20180370 Ver 1_Initial Review Form_20180314

Action History (UTC-05:00) Eastern Time (US & Canada)
�brrrit by Anonymous User 3/14/2018 1:59:01 PM (Supplemental Submital)
Accept by Carpenter,Kristi 3/14/2018 3:09:25 PM (DOT project)
• The task was assigned to Carpenter,Kristi 3/14/2018 1:59 PM

Water Resources
ENVIRONMENTAL OUALITY
Staff Review:
ID#* Version *
20180370 1
Reviewer List:* Garcy Ward:eads\gpward
Select Reviewing Office:* Washington Regional Office -[phone]
Submittal Type:* 401 Application
Is the project located within a NC DCM Area of Environmental Concern (AEC)?*
l' Yes r No �' Unknown
Does this project �' Yes
require a request (' No
for payment to be
sent?*
Project Submittal Interim Form
subrritted: 3/14/2018
Submittal Type: �' New Project
C' Pre-Application Submittal
C' More Information Response
Project Contact Information:
Name: Paul Williams
Who is subrritting the irrforrretion?
Email Address: [e-mail]
Project Information:
Project Name: Courtesy Notification - Gates SR 1318
Middle Swamp Road - Pipe Replacement
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 C' Unknown
TI P#:
WBS#: 1 B.203711
(Applies to DOT projects only)

County(ies)*
Gates
Describe the attachments:
This is a courtesy notification that NCDOT will be replacing dual pipes in a jurisdictional area in Pasquotank
County under Nationwide Permit 3 conditions. Location is on Taylor Swamp, Stream Index No. 30-3-2-1-1-1,
Pasquotank River Basin.
Existing (2) 72" X46" X40' CMP's will be replaced by a 16'2" X 5'1" X40'6" AI. Box Cculvert at N 36.5436° W
76.6187°.
Please upload all files that need to be submited.
Topo.pdf 1.14MB
NCDOT GATES SO 1663 MIDDLE SWAMP RD CORAPEAKE NC.pdf 173.67KB
Only pdF or larn files are accepted.
r7 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:
:'f%r�rt! �rxr..• f'l,tr�rrr�.rsf.