email address:
Consultant Name (if applicable}: ~~r ~ r~~X.z-
Consultant address (if applicable):
Consultant's phone number: ~~ ~ ~{__~ {oC~ Z- ~O(~ Fax number; (~~ ~J ~$Z~ Z~- __
Consultant's email address: L'c,~ F~~ ~~L~~/~-~~, ~~-
Type of action requested under tl~e Express Review Program (check all that apply):
^ 401 Water Quality Certification
^ Isolated Wetland Permit
^ Riparian Buffer Approval
^ Riparian Buffer Minor Variance
^ Coastal General "Major" Variance
[~~ Stream Origin Determination
~..- # of Determinations Requested
^ Intermittent/Perennial Determination
# of Determinations Requested
^ Isolated Wetland Determination
linear feet or acres
^ Stormwater Management Plan (this fee is not additive when approval is combined with 401 Cert.)
# of Drain,~g~re.~s/Project Site r
NameofProject: >>~e~! t~~ ~Tv~~`(~-I e~~.fYf O~-I County: ~~~C.~_
Tota] project acreage: z. z~~ {acres) Total built out impervious area: Lt~', 3~ (acres)
Nearest l~,ame~re~a~ R{ver l~ ein (from USGS topo map):
~ xa.~~
Please provide a brief description of this project (attach site plan iFavailable):
Q~bc~-to~l `t-y ~r~.. .~~t~T`t~C~ ~~t ~~~1~~ 5~q?7e7+~
Please attach a map of site location using USGS 1:24,000 map and county soil survey.
Location of project s~ite -please include re,/ference to the county, nearest name town and highway number:
~ Q '~ ~~ + \~.- 4~-t~~J ~i, CROSS ~i~`ll~l (~. ~ ~~ i! {S T ~rz ~ ~~"
~~o~ ~~~ ~,~~~ ~a~ - S~~ o`er ~w~~ ~~
Proposed impacts:
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 consultant~r~applicant attended any DWQ-sponsored training sessions in the past two years? If so, please list
which ones.
Has any DWQ staff visited the site? Ua , if yes, please provide DWQ staff name,
dake of visit:
and
Wlticlt other environmental permits from other agencies will be needed for this project? Please list the permits and
issuing agencies below:
D~ s this project require approval under the State Environmental Policy Act or National Environmental Folicy Act?
Is this project an After-the-fact application or Etas this project received a previous Notice of Violation from DWQ?
Does this project require approval of a Variance from the NC Environmental Management Commission?
Are you aware of any local controversy concerning this project? If so, please describe the controversy and any
m~~ea((sures that have been taken with respect to public involvement.
Vy~
Tltis form must be submitted via email (c/o 401 express(a?.ncmail.net), faxed (919-733-6893) or hand-delivered to the
Parkview Building, 232] Crabtree Blvd. Suite 250, Raleigh, NC 27b04. Applicants wlto are selected to participate in
the Express 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 ort Friday after 12:00 pr~2
swill be stamped as received on the next business day).
Please contact Cynthia Van Der Wiele at 919-715-3473 if you have any questions regarding t}tis form.
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