20200174 Ver 2_401 Application_20201030

Project Submittal Interim Form
NORTH CAROLINA
Ererfronentnte Quality
Updated September 4,2020
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)
✓ New Project
✓ Modification/New Project with Existing ID
✓ More Information Response
✓ Other Agency Comments
✓ Pre-Application Submittal
r Re-Issuance\Renewal Request
✓ Stream or Buffer Appeal
Pre-Filing Meeting Information
Before submitting this form please ensure you have submitted the Pre-Filing Meeting Request Form as we will not
be able to accept your application without this important first step.The Pre-Filing Meeting Request Form is used in
accordance with 40 C.F.R. Section 121.4(a)"At least 30 days prior to submitting a certification request,the project
proponent shall request a pre-filing meeting with the certifying agency"and in accordance with 40 C.F.R. Section
121.5(b)(7),and (c)(5)all certification requests shall include documentation that a pre-filing meeting request was
submitted to the certifying authority at least 30 days prior to submitting the certification request.Click here to read
more information on when this form is needed prior to application submission or here to view the form.
Attach documentation of Pre-Filing Meeting Request here:* DWR Pre-
Filing
Meeting
56.2K..
Request
Form
(002).pdf
Date for Meeting Request* 9/30/2020
ID# 20200174 Version 2
Project Contact Information
Name: Philip S. Harris III, P.E., CPM
\A io is submitting the inforrration?
Email Address:* [e-mail]
Project Information

Existing ID#:* Existing Version:*
20200174 2
20170001(no dashes) 1
Project Name:* Replacement of Bridge No.82 over Burnt Coat Creek on NC 11 /NC 111
Is this a public transportation project?*
✓ Yes
f No
Is this a DOT project?*
( Yes
✓ No
Is the project located within a NC DCM Area of Environmental Concern (AEC)?*
✓ Yes C' No r Unknown
TIP#: WBS#:
B-5534 55034.1.1
(Applies to DOT projects only)
County(ies)*
Duplin
Please upload all files that need to be submited.
Dick the upload button or drag and drop files here to attach docunent
Only pdf or Ivar files are accepted.
Describe the attachments or add comments:
This is a request for the previously issued a GP 31 (expired 4/30/2020)and NW12(still valid). Please
reference USACE Action ID: SAW-2015-00993 issued 3/6/2020 and DWR 20200174 issued on 3/6/2020.
The previously issued permits can be found at
https://xfer.services.ncdot.gov/pdea/Permissued/B-
5534%20General_Nationwide%20Duplin%20March%206%202020.pdf
Review of T&E species found May Affect, Not Likely to Adversely Affect for wood stork and No Effect for red-
cockaded woodpecker. No bald eagles or nests were found during surveys. NCDOT is coordinating with the
U.S. Fish and Wildlife Service to extend programmatic consideration for the northern long-eared bat.
We are hereby requesting a reissuance of these permits as a GP 50 and NW 12.
* I By checking the box and signing box below, I certify that:
• 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");
• I 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:
fl C- 467,44441 /J/
Submittal Date: Is filled in automatically once submitted.