20180865 Ver 1_PCN Form Submission_20180621

Action History (UTC-05:00) Eastern Time (US & Canada)
�brrrit by Anonymous User 6/21/2018 2:04:59 PM (Start Event)
Accept by Carpenter,Kristi 6/21/2018 3:07:43 PM (DOT Initial Review)
. The task was assigned to Carpenter,Kristi. The due date is: June 26, 2018 5:00 PM
6/21 /2018 2:06 PM

�� �
6fvlslaa of Water Resources
Pre-Construction Notification (PCN) Form
For Nationwide Permits and Regional General Permits
(along with corresponding Water Quality Certifications)
January 31, 2018 Ver 2.3
*
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 ans�red.
Also, if at any point you wish to print a copy of the E-PCN, all you need to do is right-click on the document and you can print a copy of the form.
Below is a link to the online help file.
https://edocs. deq. nc.gov/WaterResources/0/edoc/624704/PCN%20Help%20File%202018-1-30. pdf
A. Processing Information
County(or Counties) where the project is located:*
Martin
Is this project a public transportation project?*
�' Yes C' No
This is any publicly funded by rrunicipal,state or federal funds road, rail, airport transportation project.
Is this a NCDOT Project?*
�' Yes C' No
(NCDOT only) T.I.P. or state project number:
B-5503 Bridge # 53
WBS #
55003.1. F R1
(for NCDOT use only)
1a. Type(s) of approval sought from the Corps:*
rJ Section 404 Permit (wetlands, streams and waters, Clean Water Act)
r Section 10 Permit (navigable waters, tidal waters, Rivers and Harbors Act)
1b. What type(s) of permit(s) do you wish to seek authorization?*
�J Nationwide Permit (NWP)
r Regional General Permit (RGP)
� Standard (IP)
This form may be Corps to initiate the standard/individual permit process. Please contact your Corps representative for submittal of standard permits.
All required items that are not provided in the E-PCN and be added to the miscellaneous upload located at the bottom of this form.
Nationwide Permit (NWP) Number: 14 - Linear transportation
Nationwide Permit (NWP) Number: 12 - Utility Lines
NWP Number Other:
List all MN nurrbers you are applying for not on the drop dow n list.

1c. Type(s) of approval sought from the DWR:*
check all that apply
N7 401 Water Quality Certification - Regular
r Non-404 Jurisdictional General Permit
� Individual Permit
r 401 Water Quality Certification - Express
�7 Riparian Buffer Authorization
*
1d. Is this notification solelyfor the record because written approval is not required?
For the record only for DWR 401 Certification: f Yes C•' No
For the record onlyfor Corps Permit: C' Yes C•' No
1e. Is payment into a mitigation bank or in-lieu fee program proposed for mitigation of impacts?
If so, attach the acceptance letter from rritigation bank or in-lieu fee program
C' Yes �' No
1f. Is the project located in anyof NC's twentycoastal counties?*
C' Yes �' No
1h. Is the project located in a designated trout watershed?*
C' Yes C' No
Link to trout information: http://w�nn�v.saw.usace.army.mil/Missions/Regulatory-Permit-PrograrrUAgency-Coordination/Trout.aspx
6. Applicant Information
1a. Who is the Primary Contact?*
Clay Willis
1b. PrimaryContact Email:*
[e-mail]
1c. PrimaryContact Phone:*
(xxx)xxx-xxxx
[phone]
1d. Who is applying for the permit?
I7 Owner r Applicant (other than owner) r AgenUConsultant
(Check all that apply)
� 2. Owner I nformation
2a. Name(s) on recorded deed:
i NCDOT - Division One ROW
2b. Deed book and page no.:
N/A
2c. Responsible party:
(for Corporations)
2d.Address
Street Address
118 Airport Drive Suite 100
Address Line 2
a�y
Edenton
Fbstal / Zip Code
27871
State / R'ovince / F�gion
NC
Country
USA

