20191064 Ver 1_401 Application_20190812

Staff Review
Does this application have all the attachments needed to accept it into the review process?
r Yes r No
ID#* Version* 1
20191064
Is this project a public transportation project?* r Yes
r No
Is this a DOT r Yes r No
project?*
Reviewer List:* Garcy Ward: eads\gpward
Select Reviewing Office:* Washington Regional Office - [phone]
Submittal Type:*
401 Application
Does this project require a request for payment to be sent?*
r
Yes
c:
No

Project Submittal Form
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 answered.
Project Type: r New Project
r Pre -Application Submittal
r More Information Response
r Other Agency Comments
r For the Record Only (Courtesy Copy)
r 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 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 Information
Name: Steve Trowell
Who is subrritting the information?
Email Address: [e-mail]
Project Information
Project Name: Courtesy Notification - Northampton SR 1510 Jenkins Mill Road - Pipe Replacement
Is this a public transportation project?
r• Yes
r' No
Is the project located within a NC DCM Area of Environmental Concern (AEC)?
C Yes (-- No r' Unknown
TIP#: WBS#:
1.206611
(Applies to DOT projects only)
County (ies)
Please upload all files that need to be submited.
nick the upload button or drag and drop files here to attach document
Topo SR 1510 Jenkins Mill Road RMIP 2020.pdf 1.35MB
Only pdf or lqm files are accepted.
Describe the attachments:
This is a courtesy notification that NCDOT will be replacing a pipe in a jurisdictional area in Northampton
County under Nationwide Permit 3 conditions. Location is on a Ur to Wildcat Swamp, Stream Index 25-4-8-2
in the Chowan River Basin.

rJ By checking the box and signing box below, I certify that:
• I have given true, accurate, and complete information on this 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
o I intend to electronically sign and submit the online form."
Signature:
t5�MAWIZ-
Submittal Date: 12 August 2019
Is filled in automatically.

Pipe Replacement on SR 1510
Jenkins Mill Road
Northhampton County Quad Name Galatia
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Existing 48" X 40' CMP
'yG1 Proposed 18" X 45' CMP
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NCDOT GIS Unit, NCDOT G1S Uriit! N �rth Carolina Center for
q /� G graphialnfdrma_tion and Ana is, North1 Carolina Center for
41ter Cen+ l Geographic Information and Anal.. ls�,Copyright:© 2013
;a' ; a s fNational Geographic Society, i-cubed?'l
0 0.5 1 2 Miles
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