20210818 Ver 1_401 Application_20210728

Staff Review
Does this application have all the attachments needed to accept it into the review process?*
r Yes r No
ID#*
20210818
Version* 1
Is this project a public transportation project?* r Yes
r No
Reviewer List:* Rick Trone:eads\rvtrone
Select Reviewing Office:*
Submittal Type:*
Central Office - [phone]
401 Application
Does this project require a request for payment to be sent?*
r
Yes
r
No
How much is r $240.00
owed?* r $570.00

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
For the Record Only (Courtesy Copy)
r
New Project
r
Modification/New Project with Existing ID
r
More Information Response
r
Other Agency Comments
r
Pre -Application Submittal
r
Re-Issuance\Renewal Request
r
Stream or Buffer Appeal
Pre -Filing Meeting Information
Before submitting this form please ensure you have submitted the Pre -Filing Meeting Request Form as we will not
be able to accept your application without this important first step. The Pre -Filing Meeting Request Form is used in
accordance with 40 C.F.R. Section 121.4(a) "At least 30 days prior to submitting a certification request, the project
proponent shall request a pre -filing meeting with the certifying agency" and in accordance with 40 C.F.R. Section
121.5(b)(7), and (c)(5) all certification requests shall include documentation that a pre -filing meeting request was
submitted to the certifying authority at least 30 days prior to submitting the certification request. Click here to read
more information on when this form is needed prior to application submission or here to view the form.
Attach documentation of Pre -Filing Meeting Request here:
Prefile Submittal_04.21.21.pdf
Date for Meeting Request 4/21/2021
ID# 20210818 Version 1
Project Contact Information
Name: Heather LaGagamba
who is submitting the information?
Email Address: [e-mail]
Project Information
Project Name: The Preserve at Tallulah Springs
Is this a public transportation project?
r Yes
r No
50.92KB
Is the project located within a NC DCM Area of Environmental Concern (AEC)?
r Yes r No r Unknown
County (ies)
Orange
Please upload all files that need to be submited.

click the upload button or drag and drop files here to attach document
6754-The Preserve at Tallulah
15.35MB
Springs_PCN_7.28.2021. pdf
Only pdf or krre files are accepted.
Describe the attachments
or comments:
PCN for 401 WQC
Sign and Submit
V By checking the box and signing box below, I certify that:
■ I, the project proponent, hereby certifies that all information contained herein is true, accurate, and complete to
the best of my knowledge and belief.
■ I, the project proponent, hereby requests that the certifying authority review and take action on this CWA 401
certification request within the applicable reasonable period of time.
■ I agree that submission of this online 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:
W,WmeL. O. zaWmWA-7,
Submittal Date: Is filled in automatically.

Preliminary ORM Data Entry Fields for New Actions
ACTION ID 9: SAW- 2021
Prepare file folder ❑
Begin Date (Date Received): July 28,2021
Assign Action ID Number in ORM ❑
1. Project Name [PCN Form A2a]: The Preserve at Tullulah Springs
2. Work Type: ❑✓ Private ❑Institutional ❑Government ❑ Commercial
3. Project Description / Purpose [PCN Form B3d and B3e]:
The site contains wooded land and fields. The site is proposed for residential development.
4. Property Owner / Applicant [PCN Form A3 or A4]: Margaret Kiser
5. Agent / Consultant [PNC Form A5 — or ORM Consultant ID Number]:
Pilot Environmental, Inc.
6. Related Action ID Number(s) [PCN Form B5b]:
7. Project Location —Coordinates, Street Address, and/or Location Description [PCN Form Blb]:
Eno Cemetery Road
36.1630690/-79.1529100
8. Project Location —Tax Parcel ID [PCN Form Bla]: 9857487266
9. Project Location — County [PCN Form A2b]: Orange
10. Project Location — Nearest Municipality or Town [PCN Form A2c]: Cedar Grove
11. Project Information —Nearest Waterbody [PCN Form 132a]: East Fork Eno River (Lake Orange)
12. Watershed / 8-Digit Hydrologic Unit Code [PCN Form 132c]: 03020201
Authorization: Section 10 ❑ Section 404 ✓❑
Regulatory Action Type:
❑ Standard Permit
✓ Nationwide Permit 9
Regional General Permit 9
Jurisdictional Determination Request
Section 10 and 404 ❑
❑ Pre -Application Request
::]Unauthorized Activity
❑ Compliance
❑ No Permit Required
Revised 20150602

NORTH CAROLINA
Environmental Quality
Water Resources
Office Use Only
Corps Action ID no. SAW-2021-01312 Date received: [Click to enter.]
DWR project no. 20210818 Date received: [Click to enter.]
Site Coordinates:
Latitude (DD.DDDDDD): 36.163077'
Longitude (DD.DDDDDD): 79.153211'
Form Version 1.5, September 2020
Pre -Construction Notification (PCN) Form
(Ver. 1.5, September 2020)
For Nationwide Permits and Regional General Permits and corresponding Water Quality Certifications
Please note: fields marked with a red asterisk are required. The form is not considered complete until all mandatory
questions are answered.
The online help file may be found at this link:
https:Hedocs.deg.nc.gov/WaterResources/0/edocl6247041PCN%2OHelp%2OFile%202018-1-30.pdf
The help document may be found at this link:
http://www.saw. usace.army. mil/Missions/Regulatory-Permit-Program/Permits/2017-Nationwide-Permits/Pre-
construction-Notification/
Before submitting this form, please ensure you have submitted the Pre -Filing Meeting Request Form as DWR will not be
able to accept your application without this important first step. The Pre -Filing Meeting Request Form is used to satisfy 40
C.F.R. Section 121.4(a) which states "At least 30 days prior to submitting a certification request, the project proponent shall
request a pre -filing meeting with the certifying agency." In accordance with 40 C.F.R. Section 121.5(b)(7), and (c)(5), all
certification requests must include documentation that a pre -filing meeting request was submitted to the certifying authority
at least 30 days prior to submitting the certification request.
Attach documentation of Pre -Filing Meeting Request to this Application.
Date of Pre -filing Meeting Request (MM/DD/YYYY) : 4/21/2021
DWR ID # 20210818 Version 1 (If applicable)
A. Processing Information
County (counties) where project is located:
Orange Additional (if needed).
Is this a public transportation project?
(Publicly funded municipal, state, or federal road, rail,
❑ Yes ❑x No
or airport project)
Is this a NCDOT project?
❑ Yes ❑x No
If yes, NCDOT TIP or state project number:
Click to enter.
If yes, NCDOT WBS number:
Click to enter.
❑x Section 404 Permit (wetlands, streams, waters,
Clean Water Act)
la. Type(s) of approval sought from the Corps:
❑ Section 10 Permit (navigable waters, tidal
waters, Rivers and Harbors Act)
Pagel of 21 PCN Form - Version 1.5, September 2020

