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Home My WebLink About20220841 Ver 1_401 Application_20220623 o 0 vim. NORTH CARO.INA Staff Review Form Envlmnm¢ntrtl Qvofiry Updated September2020 Staff Review Does this application have all the attachments needed to accept it into the review process?* Yes No ID#* Version* 1 20220841 Is this project a public transportation project?* Yes No Is this a DOT Yes No project?* Reviewer List:* Hannah Sprinkle:eads\hhsprinkle Select Reviewing Office:* Wilmington Regional Office-(910)796-7215 Does this project require a request for payment to be sent?* Yes 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:* For the Record Only(Courtesy Copy) New Project Modification/New Project with Existing ID More Information Response Other Agency Comments Pre-Application Submittal Re-Issuance\Renewal Request Stream or Buffer Appeal Pre-Filing Meeting Date Request was submitted on: Project Contact Information ............................................................................................................................................................................................................... Name: NCDOT Division 6 Who is submitting the information? Email Address: gwprice2@ncdot.gov Project Information ........................................ .................................................. Project Name: Replace Culvert 303 on SR 1428(Thompson Town Road)over Fivemile Branch Is this a public transportation project? Yes No Is the project located within a NC DCM Area of Environmental Concern (AEC)? Yes No Unknown TIP#: WBS#: B P6.R001.1 (Applies to DOT projects only) County(ies) Columbus Please upload all files that need to be submited. Click the upload button or drag and drop files here to attach document BP6.R001_Permit Drawings_20220309.pdf 1.65MB Only pdf or kmz files are accepted. Describe the attachments or comments: Nationwide Permit#3 Non-reporting Lat/Long 34.288383,-78.784056 Permit Drawings attached Sign and Submit ...................................................................................................................................................................................................................................................................................................................................................................................................... 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: Submittal Date: Is filled in automatically.