20171434 Ver 1_Initial Review Form_20171127

Action History (UTC-05:00) Eastern Time (US & Canada)
�brrrit by Anonymous User 11/27/2017 2:15:58 PM (Supplemental Submital)
Accept by Carpenter,Kristi 11/27/2017 4:15:41 PM (DOT project)
• The task was assigned to Carpenter,Kristi 11/27/2017 2:16 PM

Water Resources
ENVIRONMENTAL OUALITY
Staff Review:
Submittal Type: C•' New Project
C' Pre-Application Submittal
C' More Information Response
New Project - Please check the new project type if you are trying to submit a new project that needs an official approval
decision.
Pre-Application Submittal - Please check the pre-application submittal if you just want feedback on your submittal and do
not have the expectation that your submittal will be considered a complete application requiring a formal decision.
More Information Response - Please check this type if you are responding to a request for information from staff and
you have and ID# and version for this response.
ID#*
20171434
Version*
1
Is this project in a CAMAAEC area?* �' Yes
�' No
Reviewer List:*
Select Reviewing Office:*
Joanne Steenhuis:eads\jhsteenhuis
Wilmington Regional Office - [phone]
Project Submittal Interim Form
subrritted: 11/27/2017
Project Contact Information:
Name: James J Rerko, PWS
Who is subrritting the inforrration?
Email Address: [e-mail]
Project Information:
Project Name: R-5749 US 74 & SR 1001 Interchange
Is this a public transportation project?
C' Yes
l' No
TIP#: R-5749
WBS#: 53086.1.FD1
(Applies to
DOT projects
only)

County(ies)*
Columbus
Describe the attachments:
Adding the additional Open Water impacts that I missed to the PCN.
Please upload all files that need to be submited.
R5749additionalSWlmpacts.pdf 91.66KB
Only pdF files are accepted.
r% By checking the box and signing box below, I certify that:
o I have given true, accurate, and complete information on this form;
o I agree that submission of this form is a"transaction" subject to Chapter 66, Article 40 of the NC General Statutes (the
"Uniform Electronic Transactions AcY')
o I agree to conduct this transaction by electronic means pursuant to Chapter 66, Article 40 of the NC General Statutes
(the "Uniform Electronic Transactions AcY');
o I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written
signature; AND
o I intend to electronically sign and submit the form.
Signature:
�., � ��°