❑x Nationwide Permit (NWP)
1 b. Permit type(s)?
❑ Regional General Permit (RGP)
❑ Standard (IP)
This form may be used to initiate the standard/ individual permit process with the USACE. Please contact your Corps
representative concerning submittals for standard permits. All required items can be included as separate attachments
and submitted with this form.
1 c. Has the NWP or GP number been verified by the Corps?
❑ Yes ❑x No
NWP number(s):
NWP 14
RGP number(s):
Click to enter.
1d. Type(s) of approval sought from the DWR (check all that apply):
❑x 401 Water Quality Certification — Regular ❑ 401 Water Quality Certification— Express
❑ Non-404 Jurisdictional General Permit ❑ Riparian Buffer Authorization
❑ Individual 401 Water Quality Certification
1e. Is this notification solely for the record because written approval is not required?
For the record only for DWR 401 Certification: *
❑ Yes ❑x No
For the record only for Corps Permit: *
❑ Yes ❑x No
1f. Is this an after -the -fact permit/certification application?
❑ Yes ❑x No
1g. Is payment into a mitigation bank or in -lieu fee program proposed for
mitigation of impacts?
❑ Yes ❑x No
If yes, attach the acceptance letter from mitigation bank or in -lieu fee program.
1 h. Is the project located in any of NC's twenty coastal counties?
❑ Yes ❑x No
1 i. Is the project located within an NC DCM Area of Environmental
Concern (AEC)?
❑ Yes ❑x No ❑ Unknown
1j. Is the project located in a designated trout watershed?
❑ Yes ❑x No
If yes, you must attach a copy of the approval letter from the appropriate Wildlife Resource Commission Office.
Trout information may be found at this link: http://www.saw.usace.army.mil/Missions/Regulatory-Permit-
Program/Agency-Coordination/Trout.aspx
Page 2 of 21 PCN Form - Version 1.5, September 2020

B. Applicant Information
1 a.
Who is the primary contact?
Shawn C. Sidener
1 b.
Primary Contact Email:
[e-mail]
1 c.
Primary Contact Phone: (###)###-####
1 919.563.9041
1 d.
Who is applying for the permit/certification? (check
all that apply)
❑ Owner 0 Applicant (other than owner)
1 e.
Is there an agent/consultant for this project?
® Yes ❑ No
2.
Landowner Information
2a.
Name(s) on Recorded Deed:
Sebastian Garner & Margaret Kiser
2b.
Deed Book and Page No.:
6633/2121
2c.
Responsible Party (for corporations):
Margaret Kiser
2d.
Address
Street Address:
1017 Spike Road
Address line 2:
Click to enter.
City:
Hillsborough
State/ Province/ Region:
North Carolina
Postal/ Zip Code:
27278
Country:
U.S.
2e.
Telephone Number: - (###)###-####
[phone]
2f.
Fax Number: (###)###-####
Click to enter.
2g.
Email Address:
[e-mail]
3.
Applicant Information (if different from owner)
3a.
Name:
Shawn C. Sidener
3b.
Business Name (if applicable):
EarthCentric Engineering, Inc.
3c.
Address:
Street Address:
204 West Clay Street
Address line 2:
Click to enter.
City:
Mebane
State/ Province/ Region:
North Carolina
Postal/ Zip Code:
27302
Country
US
3d.
Telephone Number: (###)###-####
[phone]
3e
Fax Number: (###)###-####
Click to enter.
Page 3 of 21 PCN Form - Version 1.5, September 2020

3f. Email Address: [e-mail]
4. Agent/ Consultant (if applicable)
4a. Name: *
Michael T. Brame
4b. Business Name:
Pilot Environmental, Inc.
4c. Address: *
Street Address:
743 Park Lawn Court
Address line 2:
Click to enter.
City:
Kernersville
State/ Province/ Region:
NC
Postal/ Zip Code:
27284
Country:
U.S.
4d. Telephone Number: * (###)###-####
336.708.4620
4e Fax Number: (###)###-####
Click to enter.
4f. Email Address: *
[e-mail]
Agent Authorization Letter:
Attach a completed/signed agent authorization form or letter. A sample form may be found at this link:
https://www.saw. usace.army. mil/Missions/Regulatory-Permit-Program/Permits/2017-Nationwide-Permits/Pre-
construction-Notification/
Page 4 of 21 PCN Form - Version 1.5, September 2020

C. Project Information and Prior Project History
1. Project Information
la. Name of project: *
The Preserve at Tallulah Springs
1 b. Subdivision name (if appropriate):
The Preserve at Tallulah Springs
1 c. Nearest municipality/town: *
Cedar Grove, NC
2.
Project Identification
2a.
Property identification number (tax PIN or parcel ID):
9857487266
2b.
Property size (in acres):
76
2c.
Project Address:
Street Address:
Eno Cemetery Road
Address line 2:
Click to enter.
City:
Cedar Grove
State/ Province/ Region:
NC
Postal/ Zip Code:
27231
Country:
U.S.
2d.
Site coordinates in decimal degrees (using 4-6 digits
after the decimal point): *
Latitude (DD.DDDDDD): 36.163077'
Longitude (-DD.DDDDDD):-79.153211 °
3. Surface Waters
3a. Name of nearest body of water to proposed project:
East Fork Eno River (Lake Orange)
3b. Water Resources Classification of nearest receiving
WS II; HQW; NSW
water:
The Surface Water Classification map may be found at this link:
https://ncdenr.maps.arcqis.com/apps/webappviewer/index.html?id=6e125ad7628f494694e259c80dd64265
Neuse
3c. In what river basin(s) is your project located? *
Choose additional (if needed)
3d. Please provide the 12-digit HUC in which the project is
030202010301
located:
The Find Your HUC map may be found at this link:
https://ncdenr.maps.arcgis.com/apps/Publiclnformation/index.html?appid=ad3a85aOc6d644aOb97cdO69db238ac3
Page 5 of 21 PCN Form - Version 1.5, September 2020

