20180061 Ver 1_PCN Form Submission_20180111

Action History (UTC-05:00) Eastern Time (US & Canada)
�brrrit by Anonymous User 1/11/2018 4:17:25 PM (Start Event)
Accept by Carpenter,Kristi 1/11/2018 4:24:27 PM (DOT Initial Review)
• The task was assigned to Carpenter,Kristi . The due date is: January 16, 2018 5:00 PM
1/11/2018 4:17 PM

E-PCN Submittal
���
�lulslaa af Water Resources
Pre-Construction Notification (PCN) Form
For Nationwide Permits and Regional General Permits
(along with corresponding Water Quality Certifications)
December 15, 2017 Ver 2.2
*
Please note: fields marked with a red asterisk below are required. You will not be ab/e to submit the form until all mandatory questions are ans�red.
Also, if at any point you wish to print a copy of the E-PCN, all you need to do is right-click on the document and you can print a copy of the form.
Below is a link to the online help file.
http://edocs.deq.nc.gov/WaterResources/0/doc/603610/Page1.aspx
A. Processing Information
County(or Counties) where the project is located:*
Guilford
Is this project a public transportation project? *(')
C�' Yes C' No
Is this a NCDOT Project?*
r Yes C' No
(NCDOT only) T.I.P. or state project number:
WBS #
17BP.7.C.12
(for NCDOT use only)
1a. Type(s) of approval sought from the Corps:*
rJ Section 404 Permit (wetlands, streams and waters, Clean Water Act)
r Section 10 Permit (navigable waters, tidal waters, Rivers and Harbors Act)
1b. What type(s) of permit(s) do you wish to seek authorization?*
fJ Nationwide Permit (NWP)
r Regional General Permit (RGP)
Nationwide Permit (NWP) Number: 14 - Linear transportation
NWP Number Other:
List all MNnurrbers you are applying for not on the drop down list.
1c. Type(s) of approval sought from the DWR:*

check all that apply
r% 401 Water Quality Certification - Regular r 401 Water Quality Certification - E�ress
r Non-404 Jurisdictional General Permit rJ Riparian Buffer Authorization
*
1d. Is this notification solelyfor the record because written approval is not required?
For the record only for DWR 401 Certification: �' Yes C•' No
For the record only for Corps Permit: �' Yes C�' No
1e. Is payment into a mitigation bank or in-lieu fee program proposed for mitigation of impacts?
If so, attach the acceptance letter from rritigation bank or in-lieu fee program
C' Yes �' No
1f. Is the project located in anyof NC's twentycoastal counties?*
C' Yes C•' No
1h. Is the project located in a designated trout watershed?*
f Yes C•' No
Link to trout information: http://w�nn�v.saw.usace.army.mil/Missions/Regulatory-Permit-PrograrrUAgency-Coordination/Trout.aspx
B. Applicant Information
1a. Who is the Primary Contact?*
Division Engineer NC DOT Division 7, Mr. Mike Mills, PE
1b. Primary Contact Email:*
[e-mail]
1c. PrimaryContact Phone:*
(xxx)xxx-xxxx
[phone]
1d. Who is applying for the permit?
i � Owner rJ Applicant (other than owner) r AgenUConsultant
(Check all that apply)
2. Owner I nformation
2a. Name(s) on recorded deed:
North Carolina Department of Transportation
2b. Deed book and page no.:
2c. Responsible party:
(for Corporations)
i Division Engineer NC DOT Division 7, Mr. Mike Mills, PE
2d.Address
Street Address
PO Box14996
Address Line 2
��
Greensboro
Fbstal / Zip Code
27415
2e. Telephone Number:
State / Rovince / F�gion
NC
Country
USA

