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HomeMy WebLinkAbout20211461 Ver 1_401 Application_20211006Staff Review Does this application have all the attachments needed to accept it into the review process?* r Yes r No ID#* 20211461 Version* 1 Is this project a public transportation project?* r Yes r No Reviewer List:* Colleen Cohn:eads\cmcohn Select Reviewing Office:* Raleigh Regional Office - (919) 791-4200 Submittal Type:* 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: Date for Meeting Request I D# Project Contact Information Name: Walter Cole who is subrritting the information? Email Address: wcole@smeinc.com Project Information Project Name: Golden Pond Culvert Subdivision Is this a public transportation project? r Yes r No Version Is the project located within a NC DCM Area of Environmental Concern (AEC)? r Yes r No r Unknown County (ies) Granville Please upload all files that need to be submited. click the upload button or drag and drop files here to attach document 30 Day Notice email.pdf 228.73KB Pre -Construction Notification (PCN) Form.pdf 136.36KB Only pdf or kmz files are accepted. Describe the attachments or comments: 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: Submittal Date: Is filled in automatically. Ashley Steele Bentz From: Sent: To: Subject: See below Walter Cole, LSS, REHS Senior Project Manager Walter Cole Friday, October 1, 2021 2:04 PM Ashley Steele Bentz FW: [External] Golden Pond Culvert Subdivision S&ME • 3201 Spring Forest Road Raleigh, NC 27616 map O: 919.872.2660 M:919.801.3798 www.smeinc.com &U I L T F O R Linkedln I Twitter I Facebook VFRSATILIT' This electronic message is subject to the terms of use set forth at www.smeinc.com/email. If you received this message in error please advise the sender by reply and delete this electronic message and any attachments. Please consider the environment before printing this email. From: Montalvo, Sheri A <sheri.montalvo@ncdenr.gov> Sent: Friday, October 1, 2021 1:58 PM To: Goss, Stephanie <stephanie.goss@ncdenr.gov>; Walter Cole <WCole@smeinc.com> Cc: Ashley Steele Bentz <abentz@smeinc.com> Subject: RE: [External] Golden Pond Culvert Subdivision This message originated outside of S&ME. Please report this as phishing if it implies it is from an S&ME employee. Thank you. Walter, please resubmit and upload this email in place for the pre filing meeting upload. Thanks, Sheri Mootalvo Administrative Specialist 401 & Buffer Permitting Branch Division of Water Resources Department of Environmental Quality Office: (919) 707-3635 Sheri. montalvo@ncdenr.eov Mailing address: 1617 Mail Service Center, Raleigh, NC 27699-1617 Physical address: 512 N. Salisbury Street, Raleigh, NC 27604 From: Goss, Stephanie Sent: Friday, October 1, 2021 1:40 PM To: Walter Cole <WCole@smeinc.com>; Montalvo, Sheri A <sheri.montalvo@ncdenr.gov> Cc: Ashley Steele Bentz <abentz@smeinc.com> Subject: RE: [External] Golden Pond Culvert Subdivision Sheri, This email confirms that I had a pre -application meeting with Ashley Bentz and Walter Cole for this project on January 7t" Thanks. Stephanie Z. Goss Environmental Program Consultant Division of Water Resources Raleigh Regional Office 3800 Barrett Drive Raleigh, NC 276o9 919-791-4256 E-mail correspondence to and from this address may be subject to the North Carolina Public Records Law and may be disclosed to third parties. From: Walter Cole <WCole@smeinc.com> Sent: Friday, October 1, 2021 1:39 PM To: Montalvo, Sheri A <sheri.montalvo@ncdenr.eov> Cc: Goss, Stephanie <stephanie.goss@ncdenr.gov>; Ashley Steele Bentz <abentz@smeinc.com> Subject: [External] Golden Pond Culvert Subdivision CAUTION: External email. Do not click links or open attachments unless you verify. Send all suspicious email as an attachment to Report Spam. Sheri, Just received the email notice that our application was rejected because of the 30-day notice. This is a project that involves a stream undermining a sewer line and we met Stephanie and the USACE on -site on January 7t"- 2021 to discuss permitting options and impacts. Thanks! Walter Cole, LSS, REHS Senior Project Manager SWE • 3201 Spring Forest Road Raleigh, NC 