20080334 Ver 1_Initial Interest_20080222

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IIVITitAL INTEREST IN PARTICIPATION IN THE EXPRESS REVIEW PROGRAM
WITHIN THE 401 OVERSITE/EXPiRESS PERNIITTING C1NIT
October 1, 2006
Version 4
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Applicant Name: ~ ~ ~~~ l~ ~ t~ I[.~~5 l~'~ ~~ fQi ~~
Applicant Address: 31 r71 - G C7~~S5 ~~
Applicant's phone number: ~q ~ ~7~0 -- l3~'7 Fax number:
Applicant's email address:
Consultant Name (if applicable): ~~~_`` ~C Z.~~1i ~...,, r
Consultant address (if applicable): ZQ ~f ~ W1~1((zLK.Z~Qftit ~t)f-~
~~9~~W1 IC x`7701
Consultant's phone number: 1~J l; g Z ~ Zoo fe Fax numb//er: ~/ ~ 6~ Z- 7~oST
Consultant's email address: ~,~ ~.~ ~ ~tG-
Type of action requested under the Express Review Program {check all that apply):
^ 401 Water Quality Certification Stream Origin Determination.
^ Isolated Wetland Permit
^ Riparian Buffer Approval
^ Riparian Buffer Minor Variance
,~ # of Determinations Requested
^ Intermittent/Perennial Determination
# of Determinations Requested
^ Coastal General "Major" Variance ^ lsolated Wetland Determination
linear feet or acres
^ Stormwater Management Plan (this fee is not additive when approval is combined with 401 Cert.)
# of Drain ge Area ~ 3~aD Ccoas~~l4.~t
Name of Project: ~ ~ ~ ~f~Fr ~ ~ ~ r County: ~ ~~;~1 N2
Total project acreage: ~_(acres) Total built out impervious area: 1, j,.,~_(acres)
Nearest Named stream + River Basin (from, vSGS topo map):
~ (C.~~ C `Q L` L lL - N ~ s -e.
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 project site -please include reference to the county, nearest name town and highway number:
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Proposed impacts:
Has consultant
which ones.
Acres of 404/401 wetlands
Acres of isolated wetlands
Linear feet of streams
Linear feet of isolated streams
Square feet of protected stream buffers
applicant attended any DWQ-sponsored training sessions in the past two years? )f so, please I
D
Has any DWQ staff visited the site? alp , 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:
Doe this project require approval under the State Environmental Policy Act or National Environmental Policy Act?
~~~
Is thi project an After-tlie-fact application or has this project received a previous Notice of Violation from DWQ?
Does this project require approval of a Variance from the NC Environmental Management Commission? jO
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.
~~~~
This form must be submitted via email (c/o 401 express _,ncmail.netl, faxed {919-733-6893) or hand-delivered to the
Farkview Building, 2321 Crabtree Blvd. Suite 250, Raleigh, NC 27604. Applicants wlio 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 t•eviely packages on Friday after 12: 00 pnr
i+~ill be stamped as received arr the next business day).
Please contact Cynthia Van Der Wiele at 919-715-3473 if you have any questions regarding this form.

TopoZone -USGS Northwest Durham (NC) Topo Map Page 1 of 1
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htfip://www.topozone. com/print. asp71at=36.02639&lon=78.95321 &s=25 &si ae=1&symsho... 1/23/2007
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0 0.09 0.18 0.27 0.36 0.45 ni
UTM 17 684427E 3988613N (NAD27)
USGS Northwest Durham (NC) Quadrangle ~1=-ilT6`~4
Projection is UTM Zone 17 NAD$3 Datum Gsl. c~5

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SOIL SURVEY OP DURHAM COUNTY
Soil Surveil of Durham County, North Carolina
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