(xxx)x�c-xxxx
[phone]
2f. Fax Number:
[phone]
I (xxx)xxx-xxxx
2g. Email Address:*
[e-mail]
3. Applicant Information (if different from owner)
3a. Applicant is:
C' Agent
G Other ��C u� � � ��y� ���Qy �������� �,
If other please specify.
3b. Name:
Division Engineer NC DOT Division 7, Mr. Mike Mills, PE
3c. Business Name:
(if applicable)
NC DOT
3d.Address
Street Address
PO Box14996
Address Line 2
(7iy
Greensboro
Fbstal / Zip Code
27415
3e. Telephone Number:
[phone]
(xxx)xxx-xxxx
3f. Fax Number:
I [phone]
(xxx)x�c-�ocx
3g. Email Address:*
[e-mail]
State / FYovince / F�gion
NC
Country
C. Project Information and Prior Project History
1. Project Information
1a. Name of project:*
Replace Pipe #40 2144 on SR 3093 (Old Julian Rd)
1b. Subdivision name:
(if appropriate)
1c. Nearest municipality/town:*
Sedalia
1d. Driving directions*

If it is a new project and can not easily be found in a GPS rrapping system Rease provide directions.
Follow I-40 West to ebt 135 for Rock Creek Dairy Road; turn left onto Rock Creek Dairy Road and continue appro�amately 4 miles to Old
Julian Road; turn right onto Old Julian Road; project site is in approximately 1 mile
2. Project Identification
2a. Property Identification Number:
(t�vc RN or parcel ID)
2b. Propertysize:
(in acres)
2c. Project Address
Street Address
Address Line 2
��
F�stal / Zip Code
2d. Site coordinates in decimal degrees
State / Rovince / F�gion
Country
Please collect site coordinates in decimal degrees. Use between 4-6 digits (unless you are using a survey-grade GPS device) after the decimal place as
appropriate, based on howthe location was determined. (For example, most mobile phones with GPS provide locational precision in decimal degrees to
map coordinates to 5 or 6 digits after the decimal place.)
Latitude:* Longitude:*
36.013623 -79.6140553
ex:34.208504 -77.796371
3. Surface Waters
3a. Name of the nearest body of water to proposed project:*
UT to Big Alamance Creek (there are 2 within the project limits)
3b. Water Resources Classification of nearest receiving water:*
16-19-(1); WS-IV; NSW
Surface Water Lookup
3c. What river basin(s) is your project located in?*
Cape Fear
RiverBasin Lookup
4. Project Description
4a. Describe the existing conditions on the site and the general land use in the vicinity of the project at the time of this application:*
The project study area is comprised of e�asting maintained roadway with undisturbed hardwood forest and
residential properties. There are 2 UTs in the project study area; their confluence is just to the south of the
ebsting roadway. There are no other jurisdictional features associated with the project.
4b. Attach an 8 1/2 X 11 excerpt from the most recent version of the USGS topographic map indicating the location of the project site. (for
DWR)
Gick the upload button or drag and drop files here to attach docurrent
Pipe 40 2144 Guilford USGS Map.pdf 812.51 KB
Fle type rrust be pdF

4c. Attach an 8 1/2 X 11 excerpt from the most recent version of the published County NRCS Soil Survey map depicting the project site.
(for DWR)
C7ick the upload button or drag and drop files here to attach docurrent
Pipe 40 2144 Guilford Soil Map.pdf 2.18MB
Fle type rrust be pdF
4d. List the total estimated acreage of all existing wetlands on the property:
0
4e. List the total estimated linear feet of all existing streams on the property:
(interrrittent and perennial)
—175 LF in project study area
4f. Explain the purpose of the proposed project:*
To replace structurally deficient and failing 2@ 96" Corrugated Metal Pipes (CMPs) with a new 14'11"X9'10"
Corrugated Aluminum Structural Plate Pipe Arch (CASPPA) with headwall.
4g. Describe the overall project in detail, including indirect imapacts and the type of equipment to be used:*
Traffic will be detoured off-site. Erosion and sedimentation control measures will be installed. Water will be diverted
around the construction area. The old pipe will be removed. The proposed structure will be replaced on its existing
alignment. The newculvert structure will be a 14'11"X9'10" Corrugated Aluminum Structural Plate Pipe Arch
(CASPPA) with headwall. There will be 1' sills at the inlet and outlet ends of the structure. Water will be pumped
around the work area during construction by temporary flexible hose and installed impervious dikes upstream and
downstream of the ewsting pipe. Special stilling basins will be utilized on an as needed basis to pump effluent
trapped between the impervious dikes if a storm even overtops the dikes. Equipment to be used includes a track
hoe, dump truck, paving equipment, pumps, various hand tools, possibly a crane to move construction material
such as reinforced bars of steel, and concrete buckets to place concrete.
4h. Please upload project drawings for the proposed project.
Gick the upload button or drag and drop files here to attach docurrent
G1_C12_permits_wet_half_20171113.pdf 1.23M6
G1_C12_permits_buffers_half_20171113.pdf 918.09KB
230_040_17BP7C12_EC-4A.pdf 472.13KB
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5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the property or proposed impact areas?*
C� Yes C' No c' Unknown
Comments:
5b. If the Corps made a jurisdictional determination, what type of determination was made? *
C' Preliminary C' Approved C' Unknown C•' WA
Corps AID Number:
6carrple: SAV�2017-99999
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known):
Agency/Consultant Company:
Othe r:
Ben Furr
HDR Inc
Sd. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.

