20200941 Ver 1_401 Application_20200721

DWR
mrlslon of Water Resources
Pre -Construction Notification (PCN) Form
April 11, 2020 Ver 3.1
Initial Review
Has this project met the requirements for acceptance in to the review process?*
r Yes
r No
Is this project a public transportation project?*
C Yes r No
Change only if needed.
BIMS # Assigned
20200941
Is a payment required for this project?*
r No payment required
r Fee received
r Fee needed - send electronic notification
Reviewing Office *
Nboresville Regional Office - [phone]
Information for Initial Review
1a. Name of project:
Proposed Albemarle Corporate Center
1a. Who is the Primary Contact?*
Nathan Howell
1b. Primary Contact Email:*
[e-mail]
Date Submitted
7/21/2020
Nearest Body of Water
Poplin Branch
Basin
Yadkin-PeeDee
Water Classification
13-17-31-1-3
Site Coordinates
Latitude: Longitude:
35.331602-80.173307
A. Processing Information
County (or Counties) where the project is located:
Stanly
Is this a NCDMS Project
r Yes r No
Is this project a public transportation project?*
r Yes r No
1a. Type(s) of approval sought from the Corps:
W Section 404 Permit (wetlands, streams and waters, Clean Water Act)
r Section 10 Permit (navigable waters, tidal waters, Rivers and Harbors Act)
Version#*
1
What amout is owed?*
r $240.00
r $570.00
Select Project Reviewer*
Alan Johnson:eads\adjohnson1
1c. Primary Contact Phone:*
[phone]
L.1
1b. What type(s) of permit(s) do you wish to seek authorization?

W Nationwide Permit (NWP)
r Regional General Permit (RGP)
r Standard (IP)
1c. Has the NWP or GP number been verified by the Corps?
r Yes r No
Nationwide Permit (NWP) Number:
Nationwide Permit (NWP) Number:
NWP Numbers (for multiple NWPS):
1d. Type(s) of approval sought from the DWR:
W 401 Water Quality Certification - Regular
r Non-404 Jurisdictional General Permit
r Individual Permit
27 - Restoration
39 - Commercial/Institutional Developments
le. Is this notification solely for the record because written approval is not required?
For the record only for DWR 401 Certification:
For the record only for Corps Permit:
F- 401 Water Quality Certification - Express
F- Riparian Buffer Authorization
1f. Is this an after -the -fact permit application?*
r Yes r No
1g. Is payment into a mitigation bank or in -lieu fee program proposed for mitigation of impacts?
r Yes r No
1g. Is payment into a mitigation bank or in -lieu fee program proposed for mitigation of impacts?
r Yes r No
Acceptance Letter Attachment
1h. Is the project located in any of NC's twenty coastal counties?
r Yes r No
1j. Is the project located in a designated trout watershed?
r Yes r No
B. Applicant Information
1d. Who is applying for the permit?
W Owner r Applicant (other than owner)
le. Is there an Agent/Consultant for this project?*
r Yes r No
2. Owner Information
2a. Name(s) on recorded deed:
City of Albemarle, North Carolina
2b. Deed book and page no.:
1622; 780
2c. Responsible party:
N/A
2d.Address
Street Address
144 North 2nd Street
Address Line 2
PO Box190
City
Albemarle
Postal / Zip Code
28001
2e. Telephone Number:
[phone]
2g. Email Address:*
[e-mail]
State / F rovince / Fbgion
North Carolina
Country
U.S.
2f. Fax Number:
r^ Yes r No
r^ Yes r No

4. Agent/Consultant (if applicable)
4a. Name:
Nathan Howell
4b. Business Name:
Three Oaks Engineering, Inc.
4c.Address
Street Address
324 Blackwell Street
Address Line 2
Suite 1200
City
Durham
Postal / Zip Code
27701
4d. Telephone Number:
[phone]
4f. Email Address:*
[e-mail]
Agent Authorization Letter*
COA_Agent Authorization_ All Signatures.pdf
State / Rovince / Iagion
NC
Country
U.S.
