20191086 Ver 1_401 Application_20190925

Staff Review
Does this application have all the attachments needed to accept it into the review process?
r Yes r No
ID#* Version* 1
20191086
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 inforrration?
Email Address: [e-mail]
Project Information
Project Name: Courtesey Notification - Tyrrell County SR 1209 Fort Landing Road - Driveway 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)?
r Yes r No r Unknown
County (ies)
Tyrrell
Please upload all files that need to be submited.
Click the upload button or drag and drop files here to attach docurrant
Topo SR 1209 Fort Landing Road Road.pdf 1.02MB
Only pdf or krre files are accepted.
Describe the attachments:
This is a courtesy notification that NCDOT will be replacing an existing driveway pipe in a jurisdictional area in
Tyrrell County under Nationwide Permit 3 conditions. Location is on a man made drainage canal to the Little
Alligator River, stream index 30-16-22, Pasquotank River Basin.
rJ By checking the box and signing box below, I certify that:
I hwc nivcn frac nr irnfc -1 nmmnlcfc infn-finn nn fhic 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 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');
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:
611WIPOeh.
Submittal Date: Is filled in automatically.

Driveway Pipe Replacement on SR 1209
Fort Landing Road
Tyrrell County Quad Name Columbia East
Goat Neck
C9° Mt MSCia
CO
.S
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o -
• - Existing blocked driveway crossing
_-_ with an inoperable drainage pump.
Proposed 48" x 30" flanged CAP with Beamon Style Aluminum Flap
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<9 - - -76.071826°
Fort
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- - - `\:�t• Piling SRM 1
Landing , ,
� s
Rock
Point
-`NCDOT GIS Unit, NCDOT GIS Unit, North Carolina Center for
'Geographic•9nformation and Analysis, North Carolina Center for
Geographic Information and Analysis , Copyright:© 2013
National Geographic Society, i -cubed
0 0.5 1 2 Miles
I I I I I I I I