20201018 Ver 1_401 Application_20200807

Staff Review Form
NORFH CA.,i0:INA
Environmenfrr!QvoGly
Updated April 10,2018
Staff Review
Does this application have all the attachments needed to accept it into the review process?*
6* Yes r No
ID#* Version* 1
20201018
Is this project a public transportation project?* (' Yes
r No
Is this a DOT r Yes 6' No
project?*
Reviewer List:* Rob Ridings:eads\rgridings
Select Reviewing Office:* Central Office-[phone]
Submittal Type:* 401 Application
Does this project require a request for payment to be sent?*
Yes
C'
No
How much is r $240.00
owed?* (' $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:* r New Project r New Projectw Existing ID
✓ Pre-Application Submittal r More Information Response
✓ Other Agency Comments r Stream or Buffer Appeal
✓ For the Record Only(Courtesy
Copy)
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.
Project Contact Information
......................................................................................................................................................................................................................................................................................................................................................................................................
Name: Kristi Lynn Carpenter for Jason Hartshorn
Who is submitting the information?
Email Address: [e-mail]
Project Information
......................................................................................................................................................................................................................................................................................................................................................................................................
Project Name: Holly Springs Road Widening Phase II
Is this a public transportation project?
(' Yes
✓ No
Is the project located within a NC DCM Area of Environmental Concern (AEC)?
✓ Yes r No 6* Unknown
TIP#: WBS#:
(Applies to DOT projects only)
...............................................................................................................................................................................................................................................................................................................................
County(ies)
Wake
Please upload all files that need to be submited.
Oick the upload button or drag and drop files here to attach docunrent
Holly_Springs_Road_Widening_PHII_IP_Application... 13.21MB
Holly_Springs_Road_Widening_PHII_IP Application... 13.21MB
Holly_Springs_Road_Widening_PHII_Plans_(full_se... 36.64MB
Only pdf or krre files are accepted.
Describe the attachments
or comments:
Original submission via email.

Sign and Submit
fJ 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: Is filled in autorretically.