20210812 Ver 1_401 Application_20210419

STATE
Staff Review Form
NORTH CAROLINA
£nWrcnmenrcl Qua fay
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
20210812
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: Paul Williams
Who is submitting the inforrration?
Email Address: pcwilliams2©ncdot.gov
Project Information
Project Name: Northampton Bridge 13 Replacement Project
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#:
17BP.1.R.92
(Applies to DOT projects only)
County(ies)
Northampton
Please upload all files that need to be submited.
Click the upload button or drag and drop files here to attach document
17BP.1.R.92_Permit Drawings_08.21.19.pdf 738.19KB
SAW-2016-01758 NCDOT B-5502 Branches Bridge
259.22KB
Road PJD.pdf
SAW-2016-01758 NCDOT B-5502 Branches Bridge
222.02KB
Road signed PJD.pdf
Section 10 Email.pdf 115.15KB
17BP.1.R.92_Preliminary_JD_010719.pdf 23.52MB
NH 13 Topo.pdf 528.7KB
Only pdf or krre files are accepted.
Describe the attachments
or comments:

Bridge 13(155'long)in Northampton County will be replaced on the existing alignment with a 168' long bridge
over the Meherrin River.The existing bridge was built in 1976 as is Structural Deficient.The project will result
in no jurisdictional wetland impacts and no jurisdictional stream impacts.The Meherrin River is not listed as
Section 10 waters at this location.The bridge will not have deck drains. Storm water will be conveyed through
2 DI's on the west end of the bridge and discharged into vegetated areas near the west bank of the river.All
as shown in the attached permit drawings.
Sign and Submit
.......................................................................................................................................................................................................................................................................................................................................................................................................
117 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:
c rru/C r//rr Ill/44/mt.
Submittal Date: Is filled in autorretically.