4e. Fax Number:
216.77KB
C. Project Information and Prior Project History C^U
1. Project Information
1b. Subdivision name:
(if appropriate)
N/A
1c. Nearest municipality/ town:
Albemarle
2. Project Identification
2a. Property Identification Number:
654702867363;654702776623;
654702781094;654702689524;
654702792163; 654702698087;
2b. Property size:
654702696763
291
2c. Project Address
Street Address
24524 South Business 52
Address Line 2
city
State / Rovince / Ibgion
Albemarle
NC
Postal / Zip Code
Country
28001
US
3. Surface Waters
3a. Name of the nearest body of water to proposed project:*
Poplin Branch
3b. Water Resources Classification of nearest receiving water:*
13-17-31-1-3
3c. What river basin(s) is your project located in?*
Yadkin-PeeDee
3d. Please provide the 12-digit HUC in which the project is located.
030401050401 & 030401040203
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 City of Albemarle proposes to develop the Albemarle Corporate Center on parcel PIN 654702867363. As part of this project, a sewer line will need to be extended from an existing
line to parcel PIN 654702867363. This proposed gravity -fed sewer line Will parallel Poplin Branch in its Floodplain and cross an additional 5 parcels. A proposed extension of existing
Leonard Avenue to conned to the Corporate Center is also part of this project. Land use associated with this project consists of agriculture, small unnamed tributaries and their
associated floodplains, mixed pine/hardwood ridges and slopes, and a small amount of commercial.
4b. Have Corps permits or DWR certifications been obtained for this project (including all prior phases) in the past?*
r Yes r No r Unknown
4d. Attach an 8 1/2 X 11 excerpt from the most recent version of the USGS topographic map indicating the location of the project site. (for DWR)
ACC_EPCN_Topo_Figure _UPDATED _06042020.pdf
1.37 MB
4e. Attach an 8 1/2 X 11 excerpt from the most recent version of the published County NRCS Soil Survey map depicting the project site. (for DWR)
ACC_NRCS_SOILS_MAP_UPDATED_06042020.pdf 1.35MB
4f. List the total estimated acreage of all existing wetlands on the property:
2.74
4g. List the total estimated linear feet of all existing streams on the property:
13,092
4h. Explain the purpose of the proposed project:*
The City of Albemarle proposes to develop a corporate center on parcel PIN 654702867363. As a result, a gravity -fed sewer line extension from the City will need to be constructed to
the site. Additionally, existing Leonard Avenue will be extended to connect to the Corporate Center.
4i. Describe the overall project in detail, including indirect impacts and the type of equipment to be used:*
The Albemarle Corporate Center is a business park proposed by the City of Albemarle. As part of the proposed project, the City proposes to develop the project site to include up to 16
separate buildings totaling up to 1,688,750 square feet of enclosed building space. As part of the site proposal, a road network Will also be constructed that connects the corporate
center to US 52 Business, Leonard Avenue, and Henson Street in Albemarle. Utilities such as gravity sewer, water, and electricity are also proposed for the site. Typical construction
equipment, such as trucks, cranes, and dozers, Will be used during construction.
4j. Please upload project drawings for the proposed project.
Sewer Outfall Plan & Profiles 5.9.19.pdf
12.32MB
Environmental Impacts 07162020.pdf
7.82MB
Grading & Erosion Control 7.20.20.pdf
13.46MB
Roadway Plan & Profiles 7.20.20.pdf
9.36MB
5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the property or proposed impact areas?*
r Yes r No
Comments:
Three Oaks Engineering staff members delineated all potential WOUS on parcel PIN 654702867363
on February 22-23, 2018. A PJD site visit with David Shaeffer of the USACE was held on May 4,
2018 and these features were verified. Additional areas, including the proposed sewer line
extension and Leonard Avenue extension, have since been reviewed and additional features have
been identified. These new features have not yet been verified.
5b. If the Corps made a jurisdictional determination, what type of determination was made?*
r Preliminary r Approved r Not Verified r Unknown r N/A
Corps AID Number:
SAW-2018-00566
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known): Nathan Howell
Agency/Consultant Company: Three Oaks Engineering, Inc.
Other:
r Unknown
5d. List the dates of the Corp jurisdiction determination or State determination if a determination was made by the Corps or DWR
May 4, 2018 (no tear sheet provided). Features outside of parcel 654702867363 were not included in this site verification. Those outside of this parcel were recently added and have
not been verified. Information/forms related to these features are included in this permit application. If a site visit is required for these sites, please let us know and we can schedule a
site visit.
5d1. Jurisdictional determination upload
ACC_Additional_PSA_PJD_07162020_REDUCED.pdf 4.16MB
6. Future Project Plans
6a. Is this a phased project?*
r Yes r No
Are any other NWP(s), regional general permit(s), or individual permits(s) used, or intended to be used, to authorize any part of the proposed project or related activity?
No. The proposed plan is a full build -out of the project site. No additional development or expansion of the site is planned.
D. Proposed Impacts Inventory

1. Impacts Summary
1a. Where are the impacts associated with your project? (check all that apply):
® Wetlands Pr Streams -tributaries F Buffers
F7 Open Waters r- Pond Construction
2. Wetland Impacts
2a1 Reason (?)
2b. Impact type * (?)
2c. Type of W.
2d. W. name *
2e. Forested *
2f. Type of
2g. Impact
Jurisdicition*(?)
area*
2
Vegetation & stump
T
Bottomland Hardwood Forest
WAD
Yes
Corps
0.012
removal, excavation,
(acres)
refill to grade, sow
native wetland seed mix
3
Vegetation & stump
T
Bottomland Hardwood Forest
WAE
Yes
Corps
0.004
removal, excavation,
(acres)
refill to grade, sow
native wetland seed mix
4
Vegetation & stump
T
Non -Tidal Freshwater Marsh
WAF
No
Corps
0.001
removal, excavation,
(acres)
refill to grade, sow
native wetland seed mix
4
Vegetation & stump
T
Non -Tidal Freshwater Marsh
WAG
No
Corps
0.006
removal, excavation,
(acres)
refill to grade, sow
native wetland seed mix
5
Vegetation & stump
T
Bottomland Hardwood Forest
WB
Yes
Corps
0.010
removal, excavation,
(acres)
refill to grade, sow
native wetland seed mix
6
Vegetation & stump
T
Bottomland Hardwood Forest
WK
Yes
Corps
0.001
removal, excavation,
(acres)
refill to grade, sow
native wetland seed mix
11
Culvert placement and
f
Headwater Forest
WO
Yes
Corps
0.014
roadbed construction
(acres)
12
Vegetation & stump
T
Non -Tidal Freshwater Marsh
WAG
No
Corps
0.001
removal, excavation,
(acres)
refill to grade, sow
native wetland seed mix
12
Vegetation & stump
T
Bottomland Hardwood Forest
WAI
Yes
Corps
0.007
removal, excavation,
(acres)
refill to grade, sow
native wetland seed mix
13
Vegetation & stump
T
Bottomland Hardwood Forest
WW
Yes
Corps
0.001
removal, excavation,
(acres)
refill to grade, sow
native wetland seed mix
E�Ity
Fill 71
P
Headwater Forest
Yes
ff
0.070
]WAJ
(acres)
2g. Total Temporary Wetland Impact
0.043
2g. Total Wetland Impact
0.127
2h. Comments:
2g. Total Permanent Wetland Impact
0 084
Wetland WAF impacts on sheet 4 = .0002 acre
Wetland WAG impacts on sheet 12 = .0001 acre
The temporary wetland impacts are all associated with the placement of the gravity sewer line. Existing vegetation will be removed and wetland soil will
be temporarily displaced to install the sewer line. After installation, the wetland soil will be returned and the contour and elevation of the sites will be
restored to pre-existing conditions. A native wetland seed mixwill then be spread to restore hydrophytic vegetation to the sites.