4.
Project Description and History
4a.
Describe the existing conditions on the site and the general land use in the vicinity of the project at the time of
this application:
The site contains wooded land and fields. The site is located in a residential area of Hillsborough.
4b.
Have Corps permits or DWR certifications been obtained for this
❑ Yes ❑X No ❑ Unknown
project (including all prior phases) in the past?
4c.
If yes, please give the DWR Certification number and/or Corps
SAW-2021-01312
Action ID (ex. SAW-0000-00000):
jClick to enter.]
Attach any pertinent project history documentation
4d.
Attach an 8'h x 11" excerpt from the most recent version of the USGS topographic map indicating the location of
the project site.
4e.
Attach an 8'h x 11" excerpt from the most recent version of the published County NRCS Soil Survey map
depicting the project site.
4f.
List the total estimated acreage of all existing wetlands on the
2.612 acres
property:
4g.
List the total estimated linear feet of all existing streams (intermittent
3000 linear feet
and perennial) on the property:
4g1.
List the total estimated acreage of all existing open waters on the
4.102 acres
property:
4h.
Explain the purpose of the proposed project:
The purpose of the proposed project is to construct a 7 lot single family residential subdivision.
4i.
Describe the overall project in detail, including the type of equipment to be used:
The overall project includes the construction of a 7 lot single family residential subdivision. In order to facilitate the
proposed development and access the site, it is necessary to cross a stream. To facilitate the development of the site,
clearing and grading the site is necessary. Graders, haulers, excavators and other heavy equipment will be used
during grading and construction of the site.
4j.
Attach project drawings/site diagrams/depictions of impact areas for the proposed project.
5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the property or in
® Yes ❑ No ❑ Unknown
proposed impact areas?
Comments:
The site was delineated by Pilot Environmental on April 28, 2021. Based on an e-mail from Ms. April Norton with
the USACE on July 15, 2021, she concurs with the delineation and will issue a Jurisdictional Determination
based on a desktop review.
Name (if known): David Brame/Michael Brame
5b. If 5a is yes, who delineated the jurisdictional
Agency/Consultant Company: Pilot Environmental
areas?
Other: Click to enter
5c. If the Corps made a jurisdictional determination,
❑X Preliminary ❑ Approved ❑ Emailed Concurrence
what type of determination was made?
❑ Not Verified ❑ Unknown
Corps AID number (ex. SAW-0000-00000):
SAW — 2021-01312
Page 6 of 21 PCN Form - Version 1.5, September 2020

5d. List the dates of the Corps jurisdictional determination or State determination if a determination was made by
either agency.
USACE e-mail concurrence of delineation on July 15, 2021.
5d1. Attach jurisdictional determinations.
Page 7 of 21 PCN Form - Version 1.5, September 2020

6. Future Project Plans
6a. Is this a phased project?
❑ Yes ❑x No
6b. If yes, explain.
'lick to enter.
Are any other NWP(s), regional general permit(s), or individual permit(s) used, or intended to be used, to authorize
any part of the proposed project or related activity? This includes other separate and distant crossings for linear
projects that require Department of the Army authorization but don't require pre -construction notification.
No other permits are intended to be used.
Page 8 of 21 PCN Form - Version 1.5, September 2020

D. Proposed Impacts Inventory
Impacts Summary
1 a. Where are the impacts associated with your project
(check all that apply):
❑ Wetlands
❑ Buffers
❑ Pond Construction
❑x Streams - tributaries
❑ Open Waters
2. Wetland Impacts
If there are wetland impacts proposed on the site, complete this table for each wetland area impacted.
2a.
2a1.
2b.
2c.
2d.
2e.
2f.
2g.
Site #
Impact
Impact
Wetland Name
Wetland Type*
Forested
Jurisdiction
Impact Area
Reason/Type
Duration
?*
Type*
(ac)
W1
Choose one
Temp/
Click to enter
Choose one
Y/N
Choose one
Click to
Perm
enter
W2
Choose one
Temp/
Click to enter
Choose one
Y/N
Choose one
Click to
Perm
enter
W3
Choose one
Temp/
Click to enter
Choose one
Y/N
Choose one
Click to
Perm
enter
W4
Choose one
Temp/
Click to enter
Choose one
Y/N
Choose one
Click to
Perm
enter
W5
Choose one
Temp/
Click to enter
Choose one
Y/N
Choose one
Click to
Perm
enter
W6
Choose one
Temp/
Click to enter
Choose one
Y/N
Choose one
Click to
Perm
enter
2g1. Total temporary wetland impacts
Click to enter. ac
2g2. Total permanent wetland impacts
Click to enter. ac
2g3. Total wetland impacts
Click to enter. ac
2h. Comments:
Wetland impacts have been avoided and are not proposed.
Page 9 of 21 PCN Form - Version 1.5, September 2020

