20191006 Ver 4_401 Application_20221222

Staff Review
Does this application have all the attachments needed to accept it into the review process?*
Yes No
ID#* Version* 4
20191006
Is this project a public transportation project?* Yes
No
Is this a DOT Yes No
project?*
Reviewer List: * Amy Chapman:eads\aschapman:[e-mail]
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:
12/9/2021
Project Contact Information
Name: Erin Cheely
Who is submitting the information?
Email Address: [e-mail]
Project Information
Existing ID #: Existing Version:
20191006 3
20170001(no dashes) 1
Project Name: 1-3819 B
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#:
1-3819 B 34192.3.2
(Applies to DOT projects only)
County (ies)
Iredell
Please upload all files that need to be submited.
Click the upload button or drag and drop files here to attach document
1-3819B Modification Iredell December 22 2022.pdf 14.42MB
Only pdf or kmz files are accepted.
Describe the attachments or
comments:
Individual Permit Modification 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: 12/22/2022
Is filled in automatically.