20080582 Ver 1_Initial Interest_20080331

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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: P.O. Box 960
Youngsville, NC 27596
Applicant's phone number: 215-2277 Fax number:
Applicant's email address: mosswoodfarm hotmail.com
Consultant Name (if applicable): Jay Keller
Consultant address (if applicable): _ 7921 Haymarket Lane; Raleigh, NC 27615
Consultant's phone number: 919 844-7437 Fax number: (919 844-7438
Consultant's email address: 'a kellerenvironmental.com
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
~ Stream Origin Determination
3 # of Determinations Requested
^ Intermittent/Perennial Determination
# of Determinations Requested
^ Coastal General "Major" Variance
^ Isolated Wetland Determination
linear feet or acres
^ Stormwater Management Plan (this fee is not additive when approval is combined with 401 Cert.)
# of Drainage Areas/Project Site
Name of Project: Tarboro Road County: Franklin
Total project acreage: 35 (acres) Total
1 built out impervious area: 0 (acres)
Nearest Named stream + River Basin (from USGS topo map): Little River; Neuse River Basin
Please provide a brief description of this project (attach site plan if available):
Residential
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:
1

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Site behind Dollar General on Tarboro Road approximatelyl mile east of Youngsville NC Franklin County
Proposed impacts:
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. April 18, 2006 Intermittent/Perennial Stream Determination Class
Has any DWQ staff visited the site? no , if yes, please provide DWQ staff name, and
date of visit:
Which other environmental permits from other agencies will be needed for this project? Please list the permits and
issuing agencies below:
Does this project require approval under the State Environmental Policy Act or National Environmental Policy Act?
no
Is this project an After-the-fact application or has this project received a previous Notice of Violation from DWQ?
no
Does this project require approval of a Variance from the NC Environmental Management Commission? no
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 401express ~,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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