20170637 Ver 2_Modifications_20180509

Action History (UTC-05:00) Eastern Time (US & Canada)
�brrrit by Anonymous User 5/9/2018 4:58:53 PM (Message Start Event)
Accept by Carpenter,Kristi 5/9/2018 5:02:38 PM (DOT project)
. The task was assigned to Carpenter,Kristi. The due date is: May 14, 2018 5:00 PM 5/9/2018 4:59 PM

Water Resources
ENVIRONMENTAL �UPLITV
Staff Review
i�#*
20170637
Version* 2
Is this project a public transportation project? * �' Yes
�' No
Reviewer List:* Dave Wanucha:eads\djwanucha
Select Reviewing Office:*
Submittal Type:*
Modifications
Winston-Salem Regional Office - [phone]
Does this project require a request for payment to be sent? *
r•
Yes
r
No
How much is l" $240.00
owed?* �' $570.00

Project Submittal Dated 5/9/2018
*
Please note: fields marked with a red asterisk beloware required. You will not be able to submit the form until all
mandatory questions are ans�red.
Project Type:* �' New Project
C' Pre-Application Submittal
C' More Information Response
r Other Agency Comments
l' For the Record Only (Courtesy Copy)
New Project - Please check the new project type if you are trying to submit a new project that needs an official approval
decision.
Pre-Application Submittal - Please check the pre-application submittal if you just want feedback on your submittal and
do not have the e�ectation that your submittal will be considered a complete application requiring a formal decision.
More Information Response - Please check this type if you are responding to a request for information from staff and
you have and ID# and version for this response.
Other Agency Comments - Please check this if you are submitting comments on an ebsting project.
Project Contact Information
Name: Kristi Lynn Carpenter for Johnathan H
Slaughter
Who is subrritting the irrforrration?
Email Address:* [e-mail]
Project Information
Project Name:* SR 1526A, Sampson Road
Is this a public transportation project? *
�' Yes
�' No
Is the project located within a NC DCM Area of Environmental Concern (AEC)?*
C' Yes�' No �' Unknown
TI P#: WBS#:
(Applies to DOT projects only)
County (ies) *
Watauga
Please upload all files that need to be submited.

C7ick the upload button or drag and drop files here to attach docurrent
20170637v.2 Email.pdf 77.44KB
17-06-22- NCW RC-WatSR1526Au tsJoesC2017-06
42.61 KB
(002).pdf
401 Cert SR 1526A.pdf 1.49MB
NCDOT_SR1526A_Sampson Rd_Watauga_14.pdf 95.55KB
SR 1526A Improvements Revised Mitigation.pdf 78.59KB
SR1526A_6+05 SpringBox.pdf 98.44KB
Only pdf or Ivre files are accepted.
Describe the attachments:
Emailed modification request.
* �J 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 online form."
Signature:
:�rurr �fl.r�v C� r�r��r�r
Submittal Date: