20181598 Ver 5_401 Application_20210617

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* 5
20181598
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
✓ Modification/New Project with Existing ID
✓ More Information Response
✓ Other Agency Comments
r Pre-Application Submittal
✓ Re-Issuance\Renewal Request
r Stream or Buffer Appeal
Pre-Filing Meeting Information
Pre-Filing meeting request information is not needed for this project.
Project Contact Information
.......................................................................................................................................................................................................................................................................................................................................................................................................
Name: Kristi Lynn Carpenter for Chris Rivenbark
Who is submitting the information?
Email Address: [e-mail]
Project Information
...........................................................................................................................................................................................................................................................
Existing ID#: Existing Version:
20181598 5
20170001(no dashes) 1
Project Name: US 70 Havelock Bypass(R-1015)
Is this a public transportation project?
a Yes
✓ No
Is the project located within a NC DCM Area of Environmental Concern (AEC)?
✓ Yes r No a Unknown
TIP#: WBS#:
R-1015 34360.1.2
(Applies to DOT projects only)
County(ies)
Craven
Please upload all files that need to be submited.
Oick the upload button or drag and drop files here to attach docurrent
R-1015 Individual Modification Craven May 28
12.5MB
2021.pdf
Only pdf or krrz files are accepted.

Describe the attachments
or comments:
Original Submitted via email.
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:
& rcfce',.eier. L:d,,c4n er?%t
Submittal Date: Is filled in autorretically.