20070029 Ver 1_Initial Interest_20070108

~~~~~~
IN INTEREST IN PARTICIPATION IN THE EXPRESS REVIEW PROGRAM
JANE 2 Q Q 7 ~'~ T~ 401 O VERSITE/EXPRESS PERMITTING UNIT
d7ENR -WATER (lUALITY October 1, 2006 Z~~ /
WET'tANDS q1~0 STQRbIM!gTER BRANCH Version 4
Applicant Name: ~~V1 r i ~e2 L f.C ~O ~av P~Ic ~ ` ~~
Applicant Address: I Q ~ 1 S k i c~ s ~oa
o ~-~ q
Applicant's phone number: X34 ~3~f8 ~ 34rfS Fax number: ~3q- 348' 3 Z~ Z
Applicant's email address:
Consultant Name (if applicable):
Consultant address (if applicable): A~ZGO wossilY~aa ~~ur~ 5u:~c
~. ~ acP Geo~,~ VA Z387S
Consultant's phone number: S0~- S4 C - GG (1 Fax number: 8oQ -7 S"(' 07 98
Consultant's email address: bv~ar Crur4c~4.c~C! C~ ~-:wtn~ons COYv-
Type of action requested under the 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
L~J 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 Drainage AreaslProject Site
Name of Project: ~J6~ ~ ~hdi a o County: C ~ c~ ~ . hG~
Total project acreage: ~•S~e (acres) Total built out impervious area: ~ ~ 4' (acres)
Nearest Named stream + River Basin (from USGS topo map):
~tor+ Crtt~ ~' 1\1GGtSP R:,,..Y C3a3~h
1
Please provide a brief description of this project (attach site plan if available):

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Please attach a map of site location using USGS 1:24,000 map and county soil survey.
Location of proj ect site -please include reference to the county, nearest name town and highway number: .
Proposed impacts: -p
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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 or applicant attended any DWQ-sponsored training sessions in the past two years? If so, please list
which ones. ~~a
Has any DWQ staff visited the site?~, if yes, please provide DWQ staff name,
date of visit:
Which other environmental permits from other agencies will be needed for this project? Please list the permits and
issuing agencies below:
and
Does this project require approval under the State Environmental Policy Act or National Enviromnental Policy Act?
Is ~s project an After-the-fact application or has this project received a previous Notice of Violation from DWQ?
0
Does this project require approval of a Variance from the NC Environmental Management Commission? ~_
Are you awaze 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.
done
This form must be submitted via email (c/o 401expressCa»ncmail.net), faxed (919-733-6893) or hand-delivered to the
Parkview Building, 2321 Crabtree Blvd. Suite 250, Raleigh, NC 27604. Applicants who aze 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 on Friday after 12.•00 pm
will 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 this form.

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