20180509 Ver 1_401 Application_20180410

Action History (UTC-05:00) Eastern Time (US & Canada)
�brrrit by Anonymous User 4/10/2018 9:23:16 AM (Supplemental Submital)
Accept by Carpenter,Kristi 4/10/2018 3:46:02 PM (DOT project)
. The task was assigned to Carpenter,Kristi 4/10/2018 9:23 AM

Water Resources
ENVIRONMENTAL OUALITY
Staff Review:
ID#* Version *
20180509 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' YesC•' No C' Unknown
Does this project �' Yes
require a request (' No
for payment to be
sent?*
Project Submittal Interim Form
subrritted: 4/10/2018
Submittal Type: �' Courtesy Copy
(' New Project
C' Pre-Application Submittal
C' More Information Response
C' Other Agency Comments
Project Contact Information:
Name: Paul Williams
Who is subrritting the irrforrration?
Email Address: [e-mail]
Project Information:
Project Name: Courtesy Notification - Washington SR 1303
Jones White 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' YesC' No C' Unknown
TI P#:

WBS#: 1 B.209411
(Applies to DOT projects only)
County(ies)*
Washington
Describe the attachments:
This is a courtesy notification that NCDOT will be replacing a pipe in a jurisdictional area in Washington
County under Nationwide Permit 3 conditions. Location is on Deep Creek, Stream Index No. 30-14-2,
Pasquotank River Basin.
Existing 72" X 48" X 40' CMP will be replaced by a 73" x 55" x 40' CAPA at N 35.9269° W 76.4641 °.
Please upload all files that need to be submited.
Topo.pdf 1.05MB
Only pdf or Ivre files are accepted.
I� 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�rf! f✓frir..'%l'ffrrrrr�.rsf.