HomeMy WebLinkAbout20140762 Ver 7_401 Application_20220417 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* 7
20140762
Is this project a public transportation project?* Yes
No
Is this a DOT Yes No
project?*
Reviewer List:* Dave Wanucha:eads\djwanucha
Select Reviewing Office:* Winston-Salem Regional Office-(336)776-9800
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
Pre-Filing Meeting Date Request was submitted on:
Project Contact Information
Name: Erin Cheely
Who is submitting the information?
Email Address: ekcheely@ncdot.gov
Project Information
Existing ID#: Existing Version:
20140762 6
20170001(no dashes) 1
Project Name: R-2915: US 221 Widening from US 421 to US 221 Business/NC 88 in Jefferson in
Watauga and Ashe Counties
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#:
R-2915 34518.1.FR6
(Applies to DOT projects only)
.............................................................................................................
County(ies)
Ashe
Watauga
Please upload all files that need to be submited.
Click the upload button or drag and drop files here to attach document
R-2915 Modification Ashe-Watauga April 18 2022.pdf 3.25MB
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:
ItAteeT5
Submittal Date: Is filled in automatically.