2e. Telephone Number:
(xxx)xxx-xxxx
[phone]
2f. Fax Number:
(xxx)xxx-xxxx
2g. Email Address:*
[e-mail]
C. Project Information and Prior Project History
1. Project Information
1a. Name of project:*
Bridge # 53 over Collie Swamp on SR 1142 (Prison Camp Rd)
1b. Subdivision name:
(if appropriate)
wa
1c. Nearest municipality/town:*
Robersonville
1d. Driving directions*
If it is a new project and can not easily be found in a GPS rrapping system Rease provide directions.
Bridge project is located approbmately 1.5 miles east of the intersection of SR 1142 (Prison Camp Rd.) and NC 903, just south of
Robersonville.
2. Project Identification
2a. Property Identification Number:
(tax RN or parcel ID)
NCDOT ROW
2b. Propertysize:
(in acres)
2.5 acres
2c. Project Address
Street Address
Bridge 53 is located on SR 1142 (Prison Camp Road) over Collie Swamp
Address Line 2
C�ty State / Rovince / F�gion
Fbstal / Zip Code Country
2d. Site coordinates in decimal degrees
Please collect site coordinates in decimal degrees. Use between 4-6 digits (unless you are using a survey-grade GPS device) after the decimal place as
appropriate, based on howthe location was determined. (For example, most mobile phones with GPS provide locational precision in decimal degrees to
map coordinates to 5 or 6 digits after the decimal place.)
Latitude:* Longitude:*
35.7734 - 77.21
ex: 34.208504 -77.796371

3. Surface Waters
3a. Name of the nearest body of water to proposed project:*
Collie Swamp
3b. Water Resources Classification of nearest receiving water:*
C, Sw, NSW
Surface Water Lookup
3c. What river basin(s) is your project located in?*
Tar-Pamlico
River Basin Lookup
4. Project Description
4a. Describe the existing conditions on the site and the general land use in the vicinity of the project at the time of this application:*
I The e�asting conditions on the site consist of Bridge # 53 over Collie Swamp and SR 1149. The surrounding land
use is primarily forested lands and row crop agricultural fields. There are rural residential home sites around the
project vicinity, but none within the immediate project area.
4b. Attach an 8 1/2 X 11 excerpt from the most recent version of the USGS topographic map indicating the location of the project site. (for
DWR)
Qickthe upload button or drag and drop files here to attach docurrent
B-5503_QuadMap.pdf
Fle type rrust be pdf
2.62MB
4c. Attach an 8 1/2 X 11 excerpt from the most recent version of the published County NRCS Soil Survey map depicting the project site.
(for DWR)
aick the upload button or drag and drop files here to attach docurrent
65503_Soi I_Map. pdf
Fle type rrust be pdf
4d. List the total estimated acreage of all existing wetlands on the property:
1 acre
4e. List the total estimated linear feet of all existing streams on the property:
(interrrittent and perennial)
100 feet
629.64KB
4f. Explain the purpose of the proposed project:*
I To replace an existing aging bridge structure that was built in 1968 and maintain a safe bridge crossing over Collie
Swamp. SR 1149 (Prison Camp Road) is a main corridor between Williamston and Greenville. Maintaining a
reliable and safe route along SR 1149 is important for this region of Martin County and the surrounding area.
4g. Describe the overall project in detail, including indirect impacts and the type of equipment to be used:*

