20201066 Ver 1_401 Application_20200818

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
20201066
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 Projectw Existing ID
r Pre-Application Submittal r More Information Response
r Other Agency Comments r Stream or Buffer Appeal
a 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 inforrration?
Email Address: [e-mail]
Project Information
Project Name: Pipe Replacement SR 1333 Mount Carmel Road Northampton County
Is this a public transportation project?
(' Yes
r No
Is the project located within a NC DCM Area of Environmental Concern (AEC)?
r Yes a No r Unknown
TIP#: WBS#:
1.206611
(Applies to DOT projects only)
County(ies)
Northampton
Please upload all files that need to be submited.
Click the upload button or drag and drop files here to attach document
Topo SR 1333 Mount Carmel Road Pipe
1.3MB
Replacement Northampton.pdf
Only pdf or krrz files are accepted.
Describe the attachments
or comments:

This is a courtesy notification that NCDOTwill be replacing a pipe in a jurisdictional area in Northampton
County under Nationwide Permit 3 conditions. Location is on a UT to Courderoy Swamp, Stream Index 25-4-4-
1, Chowan River Basin.
Existing 36"x 42"x 45'CMP will be replaced by a 48"x 45'CAP at N 36.461371°,-77.390412°.
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 automatically.