5d1. Jurisdictional determination upload
C7ick the upload button or drag and drop files here to attach docurrent
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6. Project History
6a. Have permits or certifications been requested or obtained for this project (including all prior phases) in the past?*
C' Yes C•' No �' Unknown
7. Future Project Plans
7a. Is this a phased project?*
C' Yes C•' No
Are any other NWP(s), regional general permit(s), or individual permits(s) used, or intended to be used, to authorize any part of the
proposed project or related activity? This includes other separate and distant crossing for linear projects that require Department of the
Army authorization but don't require pre-construction notification.
D. Proposed Impacts Inventory
1. Impacts Summary
1a. Where are the impacts associated with your project? (check all that apply):
r Wetlands rJ Streams-tributaries �J Buffers
r Open Waters r Pond Construction
3. Stream Impacts
If there are perennial or intermittent stream impacts (including temporary impacts) proposed on the site, then complete this question for all stream sites
impacted.
3a. Site #- Reason for 3b.lmpact
I impact* type*
S1 11+74 - 13+00 P
LT/RT F2rrranent (Fj or
N�p label (e.g. F�ad Qassing 1) Terrporary (�
S2 11+g7-13+00 LT/RT T
N�p label (e.g. Finad CXossing 1) F2rrranent (Fj or
Terrporary (�
S3 12+33-12+47 RT T
N�p label (e.g. F�ad Qossing 1) f�rrranent (P� or
Terrporary (�
3c. Type of impact* 3d. Stream name *
Culvert
De wate ri ng
De wate ri ng
UT to Big Alamance
Creek
UT to Big Alamance
Creek
UT to Big Alamance
Creek
3e. Stream 3f. Type of
Type* Jurisdiction*
Perennial Both
F�rennial (FH�) or
interrrittent (IfVn
Perennial Both
F�rennial (FH�) or
interrrdtent (If�
Perennial Both
F�rennial (F�2) or
interrrittent (IfVn
*' All Perennial or Intermittent streams must be verified by DWR or delegated local government.
3i. Total jurisdictional ditch impact in square feet:
0
3i. Total permanent stream impacts:
40
3i. Total temporary stream impacts:
29
3i. Total stream and tributary impacts:
69
3j. Comments:
3g. Stream 3h. Impact
width* length*
20 40
Average(feet) (linearfeet)
20 20
Average(feet) (linearfeet)
10 9
Average(feet) (linearfeet)

