20091352 Ver 1_Initial Interest_20091229

Gilleski, Lia
From: Desloge, Francis T (Frank) [[e-mail]]
Sent: Tuesday, December 29, 2009 12:00 PM
To: Gilleski, Lia
Subject: RE: Express Review Link
Attachments: InitiallnterestFormV6 2-1.doc
Hi Lia,
I completed the form to the best of my ability. Please let me know if you need anything else.
Thanks,
Frank Desloge
104 Kensbury Circle
Cary, NC 27513
Cell 602-6436
Home 467-3625
From: Gilleski, Lia [mailto:[e-mail]]
Sent: Tuesday, December 29, 2009 11:23 AM
To: Desloge, Francis T (Frank)
Subject: Express Review Link
http://h2o.enr.state.nc.us/ncwetlands/express review.htm
LIA MYOTT GILLESKI
Express Coordinator
DWQ 401 Oversight/Express Review Unit
2321 Crabtree Blvd., Suite 250, Raleigh, NC 27604
Phone: [phone], Fax: [phone]
E-mail correspondence to and from this address may be subject to the
North Carolina Public Records Law and may be disclosed to third parties.
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NCDENR
UP DR -135 a.
Form Version 6.2
June 29, 2009
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
? Riparian Buffer Authorization
1 a. Type(s) of actions ? Riparian Buffer Minor Variance
requested: ? Coastal General "Major" Variance
(Check all that apply)
® Stream Determination: # Streams
1
? 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: Deck Extension
2b. County: Wake (Cary)
2c. Latitude/Longitude: Lat: 35 7 too Long:
2d. River Basin:
2e. Tax PIN or Parcel ID: DI 144 _ _ 1 5-c4

2f. Nearest Named Stream:
2g. Water Quality Classification of Nearest Named Stream:
2h. Total project acreage (Stream or wetland determinations may omit this item): (acres)
2i.,Total Built Out Imperviousness (Stream or wetland determinations may omit this item): %
2j. Provide a brief description of this project (attach a site plan):
Town of Cary is requesting a Stream Determination. We are trying to extend our deck another 4 feet and our permit
request was denied until a Stream Determination can be made.
2k. Provide directions from the nearest named town, including street names and/or highway numbers:
104 Kensbury Circle, Cary, NC 27513 (Arlington Ridge Subdivision - Lot 37)
Near intersection of Cary Parkway and High House Rd.
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 ? Other:
3b. Name: Francis Desloge
3c. Business name (if applicable):
3d. Street address: 104 Kensbury Circle
3e. City, State, zip: Cary, NC 27513
3f. Telephone no.: 919-467-3625 or 919-602-6436 3g. Fax no.:
3h. Email address: [e-mail]
4. Agent/Consultant Information (if applicable)
4a. Contact Name:
4b. Company Name:
4c. Street address:
4d. City, State, zip:
4e. Telephone no.: 4f. Fax no.:
4g. Email address:
5. Proposed Impacts (include both temporary and permanent) [Determination requests may omit this item]
5a. Total 404/401 wetland impacts: (acres) 5b. Total non-404/401 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: (sq. feet) Zone 2: (sq. feet)
6. Project History and Additional Information
6a. Has any DWQ staff visited the site? ? Yes ? No
If yes, provide staff name: and date of visit:
6b. Does this project require a Stormwater Management Plan (SMP)? ? Yes ? 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
6d. Does this project require approval under SEPA or NEPA? ? Yes ? No ? Unknown
6e. Is this project an after-the-fact application or has a DWQ notice of violation been issued? ? Yes ? No
6f. Does this project include buffer impacts that are "prohibited" in the DWQ "Red Rule Book"? ? Yes ? 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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