This project proposes to replace Bridge # 53, which is was built in 1968. It is a 86' long X 30 ' wide, 5-span bridge
with a concrete deck supported by timber beams, caps and piles. There are additional steel H-pile crutch bent
girders that have been added to the original structure. The original structure and added crutch bents will be
removed in their entirety, following NCDOT guidelines (BMPS's) for bridge removal. The new bridge will be a
precast concrete structure, with 3-spans totaling 135 ' long X 39' wide. The new bridge will be realigned
approxmately 40 ' to the north, which will reduce some of the ewsting curve and improve safety. The current
curvature of the road, limits sight visibility to oncoming traffic approaching the bridge structure, creating a hazard
for vehicle movement through the curve. The new alignment will allow for the old approach fill and roadway to be
removed down to wetland elevation and vegetated, restoring 0.46 acres of wetlands. This area will be planted with
native wetland tree species. This area can be monitored for three years and reports generated for the COE/DWR
review and approval. Restoring the old fill section will also provide buffer restoration in zones 1& 2. The bridge will
require an overhead pov�r line relocation to coincide with the newalignment of the bridge. Some hand clearing in
the wetland areas will be required for the new alignment of the aerial line. This project will maintain the existing
level of traffic service along SR 1149 (Prison Camp Rd) and will not have any indirect impacts. Equipment used on
the project will include a crane, excavator, backhoe, dump trucks, paving equipment and various smaller tools
typically associated with bridge construction.
4h. Please upload project drawings for the proposed project.
C7ick the upload button or drag and drop files here to attach docurrent
65503_Permit Package Wetland_20180621.pdf 1.84M6
Fle type rrust be pdf
5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the propertyor proposed impact areas?*
�' Yes �' No �' Unknown
Comments:
5b. If the Corps made a jurisdictional determination, what type of determination was made? *
r Preliminary l" Approved f Unknown C' N/A
Corps AID Number:
6carrple: SAV�2017-99999
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known):
Agency/Consultant Company:
Othe r:
Adam Spiller, S. Stokes, T. Seelinger
KCI
5d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
JD package sent to COE May of 2015
5d1. Jurisdictional determination upload
Qick the upload button or drag and drop files here to attach docurrent
WetlandJD_Package.pdf 1.8MB
Fle type rrust be FDF
6. Project History
6a. Have permits or certifications been requested or obtained for this project (including all prior phases) in the past?*
C' Yes
7. Future Project Plans
7a. Is this a phased project?*
C' Yes C•' No
C•' No
�' Unknown

Are any other NWP(s), regional general permit(s), or individual permits(s) used, or intended to be used, to authorize any part of the
proposed project or related activity? This includes other separate and distant crossing for linear projects that require Department of the
Army authorization but don't require pre-construction notification.
D. Proposed I m pacts I nventory
1. Impacts Summary
7a. Where are the impacts associated with your project? (check all that apply):
fJ Wetlands r Streams-tributaries rJ Buffers
fJ Open Waters r Pond Construction
2. Wetland Impacts
If there are wetland impacts proposed on the site, then complete this question for each wetland area impacted.
2a. Site #- Reason for impact* 2b. Impact type * 2c. Type of wetland*
Roadway Fill
fV�p label (e.g. f�ad CYossing 1- Qalvert,
dewatering, etc)
Hand Clearing
N�p label (e.g. F�ad C7ossing 1- CLlvert,
dewatering, etc)
Roadway Fill
fv�p label (e.g. Finad Qossing 1- Qilvert,
dewatering, etc)
Hand Clearing - EC
N�p label (e.g. f�ad Qossing 1- Qilvert,
dewatering, etc)
Roadway Fill
N�p label (e.g. F�ad Qossing 1- Q�Ivert,
dewatering etc)
Hand Clearing - EC
fV�p label (e.g. Fd�ad Qossing 1- Qilvert,
dewatering, etc)
Roadway Fill
N�p label (e.g. Fd�ad Qossing 1- Qilvert,
dewatering, etc)
Hand Clearing
fV�p label (e.g. Rnad Qossing 1- Qalvert,
dewatering etc)
P
F�rrranent (F) or
Terrporary (�
T
F2rrranent (� or
Terrporary (�
T
F2rrranent (Fj or
Terrporary (�
T
F�rrrenent (F) or
Terrporary (�
P
F2rrranent (� or
Terrporary (�
T
F2rrranent (F) or
Terrporary (�
T
F�rrrenent (Pj or
Terrporary (�
T
F�rrranent (� or
Terrporary (�
2g. Total Temporary Wetland Impact
0.531
2g. Total Permanent Wetland Impact
0.461
2g. Total Wetland Impact
0.992
2h. Comments:
Riverine Swamp
Forest
Riverine Swamp
Forest
Riverine Swamp
Forest
Riverine Swamp
Forest
Riverine Swamp
Forest
Riverine Swamp
Forest
Riverine Swamp
Forest
Riverine Swamp
Forest
2d. Wetland name *Ze. 2f. Type of 2g. Impact
Forested* Jurisdicition* area*
Site 1 Yes Both 0.140
(404, 10) or C!✓UR(401, (acres)
other)
Site 1 Yes Both 0.230
(404, 10) or D✓N2(401, (acres)
other)
Site 2 Yes Both 0.022
(404, 10) or �R(401, (acres)
other)
Site 2 Yes Both 0.041
(404, 10) or DJ�R(401, (acres)
other)
Site 3 Yes Both 0.321
(404, 10) or DJUR(401, (acres)
other)
Site 3 Yes Both 0.040
(404, 10) or D✓�R(401, (acres)
other)
Site 4 Yes Both 0.032
(404, 10) or [7✓UR(401, (acres)
other)
Site 4 Yes Both 0.166
(404, 10) or D✓�R(401, (acres)
other)
4. Open Water Impacts
If there are proposed impacts to lakes, ponds, estuaries, tributaries, sounds, the Atlantic Ocean, or any other open water of the U.S. then individually list
all open water impacts below.