3.
Stream Impacts
If there are perennial or intermittent stream/ tributary impacts (including temporary impacts) proposed on the site,
complete this table for all stream/ tributary sites impacted.
** All Perennial or Intermittent streams must be verified by DWR or delegated local government
Site #
3a.
Impact Reason/
Type
3b.
Impact
Duration
3d.
Stream Name
3e.
Stream
Type
3f.
Jurisdiction
Type
3g.
Stream Width
(avg ft)
3h.
Impact length
(linear ft)
S1
Crossing/ Culvert
Permanent
Unnamed
Perennial
Both
11.90/15.27
31/22
S2
Dewatering
Temporary
Unnamed
Perennial
Both
15.85
20
S3
Choose one
Temp/ Perm
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S4
Choose one
Temp/ Perm
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S5
Choose one
Temp/ Perm
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S6
Choose one
Temp/ Perm
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S7
Choose one
Temp/ Perm
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S8
Choose one
Temp/ Perm
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S9
Choose one
Temp/ Perm
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S10
Choose one
Temp/ Perm
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S11
Choose one
Temp/ Perm
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S12
Choose one
Temp/ Perm
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S13
Choose one
Temp/ Perm
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S14
Choose one
Temp/ Perm
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S15
Choose one
Temp/ Perm
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
3i1.
Total jurisdictional ditch impact:
Click to enter. linear ft
3i2.
Total permanent stream impacts:
31/22 linear ft
36.
Total temporary stream impacts:
20 linear ft
3i4.
Total stream and ditch impacts:
73 linear ft
3j.
Comments:
31 linear feet (369 square feet or 0.008 acres) of stream channel will be permanently impacted with a culvert and
associated fill. 22 linear feet (336 square feet or 0.008 acres) of stream channel will be permanently impacted
with rip rap that is to be keyed in. 20 linear feet (317 square feet or 0.007 acres) of stream channel will be
temporarily impacted by a cofferdam and associated pump around.
The total permanent stream impacts (excluding keyed -in rip rap) is to 31 linear feet (0.008 acres) of stream
impact. It is below the mitigation threshold. Therefore, mitigation should not be required and is not proposed.
Page 10 of 21 PCN Form - Version 1.5, September 2020

4.
Open Water Impacts
If there are proposed impacts to lakes, ponds, estuaries, tributaries,
sounds, the Atlantic Ocean, or any other
open water of the U.S., individually list all open water impacts in the table below.
4a.
4b.
4c.
4d.
4e.
4e1.
4f.
Site #
Impact Reason/
Impact
Waterbody Name
Waterbody
Jurisdiction
Impact area (ac)'
Type
Duration
Type*
Type
01
Choose one
Temp/
Click to enter.
Choose one
Choose one
Click to enter.
Perm
02
Choose one
Temp/
Click to enter.
Choose one
Choose one
Click to enter.
Perm
03
Choose one
Temp/
Click to enter.
Choose one
Choose one
Click to enter.
Perm
04
Choose one
Temp/
Click to enter.
Choose one
Choose one
Click to enter.
Perm
4g.
Total temporary open water impacts
Click to enter. ac
4g.
Total permanent open water impacts
Click to enter. ac
4g.
Total open water impacts
Click to enter. ac
4h.
Comments:
Open water impacts are not proposed.
5.
Pond or Lake Construction
If pond or lake construction is proposed, complete
the table
below. (*This
does NOT include ofFline stormwater
management ponds.)
5a.
5b.
5c.
5d.
5e.
Pond ID
Proposed use or
Wetland Impacts
(ac)
Stream
Impacts (ft)
Upland
#
purpose of pond
Impacts (ac)
Flooded
Filled
Excavated
Flooded
Filled
Excavated
P1
Choose one
Click to
Click tL
Click to
Click to
Click to
Click to
Click to
enter.
enter.
enter.
enter.
enter.
enter.
enter.
P2
Choose one
Click to
Click to
Click to
Click to
Click to
Click to
Click to
enter.
enter.
enter.
enter.
enter.
enter.
enter.
5f.
Total
Click to
Click to
Click to
Click to
Click to
Click to
Click to
enter.
enter.
enter.
enter.
enter.
enter.
enter.
5g.
Comments:
Pond or lake construction is not proposed.
5h.
Is a dam high hazard permit required?
❑ Yes ❑ No
If yes, permit ID no.:
Click to enter.
5i.
Expected pond surface area (acres):
Click to enter.
5j.
Size of pond watershed (acres):
Click to enter.
5k.
Method of construction:
Click to enter.
Page 11 of 21 PCN Form - Version 1.5, September 2020

6.
Buffer Impacts (DWR requirement)
If project will impact a protected riparian buffer, then complete the chart below.
Individually list all buffer impacts.
6a.
Project is in which protected basin(s)?
(Check all that apply.)
❑x Neuse ❑ Tar -Pamlico ❑ Catawba
❑ Jordan ❑ Goose Creek ❑ Randleman
❑ Other: Click to enter.
Site #*
6b.
Impact Type*
6c.
Impact Duration*
6d.
Stream Name*
6e.
Buffer
Mitigation
Required?*
6f.
Zone 1 Impact*
(sq ft)
6g.
Zone 2 Impact*
(sq ft)
B1
Crossing/ Culvert/
Bridge
Permanent
Click to enter.
No
3366
2231
B2
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B3
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B4
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B5
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B6
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter
Click to enter.
B7
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter
Click to enter.
B8
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter
Click to enter.
B9
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter
Click to enter.
B10
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
6h.
Total temporary impacts:
Zone 1: Click to enter. sq ft
Zone 2: Click to enter. sq ft
6h.
Total permanent impacts:
Zone 1: 3366 sq ft
Zone 2: 2231 sq ft
6h.
Total combined buffer impacts:
Zone 1: 3366 sq ft
Zone 2: 2231 sq ft
6i.
Comments:
Buffer impacts are associated with a road crossing and are allowable without mitigation.
Please attach supporting documentation (impact maps, plan sheets, etc.) for the proposed project.
Page 12 of 21 PCN Form - Version 1.5, September 2020

