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Home My WebLink About20230468 Ver 1_401 Application_20230327Staff Review Does this application have all the attachments needed to accept it into the review process?* Yes No ID#* Version* 1 20230468 Is this project a public transportation project?* Yes No Reviewer List: * Seren Homer:Seren.Homer@ncdenr.gov Select Reviewing Office: * Winston-Salem Regional Office - (336) 776-9800 Submittal Type: * 401 Application Does this project require a request for payment to be sent? Yes No How much is owed?* $240.00 $570.00 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: 11 / 17/2022 Project Contact Information Name: Heather LaGamba Who is submitting the information? Email Address: hlagamba@pilotenviro.com Project Information Project Name: Jackson Lake Is this a public transportation project? Yes No Is the project located within a NC DCM Area of Environmental Concern (AEC)? Yes No Unknown Is this project connected with ARPA funding? Yes No County (ies) Guilford Please upload all files that need to be submited. Click the upload button or drag and drop files here to attach document 6863.2_Jackson Lake_PCN_03.27.23.pdf 9.81 MB Only pdf or kmz files are accepted. Describe the attachments or comments: PCN for 401 WQC 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: ��nrirs�t ,✓�..��iairrAii Submittal Date: 3/27/2023 Is filled in automatically.