20140762 Ver 4_Modification_20180618

Action History (UTC-05:00) Eastern Time (US & Canada)
�brrrit by Anonymous User 6/18/2018 12:41:53 PM (Message Start Event)
Accept by Carpenter,Kristi 6/18/2018 12:42:40 PM (DOT project)
. The task was assigned to Carpenter,Kristi. The due date is: June 21, 2018 5:00 PM
6/18/2018 12:42 PM

Staff Review
i�#*
20140762
Version* 4
Is this project a public transportation project? *
Is this a DOT F Yes f No
project?*
Reviewer List:*
Select Reviewing Office:*
Submittal Type:*
Modifications
C•' Yes
�' No
Dave Wanucha:eads\djwanucha
Winston-Salem Regional Office - [phone]
Does this project require a request for payment to be sent? *
r
Yes
r•
No
Water Resources
ENVIRONMENTAL �UPLITV

Project Submittal Dated 6/18/2018
*
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 Erin Cheely
Who is subrritting the irrforrration?
Email Address:* [e-mail]
Project Information
Project Name:* US 221 (R-2915B) Widening
Is this a public transportation project? *
C•' Yes
C' No
Is the project located within a NC DCM Area of Environmental Concern (AEC)?*
C' Ye�" No �' Unknown
TI P#: WBS#:
R-2915 34518.1.1
(Applies to DOT projects only)
County (ies) *
Watauga
Ashe
Please upload all files that need to be submited.
C7ick the upload button or drag and drop files here to attach docurrent
R-2915 Modification Ashe-Watauga June 15
2.19MB
2018.pdf
Only pdf or Ivre files are accepted.
Describe the attachments:
Original Submission sent via email.

* rJ 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:
::�jr'�ltr'�j+rrr ['��r�t�.r�frt
Submittal Date: