20171282 Ver 3_Modification_20180827

Action History (UTC-05:00) Eastern Time (US & Canada)
�brrrit by Anonymous User 8/27/2018 1:48:25 PM (Message Start Event)
Accept by Montalvo, Sheri A 8/30/2018 10:54:08 AM (DOT - E�asting Project)
• Carpenter,Kristi reassigned the task to Montalvo, Sheri A 8/27/2018 2:26 PM
• The task was assigned to Carpenter,Kristi. The due date is: August 30, 2018 5:00 PM
8/27/2018 1:48 PM

Water Resources
ENVIRONMENTAL �UPLITV
Staff Review
ID#* Version* 3
20171282
Is this project a public transportation project? * �' Yes
�' No
Reviewer List:* Robert Tankard:eads\rbtankard
Select Reviewing Office:* Washington Regional Office -[phone]
Submittal Type:*
Modifications
Does this project require a request for payment to be sent? *
l'
Yes
r•
No

Project Submittal Dated 8/27/2018
*
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: Environmental Professionals, Inc.
Who is subrritting the irrforrration?
Email Address: [e-mail]
Project Information
Project Name: Authorization Certificate per the Tar-Pamlico Buffer Protection Rules
Is this a public transportation project?
�' Yes
�' No
Is the project located within a NC DCM Area of Environmental Concern (AEC)?
C' Ye�' No l' Unknown
TI P#: WBS#:
(Applies to DOT projects only)
County (ies)
Pitt
Please upload all files that need to be submited.
Qick the upload button or drag and drop files here to attach docurrent
Karen Higgins8-24-18.Itr.pdf 1.51MB
Only pdf or krre files are accepted.
Describe the attachments:
Tar-Pamlico Riparian Buffer Permanent Impacts Runway 26 Grading Work
Authorization Certificate
Cover Letter
rJ By checking the box and signing box below, I certify that:
o I hava nivan triia acnirata anrl cmm�lata infnrmatinn nn this fnrm•

- .....,. �. ..�� .�.. � ........,.. � ...., .......�..�......���..�....,..�........ ...... �...� �
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:
i�-�� ff- u�&��
Submittal Date: