20211834 Ver 1_401 Application_20211217

Staff Review Form
NORTH CAROLINA
Ertrlmnmertlrtl Quality
Updated September 4, 2020
Staff Review
Does this application have all the attachments needed to accept it into the review process?*
Yes No
ID# *
20211834
Version* 1
Is this project a public transportation project?*
Is this a DOT
project? *
Reviewer List:*
Select Reviewing Office: *
Submittal Type:*
Yes No
Yes
No
Dave Wanucha:eads\djwanucha
Winston-Salem Regional Office - [phone]
401 Application
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: Amy Euliss
Who is submitting the information?
Email Address: [e-mail]
Project Information
Project Name: Sheek Street Upgrade
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#:
49748
(Applies to DOT projects only)
County (ies)
Davie

Please upload all files that need to be submited.
Click the upload button or drag and drop files here to attach document
Sheek Street cover letter.pdf 179.42KB
Sheek Street PCN.pdf 493.66KB
Accept_Sheek St Ext_Div 9.pdf 208.71 KB
Sheek Street Permit Plans.pdf 1.59MB
Sheek Street_HYD_SMP_20211116.pdf 124.76KB
Sheek Street Historic Architecture NSR.pdf 494.92KB
Sheek Street No Archaeological Survey Required.pdf 2.51 MB
Tribal Coordination Sheek Street.pdf 618.43KB
Sheek St Tribal Response.pdf 468.98KB
Sheek street location map.pdf 429.47KB
DMP 200229 - V3 - Liberty Storage Solutions - Site
3.42MB
and Utility Plan.pdf
Only pdf or kmz files are accepted.
Describe the attachments or
comments:
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: December 17, 2021
Is filled in automatically.