20061859 Ver 1_Initial Interest Form_20060124

INITIAL INTEREST IN PARTICIPATION IN THE EXPRESS REVIEW PROGRAM
WITHIN THE 401 OVERSITE/EXPRESS PERMITTING UNIT
October 1, 2006 LX 1P C to .. 8 Sq
Version 4
Applicant Name: Steve Gould
Applicant Address: 833-A Wake Forest Business Park PAYMENT
_ Wake Forest, NC 27587 RECEIVED
Applicant's phone number: _(919) 556-2000 Fax number: 919 556-2001
Applicant's email address: gcar2 earthlink.net
Consultant Name (if applicable): Jay Keller
Consultant address (if applicable): 7921 Haymarket Lane: Raleigli 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 Stream Origin Determination
? Isolated Wetland Permit 2 # of Determinations Requested
? Riparian Buffer Approval
? intermittent/Perennial Determination
? Riparian Buffer Minor Variance # 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: Holden Road County: Franklin
Total project acreage: 132 (acres) Total
1 built out impervious area: 0 (acres)
Nearest Named stream + River Basin (from USGS topo map): Richland Creek; 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:
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Subject: Holden road youngsville express stream call
From: "Jay Keller" <[e-mail]>
Date: Tue, 28 Nov 2006 00:20:11 -0500
To: <40 1 express @ncmail.net>
We are requesting express assistance for 2 stream dete mination calls at
a property located on holden road 1 mile east of US1 in Youngsville. We
appreciate your help.
Jay Keller
Jay Keller
Principal
Keller Environmental, LLC
[phone]
[phone] fax
[phone] cell
7921 Haymarket Lane
Raleigh, NC 27615
Keller Jay <[e-mail]>
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