20190109 Ver 2_401 Application_20221110

Staff Review
Does this application have all the attachments needed to accept it into the review process?*
Yes No
ID#* Version* 2
20190109
Is this project a public transportation project?* Yes
No
Is this a DOT Yes No
project?*
Reviewer List: * Rob Rid ings:eads\rgridings
Select Reviewing Office:* Central Office - [phone]
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:
2/9/2021
Project Contact Information
Name: Jason Dilday
Who is submitting the information?
Email Address: [e-mail]
Project Information
Existing ID #: Existing Version:
20190109 1
20170001(no dashes) 1
Project Name: Bridge 247 over White Oak Creek on SR2555 (Raynor Road)
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-5326 46040.1.1
(Applies to DOT projects only)
County (ies)
Wake
Please upload all files that need to be submited.
Click the upload button or drag and drop files here to attach document
B-5326 Nationwide Wake January 28 2019.pdf 9.17MB
Pre -Construction Notification (PCN) Form (6).pdf 135.61 KB
TalecrisB-5326.pdf 126.75KB
Only pdf or kmz files are accepted.

Describe the attachments or
comments:
Attached is the PCN and permit package distributed in 2019. At the time, written approval was not required
from either the USACE or NCDWR. Work in jurisdictional areas will not be completed by March 2023. There
have been no changes to design or impacts since the original permits. Protected species surveys for this
project are up to date, with surveys for Michaux's sumac last being conducted in 7/26/2022 with no individuals
of either species found. NCDOT is hereby requesting renewal/reissuance under Nationwide 3 from the USACE
(non -written) and an Individual Water Quality Certification from NCDWR.
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:
CAO R
Submittal Date: 11/10/2022
Is filled in automatically.