20211478 Ver 1_401 Application_20211008

Staff Review
Does this application have all the attachments needed to accept it into the review process?*
r Yes r No
ID#*
20211478
Version* 1
Is this project a public transportation project?* r Yes
r No
Reviewer List:* Colleen Cohn:eads\cmcohn
Select Reviewing Office:* Raleigh Regional Office - [phone]
Submittal Type:* 401 Application
Does this project require a request for payment to be sent?*
r
Yes
r
No
How much is r $240.00
owed?* r $570.00

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
r
More Information Response
r
Other Agency Comments
r
Pre -Application Submittal
r
Re-Issuance\Renewal Request
r
Stream or Buffer Appeal
Pre -Filing Meeting Information
Before submitting this form please ensure you have submitted the Pre -Filing Meeting Request Form as we will not
be able to accept your application without this important first step. The Pre -Filing Meeting Request Form is used in
accordance with 40 C.F.R. Section 121.4(a) "At least 30 days prior to submitting a certification request, the project
proponent shall request a pre -filing meeting with the certifying agency" and in accordance with 40 C.F.R. Section
121.5(b)(7), and (c)(5) all certification requests shall include documentation that a pre -filing meeting request was
submitted to the certifying authority at least 30 days prior to submitting the certification request. Click here to read
more information on when this form is needed prior to application submission or here to view the form.
Attach documentation of Pre -Filing Meeting Request here:
DWR Pre -Filing Meeting Request Form (26) (2).pdf 49.58KB
Date for Meeting Request 8/31/2021
I D#
Project Contact Information
Name: Ian McMillan
who is subrritting the information?
Email Address: [e-mail]
Project Information
Project Name: Oasis Church
Is this a public transportation project?
r Yes
r No
Version
Is the project located within a NC DCM Area of Environmental Concern (AEC)?
r Yes r No r Unknown
County (ies)
Wake
Please upload all files that need to be submited.

click the upload button or drag and drop files here to attach document
Pre -Construction Notification (PCN) Form (10)
154.2KB
(1).pdf
Neu -Con SOA - Blackbird - Oasis Church (3) (1).pdf
142.08KB
02 - Oasis Church PCN Cover Letter Final (1).pdf
143.47KB
03 - 2-signed AGENT AUTHORIZATION FORM for
191.37KB
2018.27 (1).pdf
04 - Figure 1 - 1828 USGS (1).pdf
2.21 MB
05 - Figure 2 - 1828 Soils (1).pdf
2.34MB
06 - Figure 3-PJD Sketch Map (2).pdf
679.27KB
07 - Figure4 - SHPO (1).pdf
286.46KB
08 - NHP Report - Oasis Church 09-20-2021 (1).pdf
1011.83KB
09 - Oasis Church Enviro Impact Maps Set-2nd
2.33M6
Submittal (1) (4).pdf
10-
ORM_Upload_Sheet_Consolidated_NWPR_202006... 30.49KB
(2021.052) (8).xISm- Impacts (1).pdf
11 - USACE PJD approval email for 1828 Ralph
186.75KB
Stevens Road Submittal (2).pdf
12-NCDWR Buffer Determination Letter (NBRRO
3.95MB
#19-253) for 1825 Ralph Stephens Road Site (1).pdf
Only pdf or krm files are accepted
Describe the attachments
or comments:
Pre -construction Notification (PCN) Application Form
PCN Cover Letter
Agent Authorization Form
Figure 1-USGS Site Vicinity Map
Figure 2-Soil Survey Site Vicinity Map
Figure 3-PJD Wetland Sketch Map
Figure 4-NCSHPO Map
NCNHP Database Report
Impact Map
USACE ORM Spreadsheet
USACE PJD Approval email
NCDWR Buffer Determination Letter
Mitigation Credits Statement of Availability
Sign and Submit
V 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');
■ 1 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: Is filled in autorratically.