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Home My WebLink About20211856 Ver 1_401 Application_20211222 sy STAT Staff Review Form NORTH CAROLINA Envlronm¢ntcl Qvoray Updated September 4,2020 Staff Review Does this application have all the attachments needed to accept it into the review process?* Yes No ID#* Version* 1 20211856 Is this project a public transportation project?* Yes No Is this a DOT Yes No project?* Reviewer List:* Hannah Sprinkle:eads\hhsprinkle Select Reviewing Office:* Wilmington Regional Office-(910)796-7215 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: Mason Herndon Who is submitting the information? Email Address: tmherndon@ncdot.gov Project Information ...................................................................................................................................................................................................................................................................................................................................................................................................... Project Name: Bridge No.201 over Island Creek on SR 1946 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#: B-5641 45596.1.2 (Applies to DOT projects only) ......................................................................................................................................................................................................................................................................................................................................................... County(ies) Duplin Please upload all files that need to be submited. Click the upload button or drag and drop files here to attach document Duplin Bridge 201_B-5641 Courtesy 6.59MB Notification_signed.pdf Only pdf or kmz files are accepted. Describe the attachments or comments: Courtesy notification letter,vicinity map,environmental features map, permit drawings and impact summary 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.