20210697 Ver 1_401 Application_20210401

STATE
Staff Review Form
NORTH CAROLINA
£nWrcnmenrcl Qua fay
Updated September 4,2020
Staff Review
Does this application have all the attachments needed to accept it into the review process?*
6* Yes r No
ID#* Version* 1
20210697
Is this project a public transportation project?* (' Yes
r No
Is this a DOT ( Yes C No
project?*
Reviewer List:* Garcy Ward:eads\gpward
Select Reviewing Office:* Washington Regional Office-[phone]
Does this project require a request for payment to be sent?*
Yes
r
No

Project Submittal Form
Please note:fields marked with a red asterisk *below are required. You will not be able to submit the form until all
mandatory questions are answered.
Project Type:* r For the Record Only(Courtesy Copy)
r New Project
r Modification/New Project with Existing ID
✓ More Information Response
✓ Other Agency Comments
r Pre-Application Submittal
✓ Re-Issuance\Renewal Request
✓ Stream or Buffer Appeal
Project Contact Information
Name: Steve Trowel)
Who is submitting the information?
Email Address: [e-mail]
Project Information
Project Name: Refurbishment/Repair of Scour Pad Bridge Culvert no. 16 HWY 94 Causeway Lake
Mattamuskeet
Is this a public transportation project?
Yes
✓ No
Is the project located within a NC DCM Area of Environmental Concern (AEC)?
✓ Yes r No r Unknown
TIP#: WBS#:
1BPR.10481
(Applies to DOT projects only)
County(ies)
Hyde
Please upload all files that need to be submited.
Click the upload button or drag and drop files here to attach docurrent
Mod Permit Drawing Bridge 16.pdf 1.71 MB
Re_[EXTERNAL] Fwd_Mattamuskeet HWY 94
245.48KB
Culverts Riprap Scour Pad Refurbishment.pdf
Re_[EXTERNAL] Mattamuskeet HWY 94 Culverts
181.97KB
Riprap Scour Pad Refurbishment.pdf
RE_Mattamuskeet HWY 94 Culverts Riprap Scour
174.03KB
Pad Refurbishment.pdf
Topo Mattamuskeet Culverts Scour Pad Repair.pdf 1.91MB
Only pdf or krriz files are accepted.
Describe the attachments
or comments:

This is a courtesy notification that NCDOT will be refurbishing/repairing the existing scour pads on the east
and west side of culvert no. 16 on the HWY 94 causeway across Lake Mattamuskeet in Hyde County near
Fairfield.The existing riprap scour pads have subsided exposing the toe wall. NCDOT plans to add additional
granite riprap using an excavator operating from the lake shore adjacent either side of the culvert to place
riprap along the toe wall.A maintenance staff member standing at the toe wall will guide the equipment
operator in the placement.The excavator will retrieve the riprap directly from a dump truck positioned on the
pavement or shoulder.
Sign and Submit
fJ By checking the box and signing box below, I certify that:
• I,the project proponent, hereby certifies that all information contained herein is true,accurate, and complete to
the best of my knowledge and belief.
• I,the project proponent, hereby requests that the certifying authority review and take action on this CWA 401
certification request within the applicable reasonable period of time.
• I agree that submission of this online form is a"transaction"subject to Chapter 66,Article 40 of the NC General
Statutes(the"Uniform Electronic Transactions Act");
• I agree to conduct this transaction by electronic means pursuant to Chapter 66,Article 40 of the NC General
Statutes(the"Uniform Electronic Transactions Act");
• I understand that an electronic signature has the same legal effect and can be enforced in the same way as a
written signature;AND
• I intend to electronically sign and submit the online form.
Signature:
CSC °PiOX.
Submittal Date: Is filled in autorretically.