E. Impact Justification and Mitigation
1. Avoidance and Minimization
1 a. Specifically describe measures taken to avoid or minimize the proposed impacts through project design:
The applicant has designed the proposed development to avoid impacts to other streams, wetlands and the pond. A
headwall and endwall are dsigned to minimize impacts to the stream. Rip rap is being keyed in to the existing bed on
each end of the box culvert to maintain the current stream bed. The remaining roads and lots have been designed to
avoid additional impacts to jurisdictional areas.
1 b. Specifically describe measures taken to avoid or minimize proposed impacts through construction techniques:
The clearing limits will be surveyed, staked and silt fencing and clearing limit fencing will be used. Coffer dams will be
used to minimize sediment discharge during construction activities. Disturbed areas will be seeded and mulched to
limit sediment from entering downgradient waters. Slope matting will be used on steep slopes.
2. Compensatory Mitigation for Impacts to Waters of the U.S., Waters of the State, or Riparian Buffers
2a. If compensatory mitigation is required, by whom is it required? * ❑ DWR ❑ Corps
(check all that apply)
2b. If yes, which mitigation option(s) will be used for this ❑ Mitigation Bank
project? * (check all that apply) ❑ In Lieu Fee Program
❑ Permittee Responsible Mitigation
3. Complete if using a Mitigation Bank
(Must satisfy NC General Statute143-214.11 (d1).)
3a. Name of mitigation bank:
Click to enter.
3b. Credits purchased/requested:
Type: Choose one
Quantity Click to enter.
Type: Choose one
Quantity Click to enter.
Type: Choose one
Quantity Click to enter.
Attach receipt and/or approval letter.
3c. Comments:
Click to enter.
4.
Complete if Using an In Lieu Fee Program
4a.
Attach approval letter from in lieu fee program.
4b.
Stream mitigation requested:
Click to enter. linear feet
4c.
If using stream mitigation, what is the stream temperature:
Choose one
NC Stream Temperature Classification Maps can be found under the Mitigation Concepts tab on the Wilmington
District's RIBITS website: (Please use the filter and select Wilmington district)
https://ribits.usace.army.mil/ribits apex/f?p=107:27:2734709611497::NO: RP: P27 BUTTON KEY:O
4d.
Buffer mitigation requested (DWR only):
Click to enter. square feet
4e.
Riparian wetland mitigation requested:
Click to enter. acres
4f.
Non -riparian wetland mitigation requested:
Click to enter. acres
4g.
Coastal (tidal) wetland mitigation requested:
Click to enter. acres
Page 13 of 21 PCN Form - Version 1.5, September 2020

4h. Comments:
Click to enter.
5. Complete if Providing a Permittee Responsible Mitigation Plan
5a. If proposing a permittee responsible mitigation plan, provide a description of the proposed mitigation plan,
including the amount of mitigation proposed.
Click to enter
5b. Attach mitigation plan/documentation.
6.
Buffer Mitigation (State Regulated Riparian Buffer Rules) — DWR requirement
6a.
Will the project result in an impact within a protected riparian buffer
❑ Yes ❑x No
that requires buffer mitigation?
If yes, please complete this entire section — please contact DWR for more information.
6b.
If yes, identify the square feet of impact to each zone of the riparian buffer that requires
mitigation. Calculate the
amount of mitigation required in the table below.
6c.
6d.
6e.
Zone
Reason for impact
Total impact (square
Multiplier
Required mitigation
feet)
(square feet)
Zone 1
Click to enter.
Click to enter.
:,hoose one
Click to enter.
Zone 2
;lick to enter.
Click fo enter
" hnnca nna
Click to enter.
6f. Total buffer mitigation required
Click to enter.
6g.
If buffer mitigation is required, is payment to a mitigation bank or
❑ Yes ❑ No
NC Division of Mitigation Services proposed?
6h.
If yes, attach the acceptance letter from the mitigation bank or NC Division of Mitigation Services.
6i.
Comments:
Buffer mitigation is not required or proposed.
Page 14 of 21 PCN Form - Version 1.5, September 2020

F. Stormwater Management and Diffuse Flow Plan (DWR requirement)
1. Diffuse Flow Plan
1 a. Does the project include or is it adjacent to protected riparian buffers
® Yes ❑ No
identified within one of the NC Riparian Buffer Protection Rules?
1 b. All buffer impacts and high ground impacts require diffuse flow or other forms of stormwater treatment. If the
project is subject to a state implemented riparian buffer protection program, include a plan that fully documents
how diffuse flow will be maintained.
All Stormwater Control Measures (SCM) must be designed in accordance with the NC Stormwater Design
Manual (https://deg.nc.gov/about/divisions/energv-mineral-land-resources/energv-mineral-land-permit-
guidance/stormwater-bmp-manual).
Associated supplement forms and other documentation must be provided.
❑ Level Spreader
What Type of SCM are you
❑ Vegetated Conveyance (lower seasonal high water table- SHWT)
providing?
❑ Wetland Swale (higher SHWT)
(Check all that apply)
❑ Other SCM that removes minimum 30% nitrogen
❑x Proposed project will not create concentrated stormwater flow through the
buffer
For a list of options to meet the diffuse flow requirements, click here:
Attach diffuse flow documentation.
2. Stormwater Management Plan
2a. Is this an NCDOT project subject to compliance with NCDOT's
Individual NPDES permit NCS000250?
El Yes ❑x No
2b. Does this project meet the requirements for low density projects as
defined in 15A NCAC 02H .1003(2)?
❑x Yes ❑ No
To look up low density requirements, click here:
http://reports.oah.state.nc.us/ncac/title%2015a%20-%20environmental%20guality/chapter%2002%20-
%20environmental%20management/subchapter%20h/15a%20ncac%2002h%20.1003.pdf
2c. IS the project over an acre?
❑x Yes ❑ No
2d. Does this project have a stormwater management plan (SMP)
reviewed and approved under a state stormwater program or state-
❑ Yes ❑x No
approved local government stormwater program?
Note: Projects that have vested rights, exemptions, or grandfathering from state or locally implemented
stormwater programs or projects that satisfy state or locally -implemented stormwater programs through use of
community in -lieu programs should answer "no" to this question.
2e. Which of the following stormwater management program(s) apply?
❑ Local Government
(Check all that apply)
❑ State
If you have local government approval, please include the SMP on their overall impact map.
Page 15 of 21 PCN Form - Version 1.5, September 2020

❑ Phase II
❑ USMP
Local Government Stormwater Programs
❑ NSW
❑ Water Supply
Please identify which local government stormwater
program you are using.
GIicK to enter.
❑ Phase II
❑ HQW or ORW
State Stormwater Programs
❑ Coastal Counties
❑ Other
Comments:
This is a LID development with less than 6% impervious surfaces. Additionally stormwater flow will not be
concentrated and discharged at the site.
A SWMP is not required.
Page 16 of 21 PCN Form - Version 1.5, September 2020