Please note that Impact S1 includes the proposed CASPPA and some necessary bank stabilization; Impact S3 is
for an impervious dike/dewatering to the second tributary that flows onto the project site; the dewatering of the site
will occur concurrently with the construction activities (i.e. the temporary impacts associated with dewatering are
within the permanent stream impact footprint location).
6. Buffer Impacts (for DWR)
If project will impact a protected riparian buffer, then complete the chart below. Individually list all buffer impacts below.
6a. Project is in which protect basin(s)?*
Check all that apply.
r Neuse
� Catawba
� Goose Creek
r Other
6b. Impact Type *
B1 14'71 "X9'10" CASPPA
Allowable
Location and 6cerrpt, Allowable, allowable w/
rritigation
6h. Total buffer impacts:
Temporary impacts
Permanent impacts:
Total buffer impacts
6c. Per or
Temp*
P
F2rrranent (P� or
Terrporary (�
Zone 1
0.00
Zone 1
1,738.00
Zone 1
1,738.00
r Tar-Pamlico
r Randleman
rJ Jordan Lake
6d. Stream name * 6e. Buffer mitigation
required? *
UT to Big Alamance No
Creek
Zone 2
0.00
Zone 2
0.00
Zone 2
0.00
6i. Comments:
The impacts associated with the roadway crossing and culvert installation fall under the "potentially allowable"
category per the Jordan Water Supply Buffer Rules Table of Uses {15A NCAC 02B .0267 (9)}
Supporting Documentation - i.e. Impact Maps, Plan Sheet, etc.
Gick the upload button or drag and drop files here to attach docurrent
G1_C12_permits_wet_half_20171113.pdf 1.23M6
G 1 _C12_permits_buffers_half_20171113. pdf 918.09KB
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I E. Impact Justification and Mitigation
1. Avoidance and Minimization
6f. Zone 1
impact*
1,738
(square feet)
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:*
6g. Zone 2
impact *
0
(square feet)

The proposed project is to remove and replace a structurally deficient CMP and replace it with a new CASPPA with
headwall. Roadway approach work is minimized as much as is practical to reduce the overall project footprint.
Impacts to the associated protected riparian buffers have also been reduced by promoting sheet flowas well as
providing grass shoulders to promote infiltration. All natural, ewsting drainage patterns are maintained for the
roadway. No drainage structures are required. An off-site detour will be employed to avoid the need for a
temporary parallel structure.
Typically, the length of a bridge will be much longer than that of a Corrugated Metal Pipe (CMP). Increasing the
bridge length creates several issues that must be overcome. If a bridge is utilized there must be at least four feet
of clearance under the bridge to allow access for maintenance workers at the abutment. In areas where culverts
are recommended this requires us to raise the roadway grade which also increases the impacts due to the
increased fill slopes which also increases the environmental impacts. Raising the roadway grade also affects the
FEMA Flood Plain Mapping. In turn we cannot meet the requirements of the Memorandum of Agreement (MOA)
with FEMA. If the new bridge cannot be sized to meet the requirements of an MOA then map revisions need to be
performed for FEMA. First through a CLOMR (Conditional Letter of Map Revision) then a LOMR (Letter Of Map
Revision). NCDOT �nrorks very hard to make sure the replacement structure meets the requirements of the MOA.
Smaller streams in the Piedmont area are often best suited for Corrugated Metal Pipe (CMP) to minimize raising
the roadway grade.
The project is maintenance in nature. The scope of work is to replace the e�asting pipes that are failing due to
corrosion of the inverts. The proposed design includes widening the ewsting shoulders from 3' to 6' within the
project limits to meet NCDOT and AASHTO typical section requirements (minimum) for the average daily traffic
volumes and roadway design speed of 45 mph. Constructing the roadway to minimum standards for safety
requires the proposed culverts to be e�ended on each end (lengthening of the ewsting crossing). Replacing the
e�asting culverts with a proposed bridge would increase the project scope and costs significantly. Further, the
basin drainage area and estimated discharges are compatible with a pipe structure.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:*
Erosion and sedimentation BMPs will be installed prior to construction. Water will be diverted around the work area
to prevent sedimentation of downstream aquatic resources. Impacts will be minimized by strict enforcement of Best
Management Practices for the protection of surface waters, restrictions against the staging of equipment in or
adjacent to waters of the US and coordination (including a pre-construction meeting) with the Division
Environmental Supervisor.
2. Compensatory Mitigation for Impacts to Waters of the U.S. or Waters of the State
2a. Does the project require Compensatory Mitigation for impacts to Waters of the U.S. or Waters of the State?
C' Yes C•' No
2b. If this project DOES NOT require Compensatory Mitigation, explain why:
While permanent impacts to the stream are proposed, they are for the replacement of an existing, in-stream, failing pipe structure. The new
stream impacts proposed are for bank stabilization and they are minimal in nature, however, necessary to insure the resource remains
stable. Furthermore, the bank stabilization is restricted to the banks and will not encroach within the thalweg of the channel. The riparian
buffer impacts associated with the roadway crossing and culvert installation fall under the "potentially allowable" category per the Jordan
Water Supply Buffer Rules Table of Uses {15A NCAC 02B .0267 (9)} and therefore, do not require mitigation.
F. Stormwater Management and Diffuse Flow Plan (required by DWR)
"* Recent changes to the stormwater rules have required updates to this section ."*
1. Diffuse Flow Plan
1a. Does the project include or is it adjacent to protected riparian buffers identified within one of the NC Riparian Buffer Protection
Rules?
�' Yes c' No
1b. All buffer impacts and high ground impacts require diffuse flow or other form of stormwater treatment. If the project is subject to a
state implemented riparian buffer protection program, include a plan that fully documents how diffuse flow will be maintained.
All Stormwater Control Measures (SCM)s must be designed in accordance with the NC Stormwater Design Manual. Associated
supplement forms and other documentation shall be provided.
What type of SCM are you providing?

