20190591 Ver 2_Re-Issuance_Renewal Request_20210316 (2)

Staff Review Form
NORFH CA.,i0:INA
Environmenfrr!QvoGly
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* 2
20190591 20190591
Is this project a public transportation project?* (' Yes
r No
Is this a DOT ( Yes C No
project?*
Reviewer List:* Rob Ridings:eads\rgridings
Select Reviewing Office:* Central 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
✓ Pre-Application Submittal
6 Re-Issuance\Renewal Request
r 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:
NCDWR memo for B-5980.pdf 5.08MB
Date for Meeting Request 12/28/2017
ID# Version
Project Contact Information
Name: Chad Coggins
Who is submitting the inforrration?
Email Address: [e-mail]
Project Information
Existing ID#: Existing Version:
20190591 20190591 1
20170001(no dashes) 1
Project Name: B-5980
Is this a public transportation project?
(' Yes
✓ No
Is the project located within a NC DCM Area of Environmental Concern (AEC)?
✓ Yes r No r Unknown

TIP#: WBS#:
B-5980 47617.1.1 47617.1.1
(Applies to DOT projects only)
County(ies)
Nash
Please upload all files that need to be submited.
Dick the upload button or drag and drop files here to attach document
B-5980 Permit.pdf 10.86MB
Only pdf or krrz files are accepted.
Describe the attachments
or comments:
Action ID SAW-2019-00365 GP 31 expired April 30 2020 needs to be issued. It appears this project would
easily fit into new GP50. LET date is June 2021.
Sign and Submit
.......................................................................................................................................................................................................................................................................................................................................................................................................
17 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:
CAS
Submittal Date: Is filled in automatically.