20141271 Ver 4_Modification Request_20201009

Staff Review Form Is
Updated September
Staff Review
Does this application have all the attachments needed to accept it into the review process?*
r Yes r No
ID#* Version* 4
20141271
Is this project a public transportation project?* r Yes
r No
Is this a DOT r Yes r No
project?*
Reviewer List:* Donna Hood:eads\drhood
Select Reviewing Office:* Mooresville Regional Office-[phone]
Does this project require a request for payment to be sent?
r
Yes
r
No
How much is r $240.00
owed?* r $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 For the Record Only(Courtesy Copy)
r New Project
r Modification/New Project with Existing ID
r More Information Response
r Other Agency Comments
r Pre-Application Submittal
r Re-Issuance\Renewal Request
r Stream or Buffer Appeal
Pre-Filing Meeting Information
Pre-Filing meeting request information is not needed for this project.
Project Contact Information
.......................................................................................................................................................................................................................................................................................................................................................................................................
Name: Sue Hyde
Who is subrritting the inforrration?
Email Address: [e-mail]
Project Information
...............................................................................................................................................................................................................................................
Existing ID#: Existing Version:
20141271 4
20170001(no dashes) 1
Project Name: Derita Road Widening U-4910
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#: WBS#:
(Applies to DOT projects only)
County(ies)
Cabarrus
Please upload all files that need to be submited.
Oickthe upload button or drag and drop files here to attach document
U-4910AB Rocky River Bank Stabilization-Mod
802.55KB
2020.08.20.pdf
Only pdf or krre files are accepted.

Describe the attachments
or comments:
Request is to add 45'of additional bank stabilization.
Sign and Submit
.......................................................................................................................................................................................................................................................................................................................................................................................................
P By checking the box and signing box below, I certifythat:
■ I,the project proponent, hereby certifies that all information contained herein is true,accurate, and complete to
the best of my knowledge and belief.
■ I,the project proponent, hereby requests that the certifying authority review and take action on this CWA 401
certification request within the applicable reasonable period of time.
■ I agree that submission of this online form is a"transaction"subject to Chapter 66,Article 40 of the NC General
Statutes(the"Uniform Electronic Transactions Act");
■ 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");
■ 1 understand that an electronic signature has the same legal effect and can be enforced in the same way as a
written signature;AND
■ I intend to electronically sign and submit the online form.
Signature:
1 67
Submittal Date: Is filled in autonatically.