20201028 Ver 1_401 Application_20200810

Staff Review Form
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En vironmenfrr!QvoGry
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
20201028
Is this project a public transportation project?* (' Yes
r No
Is this a DOT ( Yes C No
project?*
Reviewer List:* Garcy Ward:eads\gpward
Select Reviewing Office:* Washington Regional Office-[phone]
Does this project require a request for payment to be sent?*
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
✓ Pre-Application Submittal r More Information Response
✓ Other Agency Comments r Stream or Buffer Appeal
r 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: Steve Trowell
Who is submitting the information?
Email Address: [e-mail]
Project Information
......................................................................................................................................................................................................................................................................................................................................................................................................
Project Name: Pipe Replacement HWY 264 Ponzer Hyde County
Is this a public transportation project?
(' Yes
✓ No
Is the project located within a NC DCM Area of Environmental Concern (AEC)?
✓ Yes r No ( Unknown
TIP#: WBS#:
1.204811
(Applies to DOT projects only)
...............................................................
County(ies)
Hyde
Please upload all files that need to be submited.
Oick the upload button or drag and drop files here to attach document
Topo HWY 264 Ponzer- Hyde.pdf 1.05MB
Only pdf or krry files are accepted.
Describe the attachments
or comments:

This is a courtesy notification that NCDOT will be replacing a pipe in a jurisdictional area in Hyde County
under Nationwide Permit 3 conditions. Location is on a UT to Queen Creek off the Pungo River, Stream Index
no. 29-34-15.
Existing 24"x36' RCP is to be replaced with a 30"x36'CAP at N 35.573891°,W-76.46200192.
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:
al_JCaX.
Submittal Date: Is filled in automatically.