20210451 Ver 1_More Information Received_20210607

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
20210451
Is this project a public transportation project?* (' Yes
r No
Is this a DOT ( Yes C No
project?*
Reviewer List:* Ryan Conchilla:eads\rjconchilla
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
r Pre-Application Submittal
✓ 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: Jerry Parker
Who is submitting the inforrration?
Email Address: [e-mail]
Project Information
Existing ID#: Existing Version:
20210451 1
20170001(no dashes) 1
Project Name: Gatewood Rd Bridge Removal
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#:
17BP.7.R.130
(Applies to DOT projects only)
County(ies)
Caswell
Please upload all files that need to be submited.
Click the upload button or drag and drop files here to attach docurrent
Only pdf or krrz files are accepted.
Describe the attachments
or comments:

"Excavation and temporary fill shall NOT be allowed within wetlands unless specifically identified in the permit.
For areas permitted for temporary fill in wetlands,the Contractor shall completely remove temporary fill and
restore the affected area to the pre-project conditions upon completion of the construction activity. For the
permitted areas for excavation in the wetlands associated with bridge demolition, Contractor shall restore the
affected areas to natural/pre-project conditions upon completion of the construction activity.After restoration
to the natural/pre-project conditions,all temporarily disturbed areas within wetlands shall be planted with
appropriate plant species."
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: 15ICAV OoBAA
Submittal Date: Is filled in autorretically.