3. Stream Impacts
F
3a. Reason for impact (?) 3b.lmpact type * 3c. Type of impact* 3d. S. name * ��3e. Stream Type* 3f. Type of 3g. S. width* ��3h. Impact
(?) Jurisdiction* length*

S1
Open -cut Excavation
P
Tem orar
P Y
Excavation
SO
Perennial
��_]
10
30
Average (feet)
(linearfeet)
S2
Open -cut Excavation
Tem orar
P YAverage
Excavation JSA
Perennial
BothP
(feet)
(lir�rfeet)
S3
Open -cut Excavation
P
Tem orar
P Y
Excavation
SD
Intermittent
Both
5
30
Average (feet)
(linearfeet)
S4
Open -cut Excavation
P
Tem orar
P Y
Excavation
SE
Perennial
Both
10
118
Aver�ge(feet)
(linearfeet)
S5
Culvert placement &roadbed
Permanent
Culvert
SE
Perennial
Both
10
73
construction
Average (feet)
(lin�'feet)
S6
Open -cut Excavation
P
Tem ora
P rY
Excavation
SE
Perennial
Both
7
30
Average (feet)
(linearfeet)
S7
Open -cut Excavation
Tem ora
P rYAverage
Excavation JSJ
Perennial
BothP
(feet)
(linearfeet)
SS
Culvert placement and
Permanent
Culvert
SJ
Perennial
Both
7
71
roadbed construction
Average (feet)
(lirrfeet)
�S9
O en -cut Excavation
P
Tem orar
P Y
Excavation JSA
Perennial
Both
7
30
Average (feet)
(linearfeet)
�01
Open -cut Excavation
Tem orar
P Y
Excavation
SL
Intermittent
Both
6
30
Average (feet)
(linearfeet)
S11
Open -cut Excavation
Temporary
Excavation
SL
Intermittent
Both
10
43
Average (feet)
(linearfeet)
S12
Culvert placement & roadbed
Permanent
Culvert
SL
Intermittent
Both
10
89
Construction
Average (feet)
(lir�rfeet)
31. Total jurisdictional ditch impact in square feet:
0
3i. Total permanent stream impacts:
233
3i. Total stream and ditch impacts:
704
3i. Total temporary stream impacts:
471
3j. Comments:
All stream crossings with temporary impacts will be dewatered, then open -cut to install a 12" gravity -fed sewer pipe. After installation the open -cut
areas will be covered with the original material excavated from the stream bed. Excavated stream channels will be returned to the original streambed
contour and elevation and deemed stabilized prior to allowing water to flow again through those stream reaches.
4. Open Water Impacts
4a. Site # 4a1. Impact Reason 4b. Impact type 4c. Name of wat.rbody 4d. Activity type 4e. Waterbody type 4f. Impact area
15
Drain
P
PF
Drainage
Pond
0.53
15
Drain
P
PE
Drainage
Pond
0.60
4g. Total temporary open water Impacts:
0.00
4g. Total open water impacts:
1.13
4g. Total permanent open water impacts:
1.13
4h. Comments:
These ponds are proposed to be drained in an attempt to let the original Poplin Branch channel reform along with any potential floodplain wetlands.
E. Impact Justification and Mitigation
1. Avoidance and Minimization
la. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:

This project has been designed With as few crossings of jurisdictional features as possible to allow access to each developable parcel while also
meeting County codes. The crossings have been designed to minimize jurisdictional impacts by avoiding features wherever possible. Where crossings
occur, they are as close to perpendicular as possible. Construction has been sequenced and designed to avoid/minimize impacts by locating
temporary diversion channels away from features. Rip rap at structure inlets and outlets Will be minimized and countersunk so as not to impact aquatic
passage. An estimated 733 linear feet of stream will be restored on -site by draining Ponds PE and PF and allowing Poplin Branch to reform within its
natural channel on the valley floor. Floodplains and adjacent slopes exposed due to pond drainage Will be sowed With a native riparian and upland
seed mix to stabilize slopes and banks.
For the installation of the sewer pipe, all stream crossings with temporary impacts Will be dewatered, then open -cut to install a 12" gravity -fed sewer
pipe. After installation the open -cut areas will be covered with the original material excavated from the stream bed. Excavated stream channels will be
returned to the original streambed contour and elevation and deemed stabilized prior to allowing water to flow again through those stream reaches.
