20071638 Ver 2_Initial Interest_20080108

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INITIAL INTEREST IN PARTICIPATION IN THE EXPRESS REVIEW PROGRAM
WITHIN THE 401 OVERSITE/EXPRESS PERMITTING UNIT
October 1, 2006
Version 4
Applicant Name:
Applicant Address:
CoAF~~- DE~Ec~M~~sT PA~,~EI-S Lt-G A~Nr- ~. Mme. J°`'~'kr~a IL
ZIo3 W~IrrE oaf oal.1~
BEGt~(,~~. vJES-~ .r~a~NiA tiS3ol
Applicant's phone number: C3oQ~~ ZSS - 2'Lgo x l n q- Fax number: ~~o f ~ zss ~ 22`f- ~
Applicant's email address: , 4{ aoR IL @- ~q~,gMaJn+ j of J Co~P • 1~~--1
Consultant Name (if applicable):
Consultant address (if applicable)
DA~~D ~ • at~yerz-
Po.L'T eFFCtr: ~o~ ~ I I~~
~Ar~,ll . ~~ 21 bLz
Consultant's phone number: ~~9~ ~.io "~ 9-~ Fax number: C~{9) ~~ "' o~;g
Consultant's email address: Q~ooSa~+R-+~b ~ ya~-on . to•~1
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
^ Stream Origin Determination
# of Determinations Requested
^ Intermittent/Perennial Determination
# of Determinations Requested
^ Isolated Wetland Determination
linear feet or acres
L7 Stormwater Management Plan (this fee is not additive when approval is combined with 401 Cert.)
~ # of Drainage Areas/Project Site
Name of Project: ~ASr P~~I~ Pc~Z~ County: So~tNjr°^~
Total project acreage: Slo.o(o (acres) Total built out impervious area: Z~}. ~~ (acres)
Nearest Named stream + River Basin (from USGS topo map):
~W t t~ Clt~l~ I~SE
Please provide a brief description of this project (attach site plan if available):
C~~~GR•~~4,~. $~~-Arc. CE^t'~- -to ~au.J,pE A that,-MS~t~ .~'Io~ IMAM-t, .,Wa? $a~c.nr~S
Aa0 Z ~TPAILcEt,S .
1

Please attach a map of site location using USGS 1:24,000 map and county soil survey.
Location of project site -please include reference to the county, nearest name town and highway number:

Proposed impacts:
0. vtfo
a F ~.~ ~~ ~~ c~ J o F T 44 , 6~ ~ -~ . J oy a.r To~.l (o . ,.~ . C .
Acres of 404/401 wetlands
Acres of isolated wetlands
~ ~ 9 • ~ ~ 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 site? CGS , if yes, please provide DWQ staff name, MS • ~"~ "'~Y°~
date of visit: lo~z ~ zvo~
Which other environmental permits from other agencies will be needed for this project? Please list the permits and
issuing agencies below: ~~ _ uS Rt~~Y loFPl. ~ ~~br~~.S
and
Does this project require approval under the State Environmental Policy Act or National Environmental Policy Act?
~.
Is this project an After-the-fact application or has this project received a previous Notice of Violation from DWQ?
na _
Does this project require approval of a Variance from the NC Environmental Management Commission? ~
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.
NO-~ .
This form must be submitted via email (c/o 401express(cr~,ncmail.net~ faxed (919-733-6893) or hand-delivered to the
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 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.
2

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