20200758 Ver 2_U-6010 Project Submittal Interim Form_20220922

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)
U New Project
O Modification/New Project with Existing ID
O More Information Response
O Other Agency Comments
O Pre -Application Submittal
O Re-Issuance\Renewal Request
O Stream or Buffer Appeal
Pre -Filing Meeting Date Request was submitted on:
5/2/2022
Project Contact Information
Name: Nancy Oberle
Who is submitting the information?
Email Address:* [e-mail]
Project Information
Project Name: * Intersection Improvements at US 70 (South Church Street) and SR 1311 (University
Drive), including widening South Church Street from West of University Dr. to
Westbrook Ave (SR 1309)
Is this a public transportation project?*
Yes
No
Is this a DOT project?*
Yes
No
Is the project located within a NC DCM Area of Environmental Concern (AEC)?*
Yes •) No O Unknown
TIP#: WBS#:
U-6010 47145.1.1
(Applies to DOT projects only)
County (ies)*
Alamance

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U-
274.94 KB
6010_AGENT_AUTHORIZATION_FORM_REV_...
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Describe the attachments or add comments:
This submittal serves as the Pre -Filing Meeting Request for the subject project.
This project has previously been permitted under a NWP 14. That permit expired in March 2022, therefore, a
new permit application will be submitted.
Attached is the Agent Authorization form for the project.
* 2) 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 once submitted.