4a. Site #- Reason for 4b. Impact type * 4c. Name of waterbody*
i impact*
Site # 1 Abutment Fill P
fV�p label (e.g. fd�ad CYossing 1) F�rrranent (Pj or
Terrporary (�
Site # 3 roadway fill P
Nfip label (e.g. F�ad C7ossing 1) F2rrranent (� or
Terrporary (�
Site # 3 Abutment Fill P
fv�p label (e.g. Fd�ad Qossing 1) F2rrranent (Fj or
Terrporary (�
4g. Total temporary open water Impacts:
0.00
4g. Total permanent open water impacts:
0.05
4g. Total open water impacts:
0.05
4h. Comments:
Collie Swamp
(if applicable)
Collie Swamp
(if applicable)
Collie Swamp
(if applicable)
4d. Activitytype � 4e. Waterbodytype *4f. Impact
area*
Bridge Tributary 0.01
(acres)
Bridge Tributary 0.01
(acres)
Bridge Tributary 0.03
(acres)
6. Buffer Impacts (for DWR)
If project will impact a protected riparian buffer, then complete the chart below. Individually list all buffer impacts below.
6a. Project is in which protect basin(s)?*
Check all that apply.
r Neuse �J Tar-Pamlico
r Catawba r Randleman
� Goose Creek r Jordan Lake
� Other
6b. Impact Type * 6c. Per or
i Temp*
Site 1 - Allowable P
Location and 6cerrpt, Allowable, allowable w/ F�rrranent (F) or
rrdigation Terrporary (�
Site 1- Allowable (hand clearing) T
Location and 6cerrpt, Allowable, allowable w/ F2rrranent (f� or
rritigation Terrporary (�
I Site 2- Allowable T
Location and Exerrpt, Allowable, allowable w/ F2rrranent (� or
rritigation Terrporary (�
Site 2- Allowable (hand clearing) T
Location and 6cerrpt, Allowable, allowable w/ F�rrrenent (F) or
rritigation Terrporary (�
Site 3 - Allowable P
Location and 6cerrpt, Allowable, allowable w/ F�rrranent (F) or
rritigation Terrporary (�
Site 3- Allowable (hand clearing) T
Location and Exerrpt, Allowable, allowable w/ F2rrranent (� or
rritigation Terrporary (�
Site 4- Allowable P
Location and 6cerrpt, Allowable, allowable w/ F�rrrenent (F) or
rrdigation Terrporary (�
6d. Stream name *
Collie Swamp
Collie Swamp
Collie Swamp
Collie Swamp
Collie Swamp
Collie Swamp
Collie Swamp
6e. Buffer mitigation 6f. Zone 1
required? * impact*
No 1,125
(square feet)
No 674
(square feet)
No 97
(square feet)
No 163
(square feet)
No 3,095
(square feet)
No 167
(square feet)
No 68
(square feet)
6g. Zone 2
impact*
726
(square feet)
798
(square feet)
0
(square feet)
108
(square feet)
1,782
(square feet)
113
(square feet)
35
(square feet)

