20181147 Ver 1_401 Application_20180625

Water Resources
ENVIRONMENTAL OUALITY
�'
Please note: fields marked with a red asterisk below are required. You will not be able to submit the form until all
mandatory questions are ansv�red.
Project Type:* �' New Project
C' Pre-Application Submittal
C' More Information Response
�' Other Agency Comments
C•' 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 existing project.
Project Contact I nformation
Name: Paul Williams
Who is subrritting the irrforrration?
Email Address:* [e-mail]
Project I nformation
Project Name:* Courtesy Notification - Washington SR 1204 Spruce Pine Road - Pipe
Replacement
Is this a public transportation project?*
C' Yes
l' No
Is this a DOT project?*
C' Yes
C' No
Is the project located within a NC DCM Area of Environmental Concern (AEC)?*
l' YesC•' No C' Unknown
TI P#: WBS#:
1.209411
(Applies to DOT projects only)
County (ies) *
Washington

Please upload all files that need to be submited.
qick the upload button or drag and drop files here to attach docurrent
Topo SR 1204 Spruce Pine Road RMIP 2019 -
1.56MB
Washington.pdf
Only pdF or Ivre files are accepted.
Describe the attachments:
This is a courtesy notification that NCDOT will be replacing two pipes in jurisdictional areas in Washington
County under Nationwide Permit 3 conditions. Locations are on UT's to Welch Creek, Stream Index No. 23-55,
Roanoke River Basin.
Pipe 1: Existing 18" X 36' RCP will be replaced by a 30" X 40' CAP at N 35.828350° W 76.776439°.
Pipe 2: Existing 18" X 40' RCP will be replaced by a 36" X 40' CAP at N 35.828719° W 76.621958°.
* 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:
*
:'f%r�rt! �rxr..• f'l,tr�rrr�.rsf.
Submittal Date:

Pip e 2Existing 18" X 4 0' RCPProposed 36" X 40' CAP35.82 8719°-76 .7764 39°
Pip e 1Existing 18" X 3 6' RCPProposed 30" X 40' CAP35.82 8350°-76 .7754 93°
NCDOT GIS Unit, C opyright:© 2013 National GeographicSociety, i-cubed
0 1 20.5 Miles
³
Pipe Replacements on SR 1204Spruce Pine RoadWashington County Quad Name Plymouth West