HomeMy WebLinkAbout20200220 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.