20211641 Ver 2_401 Application_20220930

Staff Review Form
NORTH CAROLINA
Envlronm¢ntcl Qvofiry
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* 2
20211641
Is this project a public transportation project?*
Yes
• No
Reviewer List: * Doug Perez:eads\djperez
Select Reviewing Office: *
Mooresville Regional Office - [phone]
Does this project require a request for payment to be sent?*
Yes
No
How much is owed?* $240.00
$570.00

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:
6/3/2022
Project Contact Information
Name:
Brandon J Phillips
Who is submitting the information?
Email Address: [e-mail]
Project Information
Existing ID #:
20211641
20170001 (no dashes)
Project Name:
Existing Version:
1
Derita Branch Sanitary Sewer Improvements Project Phase 2
Is this a public transportation project?
Yes
No
Is the project located within a NC DCM Area of Environmental Concern (AEC)?
Yes No Unknown
County (ies)
Mecklenburg

Please upload all files that need to be submited.
Click the upload button or drag and drop files here to attach document
Derita 2 PCN updated 093022 signed.pdf
Eng_Form_4345_20120CT signed.pdf
Derita Branch Sewer Improvements CATO3 DMS
acceptance reduced.pdf
2022_03_10_Derita_401_404_PHASE2 reduced.pdf
EASEMENT EXHIBIT reduced.pdf
Derita Phase 2
ORM_Upload_Sheet_Consolidated_NWPR_20200...
Derita Branch TE Report Revised 1-8-21.pdf
Derita PCN with impacts.pdf
Derita Eng 4345 Form Supplemental Information .pdf
Derita SHPO Environmental Review.pdf
Only pdf or kmz files are accepted.
Describe the attachments or
comments:
169.01KB
135.49KB
118.56KB
7.9MB
3.69MB
51.57KB
5.33MB
457.07KB
252.23KB
150.87KB
Signed PCN, Laserfiche PCN with impacts, Signed ENG Form 4345, ENG Form Supplemental Information,
Mitigation Acceptance from DMS, Derita Phase 2 Impact plans, Easement Exhibit of right-of-way areas to be
restored to wetlands, ORM Upload Sheet as pdf, (Excel ORM spreadsheet will be e-mailed to USACE),
Threatened and Endangered Species Report and SHPO concurrence letter are attached. Additional information
may be provided upon request.
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.