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Home My WebLink About20211606 Ver 1_401 Application_20211102 o 0 vim. 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* 1 20211606 Is this project a public transportation project?* Yes No Is this a DOT Yes No project?* Reviewer List:* Garcy Ward:eads\gpward Select Reviewing Office:* Washington Regional Office-(252)946-6481 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 Project Contact Information ............................................................................................................................................................................................................................................................................................................................................................ Name: Steve Trowell Who is submitting the information? Email Address: sjtrowell@ncdot.gov Project Information ...................................................................................................................................................................................................................................................................................................................................................................................................... Project Name: Pipe Replacement SR 1541 Burnt Bridges Road 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) Northampton Please upload all files that need to be submited. Click the upload button or drag and drop files here to attach document Permit Topo Burnt Bridges Road Pipe Replacement 1001.67KB Northampton Co.pdf Only pdf or kmz files are accepted. Describe the attachments or comments: This is a courtesy notification that NCDOT will be replacing a culvert pipe in a jurisdictional stream under nationwide permit 3 conditions. Location is on a LIT to Panther Swamp stream Index no.25-4-8-5-1-1 with a surface water classification C;sw in the Chowan river basin. Existing(2) 18"x 40'CMP to be replaced with 42"x 40'CAP at N 36.4019,W-77.17351 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: Omwx- Submittalal Date: Is filled in automatically.