20210869 Ver 1_More Information Received_20210430

Staff Review Form •
NORFH CA.,i0:INA
En vironmenfrr!QvoGry
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
20210869
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
r Re-Issuance\Renewal Request
✓ Stream or Buffer Appeal
Is this supplemental information that needs to be sent to the Corps?*
Yes r No
Project Contact Information
Name: Paul Williams
Who is submitting the inforrration?
Email Address: [e-mail]
Project Information
Existing ID#: Existing Version:
20210869 1
20170001(no dashes) 1
Project Name: Chowan 3 Replacement Project
Is this a public transportation project?
(' Yes
r No
Is the project located within a NC DCM Area of Environmental Concern (AEC)?
r Yes r No r Unknown
TIP#: WBS#:
17BP.1.R.91
(Applies to DOT projects only)
County(ies)
Chowan
Please upload all files that need to be submited.
Click the upload button or drag and drop files here to attach docurrent
2021-193-77.pdf 253.09KB
Only pdf or krrz files are accepted.
Describe the attachments
or comments:
Tribal Coordination Letter attached per US Army Corps of Engineers request.

Sign and Submit
fJ 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:
cST} alC.��'lrrdlY/rRm .rf
Submittal Date: Is filled in automatically.