20191006 Ver 1_401 Application (4)_20190729

Staff Review
Does this application have all the attachments needed to accept it into the review process?
r Yes r No
ID# * Version
20191006
Is this project a public transportation project?* r Yes
r No
Is this a DOT r Yes r No
project?*
Reviewer List:* Donna Hood: ead s\d rhood
Select Reviewing Office:* Mooresville Regional Office - [phone]
Submittal Type:*
401 Application
Does this project require a request for payment to be sent?*
r
Yes
r
No

Project Submittal Form
Please note: fields marked m4th a red asterisk below are required. You vid// not be able to submit the form until all
mandatory questions are ansmred.
Project Type: r New Project
• Pre -Application Submittal
• More Information Response
• Other Agency Comments
• For the Record Only (Courtesy Copy)
• Stream or Buffer Appeal
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 expectation that your submittal WII 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 Information
Name: Kristi Lynn Carpenter for Michael Turchy
Who is subrritting the inforn-ation?
Email Address: [e-mail]
Project Information
Project Name: 1-40/1-77 Interchange Improvements (1-381913)
Is this a public transportation project?
r Yes
r No
Is the project located within a NC DCM Area of Environmental Concern (AEC)?
r Yes r No r Unknown
TIP#: WBS#:
T-3819B 34192.3.2
(Applies to DOT projects only)
County (ies)
Iredell
Please upload all files that need to be submited.
aick the upload button or drag and drop f iles here to attach docun-ent
0nly pdf or lqrz files are accepted.
Describe the attachments:
original sent via email and a copy is in Laserfiche
Pr By checking the box and signing box below, I certify that:
o I h2vp nivpn tnip 2(-.mjrqtP qnd cornnlptp infnrmqtion nn thi, form-

• 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 Act")
• I agree to conduct this transaction by electronic means pursuant to Chapter 66, Article 40 of the NC General Statutes
(the "Uniform Electronic Transactions Act");
• I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written
signature; AND
• I intend to electronically sign and submit the online form."
Signature:
Submittal Date: Is filled in auton-atically.