20210940 Ver 1_More Information Received_20210823

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
20210940
Is this project a public transportation project?* (' Yes
r No
Is this a DOT ( Yes C No
project?*
Reviewer List:* Robert Patterson:eads\rdpatterson
Select Reviewing Office:* Wilmington 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: Mason Herndon
Who is submitting the inforrration?
Email Address: [e-mail]
Project Information
Existing ID#: Existing Version:
20210940 1
20170001(no dashes) 1
Project Name: B-5621 replacement of Bridge 248 over Six Runs Creek on SR 1904
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#:
B-5621 45576.1.1
(Applies to DOT projects only)
County(ies)
Sampson
Please upload all files that need to be submited.
Click the upload button or drag and drop files here to attach docurrent
B5621_Permit Drawing_20210823.pdf 3.35MB
Only pdf or krrz files are accepted.
Describe the attachments
or comments:

This project was submitted as a courtesy notification and approved on 5/17/2021.The USACE No. is SAW-
2016-00624. In review of the construction plans and permit drawings, a discrepancy was identified in the area
of the proposed rock embankment between 26+75 and 28+25 LT.The attached permit drawings have been
revised to match the construction plans.This revision decreases the overall permanent wetland impacts by
0.005 acres.These revised permit drawings and impact summary sheet are being provided for you records.
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: / 7/
Submittal Date: Is filled in autorratically.