20210034 Ver 2_401 Application_20211103

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NORTH CARO.INA
Staff Review Form
Envlmnm¢ntrtl Qvofiry
Updated September2020
Staff Review
Does this application have all the attachments needed to accept it into the review process?*
Yes No
ID#* Version* 2
20210034
Is this project a public transportation project?* Yes
No
Is this a DOT Yes No
project?*
Reviewer List:* Donna Hood:eads\drhood
Select Reviewing Office:* Mooresville Regional Office-[phone]
Does this project require a request for payment to be sent?*
Yes
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:* 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
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:
Pre-filing Info.pdf 201.38KB
Date for Meeting Request 11/3/2021
ID# 20210034 Version 2
Project Contact Information
Name: Kristi Lynn Carpenter for Andre Lennon P.E.
Who is submitting the information?
Email Address: [e-mail]
Project Information
Existing ID#: Existing Version:
20210034 2
20170001(no dashes) 1
Project Name: TPB City of Hickory-Startown/Robinson Road Connectors
Is this a public transportation project?
Yes
No
Is the project located within a NC DCM Area of Environmental Concern (AEC)?
Yes No Unknown
TIP#: WBS#:
(Applies to DOT projects only)

County(ies)
Catawba
Please upload all files that need to be submited.
Click the upload button or drag and drop files here to attach document
Cover letter 2nd Submittal to DWR.pdf 5.21 MB
Only pdf or kmz files are accepted.
Describe the attachments or
comments:
Original submission received via email.
Sign and Submit
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:
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Submittal Date: Is filled in automatically.