20090340 Ver 1_Initial Interest_20090330

*- WA
c Form Version 6.1
i? G?C.Q Dq p 3 44b February 18, 2009
NCDENR
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: )
? 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: 2 # 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: Ronnie A. Collins, Jr. Property
2b. County: Wake
2c. Latitude/Longitude: Lat: 35.775383 North Long: 78.393350 West
2d. River Basin: Neuse
2e. Tax PIN or Parcel ID: REID 0128560 PIN 1773975429
2f. Nearest Named Stream: UT of Buffalo Creek
2g. Water Quality Classification of Nearest Named Stream: B; NSW
2h. Total project acreage (Stream or wetland determinations may omit this item): (acres)
2i. Total Built Out Imperviousness (Stream or wetland determinations may omit this item): %
2j. Provide a brief description of this project (attach a site plan): Wendell United Methodist Church is looking to
purchase this property for a future campus.
2k. Provide directions from the nearest named town, including street names and/or highway numbers: From Wendell
turn south on Buffalo Street. Buffalo Street becomes Poole Road outside of town. When you pass Jake May Drive,
property is 100 yards on the left.
Please attach a map of the site location using USGS 1:24000 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 Ir4erest Form v6.1 Cont.
3. Applicant Information
3a. Applicant is: ? Owner ? Agent ® Other: Potential Buyer
3b. Name: Mike Meyers
3c. Business name (if applicable): Wendell United Methodist Church
3d. Street address: 129 North Main Street
3e. City, State, zip: Wendell, NC 27591
3f. Telephone no.: 919-365-6266 3g. Fax no.:
3h. Email address: [e-mail]
4. Agent/Consultant Information (if applicable)
4a. Contact Name: Steven S. Sanderson, P. E.
4b. Company Name: Sanderson Engineering, Inc.
4c. Street address: 25-C North Main Street P. O. Box 2016
4d. City, State, zip: Wendell, NC 27591
4e. Telephone no.: 919-366-2016 4f. Fax no.: 919-366-2017
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: (acres) 5b. Total non-404/401 wetland impacts: (acres)
5c. Total 404 stream impacts: Intermittent: (linear feet) Perennial: (linear feet)
5d. Total non-404 stream impacts: Intermittent: (linear feet) Perennial: (linear feet)
5e. Total riparian buffer impacts: Zone 1: (sq. feet) Zone 2: (sq. feet)
6. Project History and Additional Information
6a. Has any DWQ staff visited the site? ? Yes ® No
If yes, provide staff name: and date of visit:
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:
? 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 (Go 401 exoressta)ncmail.net), 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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ORTH CAROLINA - SHEET NUMBER 62