20090600 Ver 1_Initial Interest_20090528

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FEB-17-2000 THU 19:20 TEL:[phone] NAME:DWQ-WETLANDS P. 1
2000-02-09 00:43
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Form Version 6.1
February 18, 2009
INITIAL INTEREST IN PARTICIPATION IN THE EXPRESS REVIEW PROGRAM
enTU110'rU= AM n%=0Q11-%WTfVYDr7r-C? PFRIUITTINCy 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: I # Streams
? Non-404 Wetland Determination. _ _ _ # Wetlands
? Stormwater Management Plan Review (fee not additive If combined with 401):
# of Drainage Areas/Project Site
2. Projoct Information
2a, Name of project: Jackness Deck
2b. County: Wake
2c. LatitudelLongitude: Lat: Long:
2d. River Basin: e,L.dfL....
2e. Tax PIN or Parcel ID: ()`j _12- 9 2,U b 17-
2f. Nearest Named Stream: VT 5 1- ,' 1,+ t3r A C141,
2g. Water Quality Classification of Nearest Named Stream:
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):
New Deck
2k. Provide directions from the nearest named town, including street names and/or highway numbers:
Par way in Camden Forest
Off Cary
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Please attach i map of the silts location using USGS 1:24,000 topographic map and a copy Of the Most bound
and published County soil survey with the projecValte boundaries delineated. A site plan should also be included
for all projects other than stream and wetland determinations.

FEB-17-2000 THU 19:20 TEL:[phone] NAME:DWQ-WETLANDS P. 2
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Initial Interest Form v6.1 Cont.
3. Applicant Information
3a, Applicant is: ® Owner ? Agent ? Other.
3b, Name: Rob Jackness
30, Business name (if applicable): na
3d, Street address: 113 Saint LeAnvilie Dr.
3e. City, State, zip: Cary No, 27518
3f. Telephone no.: Fax no.:
3h, Email address:
4. Agent/Consultant. Information (if applicable)
4a, Contact Name: Dean Anderson
4b. Company Name: Same
4c. Street address: 116 Bikram Dr.
4d. City, State, zip: Holly Springs Nc_ 27540
4e. Telephone no. 818-9592 4f. Fax no.: 762-1770
4g. Email address: danderson008Qnc_rr.com
& Proposed Impacts (Include both temporary and permanent) [Determination requests may omit this Item]
5a. Total 4041401 wetland impacts' (acres] 5b. Total non-4041401 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 Addltlonal 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

8c. Who will be responsible for the review of the SMP? ? Certified Local Gov't:
? DWO 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"? Q Yes ? No
6g. If you are aware of any local controversy conoeming 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 (clo 4Q, sx cmail.?tl. faxed (819-733.6893), 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 eftr 12:00 pm will be stamped as
received on the next business day).
Please contact Lis Myott Gilleski or Joseph Gyamfi at 919-733-1786 if you have any questions regarding this form.
FEB-17-2000 THU 19:20 TEL:[phone] NAME:DWQ-WETLANDS P. 3
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Jackness Deck
http://imaps. co.wake.nc. us/imapslprintmap. asp?pin=0772426012&pinext=000&minX=207... 5/28/2009
Copyright 2008. City of Raleigh, Wake County. 0 69 ft