20090373 Ver 1_Initial Interest_20090401

Steele
R1'K-i i 2007 iz:39 Fr:OM: DWQ-WETLAt DS 919733GO53
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9198824390 p.2
Tp:96824390 P:2,13
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February 18.2009
INITIAL INTEREST IN PARTICIPATION IN THE EXPRESS REVIEW PROGRAM
WITHIN THE 441 OVERSIGHT/EXPRESS Pt RM171•ING UNIT
A. Applicant infOrTnati*n
I, ProcR55ing
I] 401 Water Quality Certification (List NW(s) ar GP# verified by Gores: )
I
n Non-4o4 Jurisdictional Permit bc? O 6 _ O nt
?. Riparian Buffer Authorization -1
of actions ? Riparian Buffer Minor Variance
1a. 1Type(s)
requested: Coastal Gemarai 'Major Variance
(Check all that apply) a? stream oetermination: # strooms
Non-404 Wetland Determination: # Wetlands
i
r7 Stonnwater Monagement Pldrl Review (fee not additive if combined with 401.):
i #. of Drainage Areas/Project site
2. Rrojee Information
2a, I Name of project: ?p f k ,
2b,1 County:
2C.IL.gftdolLon9itudc: tit Long:
2d.1 River Basin: k,?.
2e.! Tax PIN or Parcel ID: Q 5/1? to 4 a
2f. JN6W est Named Stream: ,
2q j Watar Quality Classification of Nearest Named Stream: ? lti!
2h] Total project acreage (stream or wetland determinations may omit ails item): (acres)
21, total Built Out imperviousness (StreaYn or wetland determinations may omit this item): %
?_j.IProvide a brief description of this protect (attach a site plan); ?o it f . 0 Z VaKrZA)
3fr•ac.... fit.. Ur.?.:e./w..u .?,tce.? 'tlEt?•?-• • c?QGa? •.? -?.4 .7-?e.c?t?J
2k,' Provide directions from the near t named town, including street names and/or highwOY numbers;
F-R o wv, -Tat Ya+v
o,V cde" d k t y ?x. `l +'?l 1;,e k, IR o v n.a wt;j"J? i
Plea Sp attach a map of the site location using USGS 1:24,004 topographic map and a copy of the latest bound
and pubiiahed County soil survey With the projeWsite boundaries delineated. A site plan should also be included
for ;all projects other than stream and wetland determinations.
?4ru? or ?'. Shed k $Oksav? tJa2ir? /0$ 21-311
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TRIANGLE MLS
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Steele 9198824390 p.4
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kLID: 0206164
OWER1: NA7IR1. SFYFDA
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ADDk1: 106 BALLAC CT
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ADDR3:
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DEED PAGC: 2766
D160 CArt: 313002005
(1FFO ACRM 1.01
BLDG VAL: 0
LAND VAL: 190600
BILLING CLASS: INDIVIDUAL
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DESCRIPTION: BST SUB PH2 SM19L4
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MAP NAME, 075112
(ANNUM; 0751978060
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APR-i 2009 12:39 FROM.,0WO-WETLANDS 9197336693
3. Applicant Information
3a. Applicant is: 1 ? Owner G Agent 8 mer:
3b. Name: L__47.
3e. Susiness name (if applicable):
3d. Street address:
3b. City, State, zip:
3f. Telephone no.:
3h. Entail address:
41 AgQnt/Consultant Information
4a. Contact Name:
4b. Company Name:
4c. Street address:
4d. City, State, zip:
4e. Telephone no,:
D/
if appllcmbie)
."7Yl l5? Y /.L.n?
9198824390 p.3
TO:98824390 P:3,13
i
initial Interest Form v6.1 Cont.
3g. Pax no.:
4f. Fax no.: I Cil
Q
49.Emall address: I WVNisla&&IllG• RIQ. C.0' 7n:
$. Proposed Impacts (inclu a bath temporary and permanent) [Datermination requests may omit this item]
So. Total 404/401 wetland impacts: (acres) ib. Total non-4041401 wetland impacts: (acres)-
Svc. Total 404 stream impacts, Intermittent; (linear feet) Perennial: (linear feet)
6d. T*I non-404 stream impacts: Intermittent: (linear feet) Perennial: {linear feet)
59, Total rlporion buffer impacts: Zone 1: (sq. fat) Zone 2: (sq. feet)
8. project History and Additional Information
6a. Has any DWQ staff visited the site? [-Yes d No r N5 )
Its yes, provide staff : et eKlYi and date of visit o o r 1tt4ra'G J Mi 1'nwaf a'Or7c+
6b. Does this protect require n Stormwater Management Plan (SMP)? ? Yes No Unknown
? Codified Local Gov't
tic. Who vv111 be responsible for the review of the 9MP? 0 DWQ $torn water Program
? DWO 401/EXpress Review Unit
6d. Does mis pro)ect require approval under SEPA or NEPA? ? Yes ? No ? Unknown
6e, lal this project an after-the-fact application or has a VWQ notice ofviotation been issued? ? Yes ? No
6f. Does this project Include buffer impacts that are "prohlbited" in the DWQ'Red Rule E"!!7-_J0 Yes ? No
6g.1f you rxe aware of any IOCeI Controversy Conceming this projeo, provlde details in a cover letter. besctibe the _
controversy and any mbssures that have been taken with roi.pect to public involvement.
This form must be submitted via email (GO 401exD[tWncmet?nefl_ faxed (919-733-•6893), or hand-delivered to.
Parkview Building, 2321 Crabtree Blvd. Suite 750, Raleigh, NC 27604. Applicantr, who arc selected to participate in the
Express Review Program will be notified via •ernair or fax. SU00SWul applicants will then be instructed regarding datailcd
procedures for full application (Note: SubmWIs of the review packages on Friday after 7200 parr will be stamped as
mca+Yed on thg next busirross day).
Please Contact Lla Myott Gllleeki or Joseph Gyemfi at 819-M-1-1786 if you have any questions regarding this form

2
Steele 9198824390
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9198824390 P.6
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Parcel Number: 0751979090-000
Copyright 2009, City of'Raleigh & Wakr
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