20061144 Ver 7_Initial Interest_20091217

.:Print Form
Form Version 6.2
June 29, 2009
NlCDENR.
INITIAL INTEREST IN PARTICIPATION IN THE EXPRESS REVIEW PROGRAM
WITHIN THE 401 OVERSIGHT/EXPRESS PERMITTING UNIT
A. Applicant Information
1. Processing
? 401 Water Quality Certification (List NW(s) or GP# verified by Corps: )
? Non-404 Jurisdictional Permit
Q Riparian Buffer Authorization
1a. Type(s) of actions ? Riparian Buffer Minor Variance
requested: ? Coastal General "Major" Variance
(Check all that apply) ? Stream Determination: # Streams
? Non-404 Wetland Determination: # Wetlands
? Stormwater Management Plan Review (fee not additive if combined with 401);
# of Drainage Areas/Project Site
2. Project Information
2a. Name of project: Depsey E. Benton WTP Water Transmission Main - 16" Water Lines
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2b. County: Wake
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2c. Latitude/Longitude: Lat: 35.700190 deg N Long: 78.592973 deg W
2d. River Basin: Neuse
2e. Tax PIN or Parcel ID: 1710898413
2f. Nearest Named Stream: Mahlers Creek -
2g. Water Quality Classification of Nearest Named Stream: C; NSW
2h, Total project acreage (Stream or wetland determinations may omit this item): 6.59 (acres)
2i. Total Built Out Imperviousness (Stream or wetland determinations may omit this item): 0%
2j. Provide a brief description of this project (attach a site plan):
The purpose of the project is to construct new water mains within the Town of Garner to reinforce the capacity of the
existing distribution system. The water mains consist of approximately 9,770 lineal feet of 16-inch ductile iron pipe on
NC 50, New Rand Road, and Garner Road.
2k. Provide directions from the nearest named town, including street names and/or highway numbers:
From Raleigh, follow US Highway 70 east. Continue on US Highway 70 straight through the intersection with New
Rand Road, The stream is culverted under US Highway 70 approximately 800 feet east of the New Rand Road
intersection.
Please attach a map of the site location using USGS 1:24,000 topographic map and a copy of the latest bound
and published County soil survey with the project/site boundaries delineated. A site plan should also be included
for all projects other than stream and wetland determinations.
Initial Interest Form v6.2 Cont.
3. Applicant Information
3a. Applicant is: ? Owner ? Agent ?x Other:
3b. Name: Mr. Perry Allen, P.E.
3c. Business name (if applicable): City of Raleigh
3d. Street address: One Exchange Plaza, Suite 620
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3e. City, State, zip: Raleigh, NC 27602
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3f. Telephone no,: 919-831-6144 3g. Fax no.: 919-857-4545
3h, Email address: [e-mail]
4. Agent/Consultant Information (if applicable)
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4a. Contact Name: Ms. Keven Duerr
4b. Company Name: ARCADIS
4c. Street address: 801 Corporate Center Drive, Suite 300
4d- City, State, zip: Raleigh, NC 27607
4e. Telephone no.: 919-854-1282 4f. Fax no.: 919-854-5448
4g. Email address: [e-mail]
5. Proposed Impacts (include both temporary and permanent) [Determination requests may omit this item]
5a. Total 404/401 wetland impacts: (acres) _T 5b. Total non-4041401 wetland impacts: (acres)
5c. Total 404 stream impacts: Intermittent: (linear feet) Perennial: (linear feet)
5d. Total non-404 stream impacts: Intermittent: (linear feet) Perennial: (linear feet)
5e. Total riparian buffer impacts: Zone 1: 1470 (sq. feet) Zone 2: 4841 (sq. feet)
6. Project History and Additional Information
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6a. Has any DWQ staff visited the site? ?X Yes ? No
If yes, provide staff name: Ms. Lia Gilleski and date of visit: 9 December 2009
6b_ Does this project require a Stormwater Management Plan (SMP)? ? Yes ?x No -? Unknown`

6c. Who will be responsible for the review of the SMP? ? Certified Local Gov't:
? DWQ Stormwater Program
? DWQ 401 /Express Review Unit
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6d Does this project require approval under SEPA or NEPA? ? Yes x? No ? Unknown
6e. Is this project an after-the-fact application or has a DWQ notice of violation been issued? ? Yes ?x No
6f. Does this project include buffer impacts that are "prohibited" in the DWQ "Red Rule Book"? ? Yes ?x No
6g. If you are aware of any local controversy concerning this project, provide details in a cover letter. Describe the
controversy and any measures that have been taken with respect to public involvement.
This form must be submitted via email (c/o Lia.M,Gilleski(a?ncdenr.gov), faxed (919-733-6893), or hand-delivered to:
Parkview Building, 2321 Crabtree Blvd. Suite 250, Raleigh, NC 27604. Applicants who are selected to participate in the
Express Review Program will be notified via email or fax. 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 on the next business day).
Please contact Lia Myott Gilleski or Joseph Gyamfi at 919-733-1786 if you have any questions regarding this form.

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PACT 4841.04 SF
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