20201140 Ver 1_401 Application_20200904

Staff Review Form •
NORFH CA.,i0:INA
En vironmenfrr!QvoGry
Updated September 4,2020
Staff Review
Does this application have all the attachments needed to accept it into the review process?*
6* Yes r No
ID#* Version* 1
20201140
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 For the Record Only(Courtesy Copy)
r New Project
r Modification/New Project with Existing ID
✓ More Information Response
✓ Other Agency Comments
r Pre-Application Submittal
✓ Re-Issuance\Renewal Request
✓ Stream or Buffer Appeal
Project Contact Information
Name: Steve Trowell
Who is submitting the inforrration?
Email Address: [e-mail]
Project Information
Project Name: Pipe Replacement SR 1227 South Mills Road Currituck
Is this a public transportation project?
r Yes
✓ No
Is the project located within a NC DCM Area of Environmental Concern (AEC)?
✓ Yes r No r Unknown
TIP#: WBS#:
1.2027111
(Applies to DOT projects only)
County(ies)
Currituck
Please upload all files that need to be submited.
Click the upload button or drag and drop files here to attach document
Topo SR 1227 South Mills Road Pipe replacement
1012.59KB
Currituck.pdf
Only pdf or kaz files are accepted.
Describe the attachments
or comments:
This is a courtesy notification that NCDOT will be replacing an existing culvert pipe in a jurisdictional area
under Nationwide Permit 3 conditions in Currituck County. Location is on SR 1227 South Mills Road at
36.521263,-76.216675, Moyock Run, Stream Index 30-1-2-2-1 in the Pasquotank River Basin.
Existing 80'x48"x 36"arch pipe.
Proposed 80'x 48"CAAP.
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.