Temporary wetland impacts are all associated with the placement of the 12" gravity sewer line. Existing vegetation will be removed, and wetland soil will
be temporarily displaced to install the sewer line. After installation, the wetland soil Will be returned, and the contour and elevation of the sites will be
restored to pre-existing conditions. A native wetland seed mix Will then be spread to restore hydrophytic vegetation to the sites.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:
Silt fencing will be installed at the base of slopes to prevent runoff during construction. Construction on this project shall be in accordance with Stanly
County standard details, code of ordinances, and standard specifications. Construction on this project shall be in accordance with all applicable
current county, state, NCDOT and utility provider standards, specifications, and building codes. The contractor shall grade, seed and sod or otherwise
provide temporary and permanent stabilization of all disturbed areas, especially slopes. The contractor Will followthe attached Grading and Erosion
Control plan during construction to avoid and minimize project -related erosion and stormwater issues.
2. Compensatory Mitigation for Impacts to Waters of the U.S. or Waters of the State
2a. Does the project require Compensatory Mitigation for impacts to Waters of the U.S. or Waters of the State?
r Yes r No
2c. If yes, mitigation is required by (check all that apply):
r DWR W Corps
2d. If yes, which mitigation option(s) will be used for this project?
r Mitigation bank r Payment to in -lieu fee W Permittee Responsible
program Mitigation
5. Complete if Using a Permittee Responsible Mitigation Plan
5a. If using a permittee responsible mitigation plan, provide a description of the proposed mitigation plan including mitigation credits generated.
On -site mitigation is being proposed where Ponds PE and PF are being drained. Following pond drainage, an estimated 733 linear feet of Poplin
Branch that was previously impounded Will be restored. The stream will be allowed to naturally re-channelize at the pond sites once the ponds are
drained. The drained area Will be re -vegetated with a native plant mix to stabilize the exposed areas and prevent future erosion and to assist in
stabilizing the banks of the re-channelized portion of Poplin Branch. It is also assumed that wetland pockets Will develop in the drained areas adjacent
to the re-channelized stream. An as -built of the restoration site Will be provided upon construction completion showing the new stream location and
any wetland areas that have developed.
5b. Mitigation Plan Upload
Environmental Impacts _Sheet15_Pond Drainage. pdf
ACC_Pond_Drainage_Stream_Mit_Schematic. pdf
1.07MB
303.06KB
F. Stormwater Management and Diffuse Flow Plan (required by DWR)
1. Diffuse Flow Plan
1a. Does the project include or is it adjacent to protected riparian buffers identified within one of the NC Riparian Buffer Protection Rules?
r Yes r No
If no, explain why:
This project is not located Within a basin subject to streamside riparian buffer rules.
2. Stormwater Management Plan
2a. Is this a NCDOT project subject to compliance with NCDOT's Individual NPDES permit NCS000250?*
r Yes r No
2b. Does this project meet the requirements for low density projects as defined in 15A NCAC 02H .1003(2)?
r Yes r No
Comments:
G. Supplementary Information
1. Environmental Documentation
1a. Does the project involve an expenditure of public (federal/state/local) funds or the use of public (federal/state) land?*
U
U
r Yes r No

1b. If you answered "yes" to the above, does the project require preparation of an environmental document pursuant to the requirements of the National or State (North Carolina)
Environmental Policy Act (NEPA/SEPA)? *
r Yes r No
Comments:*
This project is entirely municipally -funded and does not require NEPA/SEPA documentation.
2. Violations (DWR Requirement)
2a. Is the site in violation of DWR Water Quality Certification Rules (15ANCAC 2H .0500), Isolated Wetland Rules (15A NCAC 2H .1300), or DWR Surface Water or Wetland Standards or
Riparian Buffer Rules (15A NCAC 2B .0200)?*
r Yes r No
3. Cumulative Impacts (DWR Requirement)
3a. Will this project result in additional development, which could impact nearby downstream water quality?*
r Yes r No
3b. If you answered "no," provide a short narrative description.
The proposed plan is a full build -out of the project site. No additional development or expansion of the site is planned. The City also does not
anticipate acquisition of property adjacent to this project that would result in additional developement that would impact nearby downstream water
quality. As this is a business center, it is not e)pected that this project would promote/trigger any nearby residential development adjacent to the
property.