G. Supplementary Information
1. Environmental Documentation
1 a. Does the project involve an expenditure of public (federal/state/local)
❑ Yes ❑x No
funds or the use of public (federal/state) land? *
1 b. If you answered "yes" to the above, does the project require
preparation of an environmental document pursuant to the
❑ Yes ❑ No
requirements of the National or State (North Carolina) Environmental
Policy Act (NEPA/SEPA)?
1 c. If you answered "yes" to the above, has the document review been
finalized by the State Clearing House? (If so, attach a copy of the
❑ Yes ❑ No
NEPA or SEPA final approval letter.)
Comments:
A NEPA or SEPA is not required.
2. Violations (DWR Requirement)
2a. Is the site in violation of DWR Water Quality Certification Rules (15A
NCAC 2H .0500), Isolated Wetland Rules (15A NCAC 2H .1300),
DR Surface Water or Wetland Standards or Riparian Buffer Rules El Yes ❑x No
W
(15A NCAC 2B .0200)?
2b. If you answered "yes" to the above question, provide an explanation of the violation(s):
Click to enter.
3. Cumulative Impacts (DWR Requirement)
3a. Will this project (based on past and reasonably anticipated future
impacts) result in additional development, which could impact nearby
❑ Yes ❑x No
downstream water quality?
3b. If you answered "no", provide a short narrative description:
Additional development as a result of the proposed development is not proposed.
3c. If yes, attach a qualitative or quantitative cumulative impact analysis (.pdo in accordance with the most recent
DWR policy.
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project? 1 ❑ Yes ❑x No ❑ N/A
4b. If yes, describe in detail the treatment methods and dispositions (non -discharge or discharge) of wastewater
generated from the proposed project. If the wastewater will be treated at a treatment plant, list the capacity
available at that plant.
Individual septic systems will be used to treat sewage. Additional impacts associated with sewage disposal are not
proposed.
Page 17 of 21 PCN Form - Version 1.5, September 2020

5.
Endangered Species and Designated Critical Habitat (Corps Requirement)
5a.
Will this project occur in or near an area with federally protected
® Yes ❑ No
species or habitat? (IPAC weblink: hftps://www.fws.gov/ipac/ Ifws.govl)
5b.
Have you checked with the USFWS concerning Endangered Species
❑ Yes ❑x No
Act impacts?
5c.
If yes, indicate the USFWS Field Office you have contacted.
Choose one
5d.
Is another federal agency involved?
❑ Yes ❑x No ❑ Unknown
If yes, which federal agency?
Click to enter.
5e.
Is this a DOT project located within Divisions 1-8?
❑ Yes ❑x No
5f.
Will you cut any trees in order to conduct the work in waters of the
U.S.?
®Yes ElNo
5g.
Does this project involve bridge maintenance or removal? *
❑ Yes ❑x No
Link to NLEB SLOPES document: http://saw-reg.usace. army. mil/NLEB/1-30-17-signed NLEB-
SLOPES&apps.pdf
5h.
Does this project involve the construction/ installation of a wind
turbine(s)?
❑ Yes ❑x No
If yes, please show the location of the wind turbine(s) on the permit drawings/ project plans (attach .pdo
5i.
Does this project involve blasting and /or other percussive activities
that will be conducted by machines, such as jackhammers,
❑ Yes ❑x No
mechanized pile drivers, etc.?
If yes, please provide details to include type of percussive activity, purpose, duration, and specific location of this
activity on the property (attach .pdo
5j.
What data sources did you use to determine whether your site would impact Endangered Species or Designated
Critical Habitat?
US Department of the Interior— Fish and Wildlife Service Official Species List from IPaC
4 listed species are identified on the IPaC report. Neuse River Waterdog (nearest identified population on the
NHP database - 2.7 river miles — down stream); Carolina Madtom (nearest identified population on the NHP
database - 16.5 aerial miles — down stream), Atlantic Pigtoe (nearest identified population on the NHP database -
2.7 river miles — down stream) and Dwarf Wedgemussel (nearest identified population on the NHP database -
3.07 river miles — down stream) were identified on the IPaC report. The identified populations are separated
from the site by the dam associated with Lake Orange and at least one road crossing. Additionally, the identified
populations are located on the West Fork Eno River and Eno River. The stream that crosses the site feeds into
the East Fork Eno River before it merges with the West Fork Eno River. Best management practices will also be
used to avoid sediment from entering the stream and down -gradient waterbodies. Based on the distance to
known populations, fragmented potential habitat and stream characteristics in the vicinity of the crossing, we
have made the determination that the proposed project is not likely to adversely affect this species..
Attach consultation documentation.
6. Essential Fish Habitat (Corps Requirement)
Page 18 of 21 PCN Form - Version 1.5, September 2020

6a. Will this project occur in or near an area designated as
an Essential Fish Habitat?
❑ Yes
❑x No
Are there submerged aquatic vegetation (SAV) around
the project vicinity?
El Yes
❑x No El Unknown
Will this project affect submerged aquatic vegetation?
❑ Yes
❑x No ❑ Unknown
Explain:
Dlick to enter.
6b. What data source(s) did you use to determine whether your site would impact Essential Fish Habitat?
Essential Fish Habitat Mapper— NOAA Fisheries
Page 19 of 21 PCN Form - Version 1.5, September 2020

7. Historic or Prehistoric Cultural Resources (Corps Requirement)
Link to the State Historic Preservation Office Historic Properties Map (does not include archaeological data):
hftp://qis.ncdcr.gov/hpoweb/
7a. Will this project occur in or near an area that the state, federal or tribal
governments have designated as having historic or cultural
❑ Yes Z No
preservation status (e.g., National Historic Trust designation or
properties significant in North Carolina history and archaeology)?
7b. What data source(s) did you use to determine whether your site would impact historic or archeological
resources?
NC Historic Preservation Office's HPOWEB 2.0. Historic properties were not identified on the site. One "survey only"
property is identified on adjacent property southeast of the site.
7c. Attach historic or prehistoric documentation.
8. Flood Zone Designation (Corps Requirement)
Link to the FEMA Floodplain Maps: https://msc.fema.gov/portal/search
8a. Will this project occur in a FEMA-designated 100-year floodplain?
Z Yes ❑ No
8b. If yes, explain how the project meets FEMA requirements.
There is a rise that is less than one foot. Therefore, it meets FEMA requirements.
8c. What source(s) did you use to make the floodplain determination?
National Flood Hazard Layer froom FEMA Web Map Service — FEMA Panel 3710985700K
Page 20 of 21 PCN Form - Version 1.5, September 2020

