20191401 Ver 2_More Information Received_20200326

Staff Review
Does this application have all the attachments needed to accept it into the review process?
r Yes r No
ID#* Version* 1
20191401
Is this project a public transportation project?* r Yes
r No
Is this a DOT r Yes r No
project?*
Reviewer List:*
Select Reviewing Office:*
Rob Ridings:eads\rgridings
Central Office - [phone]
Does this project require a request for payment to be sent?*
r
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
New Project
r
New Project w Existing ID
r
Pre -Application Submittal
r
More Information Response
r
Other Agency Comments
r
For the Record Only (Courtesy Copy)
r
Stream or Buffer Appeal
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.
Other Agency Comments - Please check this if you are submitting comments on an existing project.
Is this supplemental information that needs to be sent to the Corps?*
r Yes r No
Project Contact Information
Name: NCDOT
VUio is subrritting the inforrration?
Email Address: [e-mail]
Project Information
Existing ID #: Existing Version:
20191401 1
20170001(no dashes)
Project Name: Bridge 22 over Town Creek on US 258
Is this a public transportation project?
r Yes
r No
Is the project located within a NC DCM Area of Environmental Concern (AEC)?
r Yes r No r Unknown
TIP#:
B-4931
County (ies)
Edgecombe
WBS#:
40134.1.1
(Applies to DOT projects only)
Please upload all files that need to be submited.

Oickthe upload button or drag and drop files here to attach document
B-4931_Environmental_Permit_Plans_20200317.pdf 3.22MB
Only pdt or Iv17 files are accepted.
Describe the attachments:
Revised permit drawings to include temporary impact for the removal of the existing concrete piers.
Sign and Submit
P 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 Act")
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 Act');
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 online form."
Signature:
Submittal Date: 03/26/2020
Is filled in autorratically.