Site 4- Allowable (hand clearing) T Collie Swamp No 145 128
Location and Exerrpt, Allowable, allowable w/ F2rrranent (� or (square feet) (square feet)
rritigation Terrporary (�
6h. Total buffer impacts:
Temporary impacts
Permanent impacts:
Total buffer impacts:
6i. Comments:
Zone 1
1,246.00
Zone 1
4,288.00
Zone 1
5,534.00
Zone 2
1,147.00
Zone 2
2,543.00
Zone 2
3,690.00
Hand cleared areas will remain vegetated. These areas will be trimmed back to improve conditions for managing
temporary erosion control measures.
� NCDOT is proposing to restore the old cause way fill to an adjacent wetland elevation and plant wetland tree
species. This will restore approximately 2,196 sq.ft in zone 1 buffer and 1,726 sq. ft. in zone 2 buffer.
Supporting Documentation - i.e. Impact Maps, Plan Sheet, etc.
C1ick the upload button or drag and drop files here to attach docurrent
B5503_Permit Package Buffer_20180619.pdf
Fle rrust be FDF
E. Impact Justification and Mitigation
1. Avoidance and Minimization
1.19M6
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:*
The project was reviewed during design for avoidance and minimization. The bridge realignment was established
using a curvature that would establish a safe movement through the curve, but would only extend the minimal
amount needed. This reduced v�tland fill from the shift north of the e�asting curve. The side slopes on the fill
section are set at a 2:1 ratio in an effort to reduce wetland impact. The new bridge is longer and only comprised of
3 spans (2 interior bents), which opens up the floodway of Collie Swamp and helps restore some the natural
hydraulic flow regime. The new bridge has eliminated deck drains and carries the storm water outside of the buffer
zones to establish a vegetated conveyance and provide treatment. The design incorporates the removal of the old
causeway fill to an adjacent wetland elevation, which will restore approximately 0.46 acres of wetlands.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:*
This bridge will be built using top down construction, which eliminates the need for a v�rork bridge. The project is
being built under a road closure, utilizing and off-site detour. The project will have an approved erosion control
plan that will be installed and maintained during the construction process.
2. Compensatory Mitigation for Impacts to Waters of the U.S. or Waters of the State
2a. Does the project require Compensatory Mitigation for impacts to Waters of the U.S. or Waters of the State?
�' Yes
l" No
2c. If yes, mitigation is required by (check all that apply):
r DWR
rJ Corps
2d. If yes, which mitigation option(s) will be used for this project?
r Mitigation bank r Payment to in-lieu fee program rJ Permittee Responsible Mitigation

5. Complete if Using a Permittee Responsible Mitigation Plan
5a. If using a permittee responsible mitigation plan, provide a description of the proposed mitigation plan including mitigation credits
generated.
Project proposes to restore 0.46 acres of old causeway approach fill, by removing the grade down to an adjacent
wetland elevation, established in the field. The wetland elevation establishment will be done through coordination
with the USACOE field representative. NCDOT will then plant wetland woody species to include Bald Cyprus,
Green Ash, and Swamp Black Gum. These plants will then be monitored for success during a three year time
period. A yearly report will be generated and reported to the regulatory agencies for review.
5b. Mitigation Plan Upload
Qick the upload button or drag and drop files here to attach docurr�nt
I B-5503 wetland_mitigation_planting.pdf
Fle type rrust be pdf
839.34KB
F. Stormwater Management and Diffuse Flow Plan (required by DWR)
""� Recent changes to the stormwater rules have required updates to this section .*"'
1. Diffuse Flow Plan
1a. Does the project include or is it adjacent to protected riparian buffers identified within one of the NC Riparian Buffer Protection
Rules?
C•' Yes �' No
1b. All buffer impacts and high ground impacts require diffuse flow or other form of stormwater treatment. If the project is subject to a
state implemented riparian buffer protection program, include a plan that fully documents how diffuse flow will be maintained.
All Stormwater Control Measures (SCM)s must be designed in accordance with the NC Stormwater Design Manual. Associated
supplement forms and other documentation shall be provided.
What type of SCM are you providing?
r Level Spreader
fJ Vegetated Conveyance (lower SMNT)
r Wetland Swale (higher SM/Vf)
� Other SCM that removes minimum 30% nitrogen
(check all that apply)
For a list of options to meet the diffuse flow requirements, click here.
Diffus Flow Documentation
C7ick the upload button or drag and drop files here to attach docurrent
Fle type rrust be Ft7F
2. Stormwater Management Plan
2a. Is this a NCDOT project subject to compliance with NCDOT's Individual NPDES permit NCS000250?*
C� Yes C' No
G. Supplementary Information
1. Environmental Documentation
1a. Does the project involve an expenditure of public (federal/state/local) funds or the use of public (federal/state) land?*
�' Yes l" No
1b. If you answered "yes" to the above, does the project require preparation of an environmental document pursuant to the
requirements of the National or State (North Carolina) Environmental PolicyAct (NEPA/SEPA)?*