H. Miscellaneous
Comments:
(`lirlr +n a -
Attach pertinent documentation or attachments not previously requested
I. Signature *
❑x By checking the box and signing below, I, as the project proponent, certify to the following:
• The project proponent hereby certifies that all information contained herein is true, accurate, and complete, to
the best of my knowledge and belief;
• The project proponent hereby requests that the certifying authority review and take action on this CWA 401
certification request within the applicable reasonable period of time;
• The project proponent hereby agrees that submission of this PCN form is a "transaction" subject to Chapter
66, Article 40 of the NC General Statutes (the "Uniform Electronic Transactions Act");
• The project proponent hereby agrees to conduct this transaction by electronic means pursuant to Chapter 66,
Article 40 of the NC General Statutes (the "Uniform Electronic Transactions Act");
• The project proponent hereby understands that an electronic signature has the same legal effect and can be
enforced in the same way as a written signature; AND
• As the project proponent, I intend to electronically sign and submit the PCN/online form.
Full Name: Michael T. Brame
Michael
Signature: om,
Bramerezoz,o ze, ,,az�eo
7/28/2021
Page 21 of 21 PCN Form - Version 1.5, September 2020

Proposal for Environmental Services
Pilot Proposal 6754
April 12, 2021
AGENT AUTHORIZATION
This form authorizes Pilot to act as our agent in stream/wetland matters including U.S. Army
Corps of Engineers and North Carolina Division of Water Resources field verification and
permitting.
Property Address:
Owner Information. Cw CJ_n
Address:
Telephone Number: 33 "
Fax Number:
E-mail Address:
Mp'13sKISQreCrV1U-I� Can1
JURISDICTIONAL DETERMINATION REQUEST
D. PROPERTY ACCESS CERTIFICATION
By signing below, I authorize representatives of the Wilmington District, U.S. Army Corps of
Engineers (Corps) to enter upon the property herein described for the purpose of conducting on -
site investigations, if necessary, and issuing a jurisdictional determination pursuant to Section
404 of the Clean Water Act and/or Section 10 of the Rivers and Harbors Act of 1899. I, the
undersigned, am either a duly authorized owner of record of the property identified herein, or
acting as the duly authorized agent of the owner of record of the property.
Print Name
Capacity: X Owner _ Authorized Agent
Date COY
Signature
61

Orange County
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This map contains parcels prepared for the inventory of real property withi n Orange County, and is compiled from
recorded deed, plats, and other public records and data. Users of this mepare hereby notified that the aforementioned
public primary information sources should be consulted for verification of the information contained on this map. The
county and its mapping compan ies assume no legal responsibility for the info rma to n o n this map.
PIN: 9857487266
OWNER 1: GARNER SEBASTIAN DUKE
OWNER 2: KISER MARGARET STEWART
ADDRESS 1: 1017 SPIKE RD
ADDRESS 2:
CITY: HILLSBOROUGH
SIZE: 76.25 A
DEED REF: 6633/2121
RATECODE: 00
DATE SOLD: 11/06/2019
BLDG SQ FT:
YEAR BU I LT:
BUILDING COUNT:
LAND VALUE:
BLDG VALUE:
USE VALUE:
TOTAL VALUE:
-
kr. 1,44t
April 6, 2021
$475,400
$0
$0
$475,400
1:3,600
0 0.03 0.06 0.12 mi
I I I
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STATE, ZIP: NC 27278
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DRAWN BY: CPK 204 W. Clay Street
PROJECT NO: 20-17 Mebane, NC 27302
DRAWING NAME: 20-17 WORKING EXHIBIT 1: BUFFER IMPACTS Phone: [phone] • •^�
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DRAWING REVISION: 0 TO RIPARIAN ZONES E-Mail: [e-mail]

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DRAWN BY: CPK 204 W. Clay Street
PROJECT NO: 20-17 Mebane, NC 27302
DRAWING NAME: 20-17 WORKING EXHIBIT 2: STREAM IMPACTS Phone: [phone] • •^�
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DRAWING REVISION: 0 (NO GRADING SHOWN) E-Mail: [e-mail]

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HORIZONTAL SCALE: 1" = 40- Licence # C-2638
PROJECT MANAGER: CPK ORANGE COUNTY, NC
DRAWN BY: CPK 204 W. Clay Street
PROJECT NO: 20-17 Mebane, NC 27302
DRAWING NAME: 20-17 WORKING EXHIBIT 3: STREAM IMPACTS Phone: [phone] • •^�
Fax: [phone]
DRAWING REVISION: 0 (WITH GRADES) E-Mail: [e-mail]

D# * 20210818
Version* 1
Regional Office * Central Office - [phone]
Reviewer List* Rick Trone
Pre -Filing Meeting Request submitted 4/21/2021
................................................................................................................................................................................................................
Contact Name* Heather LaGamba
Contact Email Address*
Project Name*
Project Owner*
Project County*
Owner Address:
[e-mail]
The Preserve Tallulah Spring
Sebastian Garner/Margaret
Orange
Street Address
1017 Spike Road
Address Line 2
aty
Hillsborough
Postal / Zip axle
27278
Is this a transportation project?* r Yes r No
State / Province / Pegion
NC
Country
USA
Type(s) of approval sought from the DWR:
* 401 Water Quality Certification - F 401 Water Quality Certification -
Regular Express
* Individual Permit F Modification
F Shoreline Stabilization
Does this project have an existing project ID#?*
C Yes (-- No
Do you know the name of the staff member you would like to request a meeting with?
Sue Homewood
Please give a brief project description below and include location information.*
The applicant does not request a meeting. The applicant may submit
a request for 401 WQC.
Please give a couple of dates you are available for a meeting.

