20110365 Ver 1_Initial Interest_20110413

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NCDENR
?? P 0 1 0 3 6 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: 39)
? 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
? 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: Rex Property-Lots 1 & 2
2b. County: Wake
2c. Latitude/Longitude: Lat: 35.8231 Long: -78.7103
2d. River Basin: Neuse River Basin
2e. Tax PIN or Parcel ID: 0785-54-6220
2f. Nearest Named Stream: UT to Richlands Creek
2g. Water Quality Classification of Nearest Named Stream: C; NSW 27-33-11
2h. Total project acreage (Stream or wetland determinations may omit this item): ± 17 (acres)
2i. Total Built Out Imperviousness (Stream or wetland determinations may omit this item): Lot 1 46 % & Lot 2 56%
2j. Provide a brief description of this project (attach a site plan): This project is a planned institutional development that
would include buildings, parking, utilities and stormwater management BMP's. The project is proposing one aerial
sanitary sewer crossing and two BMP stormwater outfalls through the riparian buffer.
2k. Provide directions from the nearest named town, including street names and/or highway numbers: From 440 West
take exit 5 (Lake Boone Trail), take right off exit, at intersection of Blue Ridge Rd. take right, take left on Macon Pond
Rd. and site will be in NW quadrant of Macon Pond Rd. and Edwards Mill 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.
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3. Applicant Information
3a. Applicant is: ? Owner ? Agent ® Other: Owner-however please send correspondence to both
owner and Agent.
3b. Name: Chad T. Loftenis
3c. Business name (if applicable): Rex Hospital
3d. Street address: 4420 Lake Boone Trail
3e. City, State, zip: Raleigh, NC 27607
3f. Telephone no.: 919-784-2242 3g. Fax no.:
3h. Email address: N/A
4. Agent/Consultant Information (if applicable)
4a. Contact Name: Debbie Edwards
4b. Company Name: Soil & Environmental Consultants, PA
4c. Street address: 11010 Raven Ridge Road
4d. City, State, zip: Raleigh, NC 27617
4e. Telephone no.: 919-846-5900 4f. Fax no.: 919-846-9467
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: 0 (acres) 5b. Total non-404/401 wetland impacts: 0(acres)
5c. Total 404 stream impacts: Intermittent: 0 (linear feet) Perennial: 21 (linear feet)
5d. Total non-404 stream impacts: Intermittent: 0 (linear feet) Perennial: 0 (linear feet)
5e. Total riparian buffer impacts: Zone 1: 2,366 (sq. feet) Zone 2: 1,467 (sq. feet)
6. Project History and Additional Information
6a. Has any DWQ staff visited the site? ® Yes ? No
If yes, provide staff name: Lauren Witherspoon and date of visit: 09125107
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: City of Raleigh
? 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(&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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