20050041 Ver 1_Express Review Document_20050105

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INITIAL. INTEREST IN PARTICIPATION IN THE EXPRESS REVIEW PROGRAIII
WITILIN THE 401 OVERSITE/EXPRESS PERMITTING UNIT
September 1, 2004 Version 3 OF, 05-0041
Applicant Name:
Applicant Address: ?1ooD \,o
Applicant's phone number: Q ?1? v l., Fax number:
Applicant's email address:
Consultant Name (if applicable):
Consultant address (if applicable): <-t- E C----
Consultant's phone number: `-&A L, - Fax number: C,7-`\ U - ? N G-T
Consultant's email address: Z->
Type of action requested under the Express Review Program (check all that apply):
? 401 Water Quality Certification
? Isolated Wetland Permit
? Riparian Buffer Approval
? Stormwater Management Plan
X Stream Origin Determination
_L_# of Determinations Requested
? Intermittent/Perennial Determination
# of Determinations Requested
? Mitigation Plan
? stream ? wetland ? buffers (check all appropriate)
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Name of Project: ?? c '; ?•???? Cam- County:
Total project acreage: SSy (acres) Total built out impervious area: 4 y (acres)
Nearest named stream (from USGS topo map): C . Trr
Please provide a brief description of this project (attach site plan if available):

0 5 2005
Please attach a map of site location using USGS 1:24,000 map and county soil survey. ESENR r?;,ATER QUALITY
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Location of project site - please include reference to the county, nearest name town and highway number.
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Proposed impacts: i` f\

Acres of 404 wetlands
Acres of isolated wetlands
Linear feet of streams
Linear feet of isolated streams
Square feet of protected stream buffers
Has consultant or applicant attended any DWQ-sponsored training sessions in the past two years? If so, please list
which ones.
Has any DWQ staff visited the site9 o if yes, please provide DWQ staff name, c1?.... \v??:St'-Ak and
date of visit:
Which other environmental permits from other agencies will be needed for this project? Please list the permits and
issuing agencies below:
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Does this project require approval under the State Environmental Policy Act or National Environmental Policy Act?
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Is this project an After-the-fact application or has this project received a previous Notice of Violation from DWQ?
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Does this project require approval of a Variance from the NC Environmental Management Commission? hl?
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.
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., Raleigh, NC 27604. Applicants who are selected to participate in the
Express Review Program will be notified via email or fax within 2 days. Successful applicants will then be instructed
regarding detailed procedures for full application (Please Note: Submittals of the review packages on Friday after
12:00 pm will be stamped as received on the next business day).
Please contact Debbie Edwards at 919-733-9502 if you have any questions regarding this form.
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