� Level Spreader
r Vegetated Conveyance (lower SM/VT)
r Wetland Swale (higher SMNT)
r Other SCM that removes minimum 30% nitrogen
(check all that apply)
For a list of options to meet the diffuse flow requirements, click here.
Diffus Flow Documentation
aick the upload button or drag and drop files here to attach docurrent
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2. Stormwater Management Plan
2a. Is this a NCDOT project subject to compliance with NCDOT's Individual NPDES permit NCS000250?*
G Yes C' No
G. Supplementary Information
1. Environmental Documentation
1a. Does the project involve an expenditure of public (federal/state/local) funds or the use of public (federal/state) land?*
C� Yes �' No
1b. If you answered "yes" to the above, does the project require preparation of an environmental document pursuant to the
requirements of the National or State (North Carolina) Environmental PolicyAct (NEPA/SEPA)?*
C' Yes C•' No
Comments:*
While this project involves an expenditure of public funds, it does not exceed the thresholds that require
NEPA/SEPA documentation preparation.
2. Violations (DWR Requirement)
I 2a. Is the site in violation of DWR Water Quality Certification Rules (15A NCAC 2H .0500), Isolated Wetland Rules (15A NCAC 2H .1300), or
DWR Surface Water or Wetland Standards or Riparian Buffer Rules (15A NCAC 2B .0200)? *
C' Yes �' No
2b. Is this an after-the-fact permit application?*
C' Yes C•' No
3. Cumulative Impacts (DWR Requirement)
3a. Will this project (based on past and reasonably anticipated future impacts) result in additional development, which could impact
nearby downstream water quality?*
C' Yes C•' No
3b. If you answered "no," provide a short narrative description.
Per the NC DWQ April 10, 2004 Version 2.1 Cumulative Impacts policy, small scale public transportation projects —
such as widening projects, bridge & pipe replacements and intersection improvements — have a"low potential for
cumulative impact since little (if any) new impervious surface is added and the projects are usually in already
developed locales." This proposed project is within a somewhat developed landscape (i.e. existing residential
homes in the vicinity), this is not a road on a new location (i.e. there is an e�sting road and pipe structure and
thus, the area already contains impervious surfaces) and the project drains to UT to Big Alamance Creek which is
Class WS-IV; Nutrient Sensitive Waters (NSW) (i.e. not ORW, HQW, or 303(d) listed waters). We anticipate the NC
DWR will advise us if a qualitative or quantitative analysis is needed.
4. Sewage Disposal (DWR Requirement)