27616 map O: 919.872.2660 M:919.801.3798 www.smeinc.com BU' L t F O P Linkedln I Twitter I Facebook VERSATILITY This electronic message is subject to the terms of use set forth at www.smeinc.com/email. If you received this message in error please advise the sender by reply and delete this electronic message and any attachments. Please consider the environment before printing this email. DWR Division of Water Resources Pre -Construction Notification (PCN) Form For Nationwide Permits and Regional General Permits (along with corresponding Water Quality Certifications) June 1, 2021 Ver 4.1 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. Also, if at any point you wish to print a copy of the E-PCN, all you need to do is right -click on the document and you can print a copy of the form. Below is a link to the online help file. https://edoes. deq. n e.gov/WaterResou rces/0/ed oc/624704/PCN % 20 Help / 20F i le / 202018-1-30. pdf A. Processing Information County (or Counties) where the project is located:* Granville Is this a NCDMS Project* r Yes C No Click Yes, only if NCDlvS is the applicant a co -applicant. Is this project a public transportation project? O Yes F No This is arty publicly funded by mnicipal,state a federal funds road, rail, airport transportabm project. 1a. Type(s) of approval sought from the Corps:* Section 404 Permit (wetlands, streams and waters, Clean Water Act) ❑ Section 10 Permit (navigable waters, tidal waters, Rivers and Harbors Act) Has this PCN previously been submitted?* O Yes O No 1 b. What type(s) of permit(s) do you wish to seek authorization?* IJ Nationwide Permit (NWP) r Regional General Permit (RGP) r Standard (IP) 1c. Has the NWP or GP number been verified bythe Corps?* F Yes r No Nationwide Permit (NWP) Number: 03 - Maintenance NWP Numbers (for multiple NWPS): List all NJVnurbers ycw are applying fa not m the drop dawn list. 1d. Type(s) of approval sought from the DWR:* check all that apply ❑ 401 Water Quality Certification - Regular r 401 Water Quality Certification - Express r Non-404 Jurisdictional General Permit W Riparian Buffer Authorization r Individual 401 Water Quality Certification le. Is this notification solelyfor the record because written approval is not required? .............................................. .................... .................... * For the record onlyfor DWR 401 Certification: O Yes O No For the record onlyfor Corps Permit: 1f. Is this an after -the -fact permit application?* r Yes O No O Yes 6 No 1g. Is payment into a mitigation bank or in -lieu fee program proposed for mitigation of impacts? If so, attach the acceptance letter from ratiga5m bank a in -lieu fee program r Yes 0 No Acceptance Letter Attachment Click the upload button a drag and drop files here to attach docurrent RLEiYFEMJSTBEFDF 1 h. Is the project located in any of NC's twenty coastal counties?* G Yes G No 1j. Is the project located in a designated trout watershed?* 6 Yes O No Link to trout information: http://www.saw.usace.army.mil/Missions/Regulatory-Permit-Program/Agency-Coordination/Trout.aspx B. Applicant Information 6 la. Who is the Primary Contact?* Walter Cole of SRME 1c. Primary Contact Phone:* 1b. Pri mary Contact Email:* (xxx)xxx-xxxx wcole@smeinc.com (919)801-3798 1d. Who is applying for the permit? ,W Owner r Applicant (other than owner) (Check all that apply) le. Is there an Agent/Consultant for this project?* r• Yes r No 2. Owner Information 2a. Name(s) on recorded deed:* City of Creedmoor 2b. Deed book and page no.: 2c. Contact Person: (fa Corporations) Michael S. Frangos; Community Development Director 2d. Address* Street Address PO Box 765 Address Line 2 aty State / Aovince / Pegicn Creed moor NC Fbstal / Zp Code Country 27522 us 2e. Telephone Number:* (xxx)xxx-xxxx (919)764-1016 2f. Fax Number: (xxx)xxx-xxxx 2g. Email Address:* MFrangos@cityofereedrnoor.org 4. Agent/Consultant (if applicable) 4a. Name:* Walter Cole 4b. Business Name: (d applicable) SRME, Inc. 4c. Address* Street Address 3201 Spring Forest Road Address Line 2 Qty State / Aovince / Pegicn Raleigh NC Fbstal / Zp Code Country 27616 us 4d. Telephone Number:* (919)801-3798 (xxx)xxx-xxxx 4f. Email Address:* wcole@smeinc.com 4e. Fax Number: (xxx)xxx-xxxx C. Project Information and Prior Project History U 1. Project Information 1a. Name of project:* Golden Pond Subdivision Culvert Repair 1b. Subdivision name: (d appropriate) Golden Pond 1c. Nearest municipality / town: * Creed moor 2. Project Identification (� 2a. Property Identification Number: 2b. Property size: (tax RN a parcel ID) (in acres) 180603321748 8.09 2c. Project Address Street Address Ferbow, Street Address Line 2 aty State / Aovince / Pe3icn Creed moor NC Postal / Zp Code Country 27522 US 2d. Site coordinates in decimal degrees Please collect site coordinates in decimal degrees. Use between 4-6 digits (unless you are using a survey -grade GPS device) after the decimal place as appropriate, based on howthe location was determined. (For example, most mobile phones with GPS provide locational precision in decimal degrees to map coordinates to 5 or 6 digits after the decimal place.) Latitude:* Longitude:* 36.12005-78.64836 ex: 34.208504-77.796371 3. Surface Waters 3a. Name of the nearest body of water to proposed project:* UT - Robertson Creek 3b. Water Resources Classification of nearest receiving water:* WS-IV;NSW Surface Water Lookup 3c. What river basin(s) is your project located in?* Neuse 3d. Please provide the 12-digit HUC in which the project is located.* 030202010503 River Basin Lookup 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:* Based on documentation from the USACE, the Golden Pond subdivision was likely constructed in 1996. The existing 72' culvert beneath Ferbow, Street requiring maintenance was most likely also constructed at that time. A recombined plat that included the current configuration of the adjacent lot was recorded in 1997, likely indicating that the pipe extension that goes across 2047 Ferbow, Street was completed at that time. While there are no records of any approval of the pipe extension, it was likely covered under the limits of Nationwide General Permit 26 when it was constructed. The pipe outlets above an existing sewer manhole operated by the South Granville Water and Sewer Authority (SGWASA). The pipe outlet is currently eroding the bank of the stream and is undercutting the emsting sewer manhole. The Town of Creedmoor and SGWASA intend to install a rip rap apron around the culvert for energy dissipation and armor the eroded stream bank with rip rap to reduce the potential for damage to the sewer line and adjacent properties. The site is within the Golden Pond subdivision, which is located apprommately two miles east of the center of the town of Creedmoor. The surrounding area is primarily undeveloped, agricultural, or residential. 4b. Have Corps permits or DWR certifications been obtained for this project (including all prior phases) in the past? R Yes r No f Unknown If yes, please give the DWR Certification number or the Corps Action ID (exp. SAW-0000-00000). unknown 4f. List the total estimated acreage of all existing wetlands on the property: 4g. List the total estimated linear feet of all existing streams on the property: (intermittent and perennial) 70 4h. Explain the purpose of the proposed project:* The purpose of the project is to relocate a sewer manhole outside of the stream channel and to stabilize the stream to prevent further erosion and potential damage to the relocated sewer line. 4i. Describe the overall project in detail, including indirect impacts and the type of equipment to be used:* The existing 72" culvert beneath Ferbow Street, which is the source ofthe erosion ofthe emsting stream bank, will remain in place. The manhole currently located within the stream will be realigned outside ofthe stream limits. The outfall ofthe pipe will include a new Class I riprap apron. The stream bank will be rebuilt and additional armoring ofthe stream bank directly downstream ofthe discharge point would be proposed. No specialized equipment not regularly seen on commercial projects is anticipated. 5. Jurisdictional Determinations 5a. Have the wetlands or streams been delineated on the property or proposed impact areas?