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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. http://www,topozone.com/print.asp?lat=35.74227&lon=-78.82201 &s=2S&size-l&u=4&Ia... 2/22/200$ 1Mtl ~a ~na,n ernwryv wKq put ml nnMw w ~euny am p~Pp1Y. ~ ~m~i~ Iow~u ~uinum~mn p~irv~ pm~y w~ mlanua a px pmnpp awp.wa w eY ~M n1 NTMm. i~rmisla. rwsnp muA p pxn aq' ~ ~v wM pw mu Iew 4>, ca aapony a~ t~a~nw rw em~iw~tn~~m~o,~s p~ns1 iplpn~lba mEnMVk Rom ~Mrvulua wun~ew pas an~m Iraq muw w pew P a ~M< n~oni tau Nuemn~xWlyu~ni~ w 4wnua w~Yni d w w~nmm pwI ]) w waY a.a cowl ~mcpm mLrN .M wp retaiM ~1w M s.e wrA. ..u ~vnN Msa~ml m ma +d r entwe ~tMy ~ ~.MwWe 4 41 m. ea~a N ..ap.e m .,1~:w ~w .ws.»m ..a . wn ... wws si4.gna we) mx mw av gF~1r~ ue~ Nmma n i~' o~ ro."ila°''4 sw~xa. ~p ce,~a~w owa. oa u. ~.rp.~~d sI w r r qpa volu me xwuenen pupolmw~I. aW~~w.rw m w..w.n wwi .me a pmKa. °"riai~wnn na p~ ~ n ~1. 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NETIO21 TtAUlOr1 Vacant planning Jurisdiction 0 Boundary AGW4MP RA 1MBER: 598-00000-0012 ANGKR APfJ[ 1903 GARY FUOUAY VARNA LAKE PINE c RNLR DR rroe~r scRwcs NNrDr1TDA:.E YW R1SlffALL RALLIGFI RGU ROL£SY1.'.E http://imaps.co.wake.nc.us/imaps/printmap.asp?pin=0752258189&pinext=&minX=2051832.42413654&minY=723871.0882453... 5/4/2007 .^.oUY~igEH 2~~?' ~~ ~ cf R3leiyn lNakE ~, ~_~~. ~ ..