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Home My WebLink About20200220 Ver 3_401 Application_20220119 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* 3 20200220 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: Gordon Cashin Who is submitting the information? Email Address: gcashin@ncdot.gov Project Information ...................................................................................................................................................................................................................................................................................................................................................................................................... Existing ID#: Existing Version: 20200220 2 20170001(no dashes) 1 Project Name: Bridge No.87 on NC 33 over Norfolk Southern Railroad, (B-5301 Central) 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-5301 46015.1.1 (Applies to DOT projects only) ...................................................................................................................................... County(ies) Pitt Please upload all files that need to be submited. Click the upload button or drag and drop files here to attach document B-5301 General Modification Pitt January 19 1.87MB 2022.pdf Only pdf or kmz files are accepted. Describe the attachments or comments: The project now involves utility impacts not anticipated in the original application,which are explained in the attached narrative and utility drawings.This will involve an additional 0.021 acre of permanent impact as an area permitted as hand clearing will be excavated. See call out box on permit drawing(sheet 2 of 2)depicting new proposed impacts in relation to previously permitted impacts for mechanized clearing and hand clearing. An additional 0.04 acre of mitigation will be debited from the Mildred Woods Mitigation Site to account for these impacts. 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: Ate4e. 4674,6a ¢, I!! Submittal Date: 1/19/2022 Is filled in automatically.