* C Yes Comments: r No 5b. If the Corps made a jurisdictional determination, what type of determination was made?* r Preliminary c Approved 6 Not Verified r Unknown r N/A Corps AID Number: Example: SAW-2017-99999 5c. If 5a is yes, who delineated the jurisdictional areas? Name (if known): Walter Cole Agency/Consultant Company: SRME, Inc. Other: 6. Future Project Plans 6a. Is this a phased project?* C Yes r No 6 Unknown Are any other NWP(s), regional general permit(s), or individual permits(s) used, or intended to be used, to authorize any part ofthe proposed project or related activity? This includes other separate and distant crossing for linear projects that require Department ofthe Army authorization but don't require pre -construction notification. D. Proposed Impacts Inventory U 1. Impacts Summary la. Where are the impacts associated with your project? (check all that apply): r Wetlands r Streams -tributaries rJ Buffers r Open Waters r Pond Construction 3. Stream Impacts If there are perennial or intermittent stream impacts (including temporary impacts) proposed on the site, then complete this question for all stream sites impacted. "S." will be used in the table below to represent the word "stream". 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* rip rap Permanent Stabilization tlRcbertson Creek Perennial Cor s p pp Avaage (feet) (linear feet) ** All Perennial or Intermittent streams must be verified by DWR or delegated local government. 3i. Total jurisdictional ditch impact in square feet: 0 3i. Total permanent stream impacts: 63 3i. Total temporary stream impacts: 0 3i. Total stream and ditch impacts: 63 3j. Comments: Impacts to the stream are necessary to remove and relocate the exsting manhole within the stream and to rebuild the stream banks. The stream banks will then be armored with Class I rip rap. A rip rap apron will be installed at the outfall to dissipate flowfrom the culvert. This will result in an impact of 63 linear feet of stream with an average width of six feet. 6. Buffer Impacts (for DWR) If project will impact a protected riparian buffer, then complete the chart below. Individually list all buffer impacts below. 6a. Project is in which protect basin(s)? * Check all that apply. [2 Neuse r Tar -Pamlico ❑ Catawba r Randleman ❑ Goose Creek r Jordan Lake ❑ Other 6b. Impact Type*(?) Allowable Upon Authorization 6c. Per or Temp*(?) P 6d. Stream name* 6e. Buffer mitigation required?* 6f. Zone 1 impact* 6g. Zone 2 impact* UT - Robertson Creek No F55 0 e feet) (square feet) Allowable Upon Authorization T UT - Robertson Creek No 7,416 (square feet) 718 (square feet) 6h. Total buffer impacts: ....................................................................................................................................................................................... Zone 1 Zone 2 Total Temporary impacts: 7,416.00 718.00 Zone 1 Zone 2 Total Permanent impacts: 2,552.00 0.00 Zone 1 Zone 2 Total combined buffer impacts: 9,968.00 718.00 6i. Comments: Temporary impacts to Zone 1 of the riparian buffer are the result of the relocation of the exsting sewer manhole within the existing sewer easement or within already cleared areas and will total 7,416 square feet. Temporary impacts to Zone 2 of the riparian buffer are also the relocation of the existing sewer and are located within the epsting sewer easement or adjacent properties. These will total 718 square feet. Permanent impacts to Zone 1 are the result of the installation of riprap to protect the stream bank, relocated sewer line, and to reduce erosion from an adjacent property. These impacts will total 2,552 square feet. 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:* The proposed area to be cleared has been minimized as much as practicable in the design of the project. Appropriate sediment and erosion control practices equaling those outlined in the most recent version of the "North Carolina Sediment and Erosion Control Planning and Design Manual' will be used to minimize impacts to the stream and adjacent riparian buffers. 