Please attach the documentation you would like to have the meeting about.
pdf only
By digitally signing below, I certify that I have read and understood that per the Federal Clean Water Act Section
401 Certification Rule the following statements:
This form completes the requirement of the Pre -Filing Meeting Request in the Clean Water Act Section 401 Certification
Rule.
1 understand by signing this form that I cannot submit my application until 30 calendar days after this pre -filing
meeting request.
1 also understand that DWR is not required to respond or grant the meeting request.
Your project's thirty -day clock started upon receipt of this application. You will receive notification regarding meeting location
and time if a meeting is necessary. You will receive notification when the thirty -day clock has expired, and you can submit an
application.
Signature
r 0. .61 r�+.A,,
Submittal Date 4/21/2021

IIJ
Drawing
USGSTopographic Map
Cedar Grove, NCQuadrangle �
Scale: 1"=2�000' 0
LEGEND
Site Boundary
USGS Topographic Map
Approximate 76-AoreTract
Eno Cemetery Road
Cedar Grove, Orange County, NC
Pilot Project 6754

'.r
7!'r
Drawing 2
USDA Web Soil Survey
of Orange County, NC F11
I7,
Scale: 1" = 500'
PILOT E N Y I R 0 N M E N 7 A L. I N C
r .,.y
E • � *� Mrs
I µ
LEGEND
Site Boundary
.M
Web Soil Map
Approximate 76-Acre Tract
Eno Cemetery Road
Cedar Grove, Orange County, NC
Pilot Project 6754

Drawing 2A
USDA Soil Survey
of Orange County, NC
Published 1977, Sheet 6
Not to Scale
j z
PILOT
P I L O T E N V I R 0 N M E N 7 A L. I N C
Published Soil Map
Approximate 76-Acre Tract
Eno Cemetery Road
Cedar Grove, Orange County, NC
Pilot Project 6754

Drawing 3
USFWS NWI
Wetlands Mapper
Scale: 1" = 500'
r
PILOT
P I L O T E N V I R 0 N M E N T A L I N C
r
�5
k
' a
LEGEND
Site Boundary
Freshwater Emergent
Freshwater Forested/Shrub
Estuarine and Marine Deepwater
Estuarine and Marine
Freshwater Pond
Lake
Rivenne
Other
r
NWI Map
Approximate 76-Acre Tract
Eno Cemetery Road
Cedar Grove, Orange County, NC
Pilot Project 6754

At A _ +►�.
Drawing 4
FEMA FIRM Panels
3710985700K
Effective 11.17.17
Scale: 1" = 500'
s } V
LEGEND
Site Boundary
196.Annual Chance Flood Hazard
Regulatory Floodvay
Sped al Floodvay
Area of Undetermined Flood Hazard
0.29(.Annual Chance Flood Hazard
Future Conditions 1'/¢Annual Chance Flood Hazard
► Area with R educed Risk Due to Levee
y �FEMA FIRM
Approximate 76-Acre Tract
Eno Cemetery Road
PILOT Cedar Grove, Orange County, NC
PILOT ENVIR0NMEN7AL,INL Pilot Project6754

FLAG NUMBERS/INFO
WETLAND FLAGS =
STREAM FLAGS =ZA
WF 1-55
1.347 Ac.
LEGEND
Site Boundary
0 Wetland
Pond
Perennial Stream
SA 1-5 Flag Number/Feature ID
DP-1 Q Data Point
WD 1-17
0.895 Ac.
WE 1-5
0.054 Ac.
THE LOCATIONS OF FEATURES SHOWN ON THIS MAP ARE APPROXIMATE. THEY WERE
VERIFIED BY MS. APRIL NORTON WITH THE USACE VIA DESKTOP REVIEW (E-MAIL FROM MS.
NORTON ON 7.15.21). THIS MAP INCLUDES GPS LOCATIONS OF DELINEATED FEATURES.
Drawing 5 Wetland Map
Aerial Imagery from ESRI Approximate 76-Acre Tract
and Pilot Field Notes - - Eno Cemetery Road
Scale: 1" = 500' PIL01 Cedar Grove, Orange County, NC
Date:4.30.21 PILOT ENVIRONMENTAL,17NC Pilot Project6754

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D# * 20210818
Version* 1
Regional Office * Central Office - [phone]
Reviewer List* Rick Trone
Pre -Filing Meeting Request submitted 4/21/2021
................................................................................................................................................................................................................
Contact Name* Heather LaGamba
Contact Email Address*
Project Name*
Project Owner*
Project County*
Owner Address:
[e-mail]
The Preserve Tallulah Spring
Sebastian Garner/Margaret
Orange
Street Address
1017 Spike Road
Address Line 2
aty
Hillsborough
Postal / Zip axle
27278
Is this a transportation project?* r Yes r No
State / Province / Pegion
NC
Country
USA
Type(s) of approval sought from the DWR:
* 401 Water Quality Certification - F 401 Water Quality Certification -
Regular Express
* Individual Permit F Modification
F Shoreline Stabilization
Does this project have an existing project ID#?*
C Yes (-- No
Do you know the name of the staff member you would like to request a meeting with?
Sue Homewood
Please give a brief project description below and include location information.*
The applicant does not request a meeting. The applicant may submit
a request for 401 WQC.
Please give a couple of dates you are available for a meeting.

Please attach the documentation you would like to have the meeting about.
pdf only
By digitally signing below, I certify that I have read and understood that per the Federal Clean Water Act Section
401 Certification Rule the following statements:
This form completes the requirement of the Pre -Filing Meeting Request in the Clean Water Act Section 401 Certification
Rule.
1 understand by signing this form that I cannot submit my application until 30 calendar days after this pre -filing
meeting request.
1 also understand that DWR is not required to respond or grant the meeting request.
Your project's thirty -day clock started upon receipt of this application. You will receive notification regarding meeting location
and time if a meeting is necessary. You will receive notification when the thirty -day clock has expired, and you can submit an
application.
Signature
r 0. .61 r�+.A,,
Submittal Date 4/21/2021