r Yes r No
Comments:*
This project qualifies under the category of preapproved actions with a CE document. Therefore a separate NEPA
document is not required.
2. Violations (DWR Requirement)
2a. Is the site in violation of DWR Water Quality Certification Rules (15A NCAC 2H .0500), Isolated Wetland Rules (15A NCAC 2H .1300), or
DWR Surface Water or Wetland Standards or Riparian Buffer Rules (15A NCAC 2B .0200)? *
C' Yes C•' No
2b. Is this an after-the-fact permit application?*
C' Yes �' No
3. Cumulative Impacts (DWR Requirement)
3a. Will this project (based on past and reasonably anticipated future impacts) result in additional development, which could impact
nearby downstream water qualit�i?*
C' Yes �' No
3b. If you answered "no," provide a short narrative description.
I Project is replacing an e�asting structure and maintaining the same level of service.
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project? *
C' Yes C' No �' f�UA
5. Endangered Species and Designated Critical Habitat (Corps Requirement)
5a. Will this project occur in or near an area with federally protected species or habitat?*
C� Yes l" No
5b. Have you checked with the USFWS concerning Endangered Species Act impacts?*
r Yes �' No
5c. If yes, indicate the USFWS Field Office you have contacted.
Raleigh
5d. Is another Federal agency involved?*
C' Yes C•' No
Se. Is this a DOT project located within Division's 1-8?*
C' Yes C' No
�' Unknown
Sj. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?
USFWS - County List for Martin County
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as an Essential Fish Habitat?*
C' Yes C•' No
6b. What data sources did you use to determine whether your site would impact an Essential Fish Habitat?*
NMFS - EFH list

7. Historic or Prehistoric Cultural Resources (Corps Requirement)
Link to the State Historic Preservation Office Historic Properties Map (does not include archaeological data: http://gis.ncdcr.gov/hpoweb/
7a. Will this project occur in or near an area that the state, federal or tribal governments have designated as having historic or cultural
preservation status (e.g., National Historic Trust designation or properties significant in North Carolina history and archaeology)? *
C' Yes �' No
7b. What data sources did you use to determine whether your site would impact historic or archeological resources? *
SHPO review and clearance
7c. Historic or Prehistoric Information Upload
C7ickthe upload button or drag and drop files here to attach docurrent
B5503_Arch Re port_NoSrvyReqd . pdf
B5503_HistArch Re port_NoSrvyReq d. pdf
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8. Flood Zone Designation (Corps Requirement)
Link to the FEMA Floodplain Maps: https://msc.fema.gov/portal/search
8a. Will this project occur in a FEMA-designated 100-year floodplain?*
C� Yes �' No
8b. If yes, explain how project meets FEMA requirements:
I Project has been designed and reviev�d by professional hydraulic engineers
8c. What source(s) did you use to make the floodplain determination?*
FEMAfloodplain maps
Miscellaneous
7.78M6
2.59M6
Miscellaneous attachments not previously requested.
C7ick the upload button or drag and drop files here to attach docurrent
multibridge 01302015_WRC.pdf 118.68KB
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Signature
rJ By checking the box and signing below, I certify that:
■ I have given true, accurate, and complete information on this form;
■ I agree that submission of this PCN form is a"transaction" subject to Chapter 66, Article 40 of the NC General Statutes (the "Uniform Electronic
Transactions AcY');
■ 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');
■ 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 PCN form.
Full Name:*
Clay Willis
Signature
��.l.�.r� ��lr{f

Date Submitted:
6/21 /2018
Initial Review
Is this project a public transportation project? *(')
r Yes C' No
Change only if needed.
� Has this project met the requirements for acceptance in to the review process?*
r Yes
C' No
BIMS # Assigned*
20180865
Version#*
1
Reviewing Office *
Washington Regional Office - [phone]
Select Project Reviewer*
Garcy Ward:eads\gpward
Is a payment required for this project?*
f No payment required
C� Fee received
C' Fee needed - send electronic notification