20200142 Ver 5_401 Application_20211216

Staff Review Form
NORTH CAROLINA
Envlronm¢ntcl Qvofiry
Updated September 4, 2020
Staff Review
Does this application have all the attachments needed to accept it into the review process?*
Yes No
ID# *
20200142
Version* 1
Is this project a public transportation project?*
Is this a DOT
project? *
Yes No
Reviewer List: * Garcy Ward:eads\gpward
Select Reviewing Office:*
Yes
No
Washington 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
Project Contact Information
Name: Jay Johnson
Who is submitting the information?
Email Address: [e-mail]
Project Information
Existing ID #:
20200142
20170001 (no dashes)
Project Name: Maple Cypress
Is this a public transportation project?
Yes
No
Existing Version:
1
Is the project located within a NC DCM Area of Environmental Concern (AEC)?
Yes No Unknown
TIP#: WBS#:
B4484 33723.3.1
(Applies to DOT projects only)
County (ies)
Craven
Please upload all files that need to be submited.
Click the upload button or drag and drop files here to attach document
C204434 Overflow Barge Use Narrative.pdf 179.43KB
C204434 Craven - Barge Locations - Overflow Work
329.94KB
Bridge.pdf
SKM_364e21121516130.pdf 36.45KB
Only pdf or kmz files are accepted.

Describe the attachments or
comments:
Please find attached the permit modification request for the barge placements on B4484 - Maple Cypress
bridge.
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:
Submittal Date: Is filled in automatically.