20190188 Ver 3_401 Application_20211003

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* 3
20190188
Is this project a public transportation project?* (' Yes
r No
Is this a DOT ( Yes C No
project?*
Reviewer List:* Rob Ridings:eads\rgridings
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)
✓ 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
Pre-Filing Meeting Information
Pre-Filing meeting request information is not needed for this project.
Project Contact Information
.......................................................................................................................................................................................................................................................................................................................................................................................................
Name: Byron G. Bateman
Who is submitting the information?
Email Address: [e-mail]
Project Information
.............................................................................................................................................................................................................................................................................................................................................................................................
Existing ID#: Existing Version:
20190188 1
20170001(no dashes) 1
Project Name: W-5600 US 70 Widening (less than 1 acre)
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 r Unknown
TIP#: WBS#:
W-5600 50056.3.1
(Applies to DOT projects only)
County(ies)
Johnston
Please upload all files that need to be submited.

Click the upload button or drag and drop files here to attach document
DMS W-5600- Division 4-STR-RW-Buffer-NS
116.08KB
01.pdf
Final W-5600 permit.pdf 37.31MB
WETLANDS SR3 SITE 6 9-2-21.pdf 306.6KB
W5600_DWR Scoping Comments.pdf 262.3KB
W-5600(DIV_4)debitBensonGrove Mitigation.pdf 170.2KB
W-5600_Jeffreys_Warehouse_Div4 Mitigation .pdf 213.22KB
Only pdf or krrz files are accepted.
Describe the attachments
or comments:
The purpose of this notification is to request an after the fact modification of an existing permit for new
impacts totaling less than 1 acre. Included with this application are:The original project scoping document,
the original 404/401 Permit, updated Permit Drawings showing the location and extent of impacts at Site 6 that
were not previously permitted,the original DMS Acceptance letter,and the DMS debit ledger for the additional
impacts totaling .46 acres of riparian wetlands.This request reflects an agreement reached on or about
September 9,2021 between NCDOT Staff(Chad Coggins),the US Army Corps of Engineers(Tom Steffens),
and NCDENR(Rob Ridings).
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:
Submittal Date: 9/21/21
Is filled in automatically.