20180117 Ver 1_B-4789 - 2/6/2018 7:16:28 PM_20180206

Action History (UTC-05:00) Eastern Time (US & Canada)
�brrrit by Anonymous User 2/6/2018 7:16:28 PM (Supplemental Submital)
Accept by Carpenter,Kristi 2/7/2018 1:12:17 PM (DOT - E�asting Project)
• The task was assigned to Carpenter,Kristi 2/6/2018 7:16 PM

Water Resources
ENVIRONMENTAL OUALITY
Staff Review:
i�#*
20180117
Reviewer List:*
Select Reviewing Office:*
Version *
1
Garcy Ward:eads\gpward
Washington Regional Office - [phone]
Is the project located within a NC DCM Area of Environmental Concern (AEC)?*
C' Yes C•' No C' Unknown
Project Submittal Interim Form
subrritted: 2/6/2018
Submittal Type: �' New Project
l" Pre-Application Submittal
C•' More Information Response
Project Contact Information:
Name: John Jamison
Who is subrritting the irrforrration?
Email Address: [e-mail]
Project Information:
Existing ID #:* Existing Version:*
20180117 1
Project Name: B-4789
Is this a public transportation project?
C' Yes
l' No
Is the project located within a NC DCM Area of Environmental Concern (AEC)?*
l' Yes �' No �' Unknown
TIP#: B-4789
WBS#: 38559.1.2
(Applies to DOT projects only)
County(ies)*
Pitt
Describe the attachments:

Attached are revised permit drawings and buffer impact drawings, in order to provide clarification and break
out the buffer impacts per quadrant (total impacts did not change).
Also, please note the applicanYs primary contact information as:
Heather Lane, PE
Division Bridge Program Manager
Division of Highways - Division 2
1037 W.H. Smith Boulevard
PO Box 1587
Greenville, NC 27835-1587
252-439-2813
Please upload all files that need to be submited.
B4789_Permit Drawings_20180130.pdf 1.47MB
B4789_Permit Drawings_BUFFER_20180130.pdf 893.18KB
Only pdF files are accepted.
r% By checking the box and signing box below, I certify that:
o I have given true, accurate, and complete information on this form;
o I agree that submission of this form is a"transaction" subject to Chapter 66, Article 40 of the NC General Statutes (the
"Uniform Electronic Transactions AcY')
o 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');
o I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written
signature; AND
o I intend to electronically sign and submit the form.
Signature:
:
�3 �'�6f [? ��Ir�JC�t