20201554 Ver 1_Project Submittal Interim Form SR 1160 Thirty Foot Canal Washington Co_20201103

Proj ect Submittal In terim Form
Updated September 4, 2020
Please note: fields mark ed with a red asterisk * below are required. You will not be able to submit the form until all
mandatory questions are answered.
Proje ct Type :*
Name :
Email Addre ss:*
Proje ct Name :*
Is this a public transportation proje ct?*
Is this a DOT proje ct?*
Is the proje ct locate d within a NC DCM Are a of Env ironme ntal Conce rn (AEC)?*
TIP#:WBS#:
County (ie s)*
Ple ase upload all file s that ne e d to be submite d.
For the Record Only (Courtesy Copy)
New Project
Modification/New Project with Existing ID
More Information Response
Other Agency Comments
Pre-Application Submittal
Re-Issuance\Renewal Request
Stream or Buffer Appeal
Project Contact Information
Steve Trowell
Who is submitting the inf ormation?
[e-mail]
Project Information
Pipe Replacement SR 1160 Thirty Foot Canal Washington County
Yes
No
Yes
No
Yes No Unknown
1.209411
(Applies to DOT projects only)
Washington
De scribe the attachme nts or add comme nts:
*
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 :*
Submittal Date :
Click the upload button or drag and drop f iles here to attach document
Topo SR 1160 Thirty Foot Canal Road Pipe
Replacement Washington County.pdf
1.23MB
Only pdf or kmz f iles are accepted.
This is a courtesy notification that NCDOT will be replacing a pipe in a jurisdictional area in Washington
County under Nationwide Permit 3 conditions. Location is on UT to Thirty Foot canal, Stream Index no. 29-34-
40-9, in the Pasquotank river basin.
Existing (2) 24" x 60' CAP and Concrete will be replaced by (2) 24" x 60' CMP at N 35.838585, W -76.377941.
By checking the box and signing box below, I certify that:
Is f illed in automatically once submitted.