20180549 Ver 1_Project Submittal Interim Form SR 1364 - Ledrew Perry Road RMIP 2018-2019_20180723

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 - Bertie SR 1364 Ledrew Perry Road - Pipe Replacement
Is this a public transportation 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#:
1.2008112
(Applies to DOT projects only)
County (ies) *
Bertie
Please upload all files that need to be submited.

Click the upload button or drag and drop files here to attach docurrent
Topo SR 1364 - Ledrew Perry Road RMIP 2018-
1.15MB
2019.pdf
Only pdf or Ivre files are accepted.
Describe the attachments:
This is a courtesy notification that NCDOT will be replacing several pipes in jurisdictional areas in Bertie
County under Nationwide Permit 3 conditions.
Pipe 1: Existing 18" X 40' RCP will be replaced by a 24" X 40' CAP at N 36.05561 ° W 76.78850°. Location is
on a UT to Cricket Swamp, Stream Index No. 25-24-2, Chowan River Basin.
Pipe 2: Existing (2) 36" X44' RCP's will be replaced by (2) 42" X44' CAP's at N 36.04986° W 76.79696°.
Location is on a UT to Dunmoor Branch, Stream Index No. 25-24-2-1, Chowan River Basin.
* �I7 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:
*
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Submittal Date: