20210853 Ver 1_401 Application_20210427

Staff Review Form
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
20210853
Is this project a public transportation project?*
Is this a DOT
project?*
Reviewer List:*
r Yes ( No
Select Reviewing Office:*
6. Yes
r No
Garcy Ward:eads\gpward
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)
✓ 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
Name: Nick Ingold
Who is submitting the information?
Email Address: [e-mail]
Project Information
Project Name: Driveway Pipe Replacement Shawboro Road Convience Site
Is this a public transportation project?
r Yes
o' No
Is the project located within a NC DCM Area of Environmental Concern (AEC)?
r Yes r No r Unknown
County (ies)
Currituck
Please upload all files that need to be submited.
Click the upload button or drag and drop files here to attach document
Topo Driveway Pipe Replacement NC 34 Shawboro
1.53MB
Road.pdf
Only pdf or kaz files are accepted.
Describe the attachments
or comments:
This is a courtesy notification that Currituck County staff will be replacing a driveway pipe in a jurisdictional
area in Currituck County under Nationwide Permit 3 conditions. Location is on a UT to Cowells Creek, Stream
Index 30-1-2-2-5-1-1, water quality classification C;Sw in the Pasquotank River Basin.
An existing metal pipe 60" x 50' will be replaced with (2) 48" x 60' CAP at N 36.433987°, W-76.088763°
Sign and Submit
rJ 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:
Submittal Date: Is filled in autorratically.

N
Driveway Pipe Replacement Shawboro Road Convience Site
NC HWY 34
Currituck County Quad Name: Currituck
Existing 60" x 50' MP
Proposed (2) 48" x 60' CAP
36.433987°
-76.088763°
NCDOT GIS Unitt
i-cubed.1
0 0.75 1.5 3 Miles