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project?*
r Yes r Nor N/A
4b. 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.
Wastewater will be connected to the City of Albemarle's sewer system via a gravity -fed sewer line extension associated with the project.
5. Endangered Species and Designated Critical Habitat (Corps Requirement)
5a. Will this project occur in or near an area with federally protected species or habitat?*
r Yes r No
5b. Have you checked with the USFWS concerning Endangered Species Act impacts?*
r Yes r No
5c. If yes, indicate the USFWS Field Office you have contacted.
Asheville
5d. Is another Federal agency involved?*
r Yes r No r Unknown
5e. Is this a DOT project located within Division's 1-8?
r Yes r No
5f. Will you cut any trees in order to conduct the work in waters of the U.S.?
r Yes r No
5g. Does this project involve bridge maintenance or removal?
r Yes r No
5h. Does this project involve the construction/installation of a wind turbine(s)?'
r Yes r No
51. Does this project involve (1) blasting, and/or (2) other percussive activities that will be conducted by machines, such as jackhammers, mechanized pile drivers, etc.?
r Yes r No
5j. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?

hftps://vmw.fm.gov/raleigh/species/cntylist/stanly.htmi ..fws.gov/raleigh/species/cntylist/stanly.htmi - bald eagle, PLEB, and Scweinitts sunflower listed
http://ncnhde.natureserve.org/content/map - Three H. schweinitai populations are known to occur within 1-mile of the southernmost boundary of the
project study area.
https://ecos.fws.gov/ipact
https://www.fws.gov/asheville/htmis/project_review/NLEB_in_WNC.html - not within red HUC
Sewer line right-of-way T&E species surveys were completd in October 2019 - Schweinitts sunflower was not found within the sewer line PSA. There
was no nesting habitat for bald eagle.
Bald eagle surveys were completed in the primary ACC study area and the Leonard Avenue extension on 6/12/20. No nesting habitat, nests, or
individuals were observed.
Schweinids sunflower surveys within the primary ACC study area and the Leonard Avenue extension study area have not yet occurred and Will be
conducted in mid -August 2020. A review of potential habitat was completed on 6/12/20 (attached) and will be the focus of the August surveys. The
results of this survey will be compiled into a survey report and presented to the City of Albemarle, the USFWS, and the USACE. If required due to
habitat presence and proximity to known occurrences, a concurrence request will be prepared and submitted to USACE/ USFWS for the project.
Consultation Documentation Upload
ACC —Sunflower Habitat.pdf 2.08MB
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as an Essential Fish Habitat?*
r Yes r No
6b. What data sources did you use to determine whether your site would impact an Essential Fish Habitat?*
https://www.habitat.noaa.gov/application/efhmpper/indexhtml
7. Historic or Prehistoric Cultural Resources (Corps Requirement)
7a. Will this project occur in or near an area that the state, federal or tribal governments have designated as having historic or cultural preservation status?*
r Yes r No
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?*
North Carolina Department of Natural and Cultural Resources State Historic Preservation Office
7c. Historic or Prehistoric Information Upload
SHPO Letter ER 19-0238.pdf 94.44KB
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA-designated 100-yearfloodplain?*
r Yes r No
8c. What source(s) did you use to make the floodplain determination?*
https://msc.fema.gov/portal/search?AddressQuery=albemarle%2C % 20nc#searchresultsanchor
Miscellaneous
Comments
Jurisdictional delineations along the proposed sewer line and Leonard Avenue extension have not been field -reviewed by USACE or NCDWR and were not included in the PJD package
for the original project study area. The PJD Package for the proposed sewer line corridor and Leonard Avenue extension area is attached to this application. An Agent Authorization
Form and Right of Entry Forms are included.
Miscellaneous attachments not previously requested.
Signature
W By checking the box and signing below, I certify that:
I have given true, accurate, and complete information on this form;
I agree 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");
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 PCN form.
Full Name:
Nathan Howell
Signature
��t1ur� `Yf k/K4�G

Date
7/21/2020