4a. Is sewage disposal required by DWR for this project? *
C' Yes C' No r f�/A
5. Endangered Species and Designated Critical Habitat (Corps Requirement)
Sa. Will this project occur in or near an area with federally protected species or habitat? *
C' Yes �' No
5b. Have you checked with the USFWS concerning Endangered Species Act impacts?*
G Yes C' No
5c. If yes, indicate the USFWS Field Office you have contacted.
I Raleigh
Sd. Is another Federal agency involved?*
C' Yes C•' No
5e. Is this a DOT project located within Division's 1-8?*
C�' Yes C' No
C' Unknown
5j. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?*
The United States Fish and Wildlife Service (USFWS) lists small whorled pagonia (Isotria medeoloides) as
threatened and northern long-eared bat (NLEB, Myotis septentrionalis) as endangered in Guilford County.
HDR�ICA conducted field investigations on 5/4/16. The project site does not provide habitat for the small whorled
pagonia. The vegetative community along the stream corridor has been disturbed resulting in dense understory
and herbaceous layers. The floodplain on the right side of the stream downstream of Old Julian Road is
maintained as a residential lawn. Small whorled pagonia was not observed during field investigations. The
biological conclusion for small whorled pagonia is no effect. The Bald Eagle is protected in every county in North
Carolina under the Bald and Gold Eagle Protection Act; however, no suitable feeding/water source is located
within one mile of the project study area to support Bald Eagle habitat. Also, Mr. Gary Jordan (USFWS) released
the Programmatic Conference Opinion (PCO) for the listed Northern Long Eared Bat (NLEB) which took effect May
4, 2015 . This opinion states in part, that "...it is the Service's conference opinion that NCDOT activities in eastern
North Carolina (Divisions 1-8), as proposed, are not likely to jeopardize the continued existence of the NLEB."
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as an Essential Fish Habitat?*
C' Yes C•' No
6b. What data sources did you use to determine whether your site would impact an Essential Fish Habitat?*
This pipe replacement project takes place in Guilford County which is not near any coastal or tidal habitat that
would support EFH (i.e. salt marshes, oyster reefs, etc.).
7. Historic or Prehistoric Cultural Resources (Corps Requirement)
Link to the State Historic Preservation Office Historic Properties Map (does not include archaeological data: http://gis.ncdcr.gov/hpoweb/
7a. Will this project occur in or near an area that the state, federal or tribal governments have designated as having historic or cultural
preservation status (e.g., National Historic Trust designation or properties significant in North Carolina historyand archaeology)?*
C' Yes C•' No
7b. What data sources did you use to determine whether your site would impact historic or archeological resources? *
This project was submitted to the North Carolina Department of Transportation's Human Environment Unit for
review in 2017. It was determined that no survey was required for historical architecture or archaeological
resources and that no cultural resources will be affected by this project. See attached concurrence letters.
7c. Historic or Prehistoric Information Upload

C7ick the upload button or drag and drop files here to attach docurrent
HA 17-10-0006NoSurveyReq.pdf 2.58M6
A 17-10-0006 Guilford No Archaeological Survey Required Form.pdf 1.09M6
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8. Flood Zone Designation (Corps Requirement)
Link to the FEMA Floodplain Maps: https://msc.fema.gov/portal/search
8a. Will this project occur in a FEMA-designated 100-year floodplain?*
C' Yes �' No
8c. What source(s) did you use to make the floodplain determination?*
North Carolina Floodplain Mapping Program
Miscellaneous
Miscellaneous attachments not previously requested.
aick the upload button or drag and drop files here to attach docurrent
17BP.7.C.12 Stormwater Management Plan.pdf 30.79KB
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Signature
*
rJ By checking the box and signing below, I certify that:
■ I have given true, accurate, and complete information on this form;
■ I agree that submission of this PCN form is a"transaction" subject to Chapter 66, Article 40 of the NC General Statutes (the "Uniform Electronic
Transactions AcY');
■ I agree to conduct this transaction by electronic means pursuant to Chapter 66, Article 40 of the NC General Statutes (the "Uniform Electronic
Transactions AcY');
■ 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 PCN form.
Full Name:*
James Michael Mills
Signature
� rf'�c%� ���
Date :
current_date

Initial Review
Is this project a public transportation project? *(?)
C� Yes C' No
Change only if needed.
Has this project met the requirements for acceptance in to the review process?*
C� Yes
C' No
BIMS # Assigned*
20180061
Version#*
Reviewing Office*
Central Office - [phone]
Select Project Reviewer*
April Norton:eads\arnorton
Is a payment required for this project?*
C� No payment required
f Fee received
C' Fee needed - send electronic notification