1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:* Specific attention will be paid to ensure grading is only performed to the extent needed for the proposed project and all grading not required will be avoided. Additional impacts to the jurisdictional stream will be avoided through the use of appropriate sediment and erosion control devices. 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? C Yes E No 2b. If this project DOES NOT require Compensatory Mitigation, explain why: Thresholds do not meet amounts generally requiring mitigation. NC Stream Temperature Classification Maps can be found under the Mitigation Concepts tab on the Wilmington District's RIBITS website. F. Stormwater Management and Diffuse Flow Plan (required by DWR) *** Recent changes to the stormwater rules have required updates to this section .*** 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 1 b. All buffer impacts and high ground impacts require diffuse flow or other form of stormwater treatment. If the project is subject to a state implemented riparian buffer protection program, include a plan that fully documents how diffuse flowwill be maintained. All Stormwater Control Measures (SCM)s must be designed in accordance with the NC Stormwater Design Manual. Associated supplement forms and other documentation shall be provided. What type of SCM are you providing? r" Level Spreader r" Vegetated Conveyance (lower SHWT) r" Wetland Swale (higher SHWT) r" Other SCM that removes minimum30% nitrogen rd Proposed project will not create concentrated stormwater flowthrough the buffer (check all that apply) For a list of options to meet the diffuse flow requirements, click here. 2. Stormwater Management Plan 2a. Is this a NCDOT project subject to compliance with NCDOT's Individual NPDES permit NCS000250?* O Yes F No 2b. Does this project meet the requirements for low density projects as defined in 15A NCAC 02H .1003(2)? * O Yes C No To look up lowdensity requirement click here 15A NCAC 02H .1003(2). Comments: This project does not require a stormwater management plan. G. Supplementary Information 1. Environmental Documentation la. Does the project involve an expenditure of public (federal/state/local) funds or the use of public (federal/state) land? * F Yes C No 1 b. 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 G No Comments:* This project does not meet the requirements necessary for the preparation of an environmental document pursuant to the requirements of NEPA/SEPA. 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), or DWR Surface Water or Wetland Standards or Riparian Buffer Rules (15A NCAC 2B .0200)? * C Yes (-- No 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 downstream water quality?* O Yes O No 3b. If you answered "no," provide a short narrative description. This project will repair and armor the banks of a stream which has been eroded. No further development is anticipated as a result of this project. 4. Sewage Disposal (DWR Requirement) 4a.Issewage disposal required byDWRforthis project?* r Yes r- No r N/A 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?* 6 Yes C1 No 5b. Have you checked with the USFWS concerning Endangered Species Act impacts?* f Yes M No 5d. Is another Federal agency involved?* r Yes F No 5e. Is this a DOT project located within Division's 1-8?* C Yes E No 5f. Will you cut anytrees in order to conduct the work in waters of the U.S.?* 61 Yes O No 5g. Does this project involve bridge maintenance or removal?* r Yes r No Link to the NLEB SLOPES document: http://saw-reg.usace.army.mil/NLEB/1-1,0-17-signed_NLEB-SLOPESRapps.pdf 5h. Does this project involve the construction/installation of a wind turbine(s)?'* r Yes r No C- Unknown 5i. 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?* The NC Natural Heritage Program online data explorer (https://www.nenhp.org/data) and US Fish and Wildlife Service Information for Planning and Consultation (IPaC) report. No critical habitat was identified within the site and no element occurrences of protected species have been observed within the site or within one mile of the site. 6. Essential Fish Habitat (Corps Requirement) 6a. Will this project occur in or near an area designated as an Essential Fish Habitat?* r Yes (-- No 6b. What data sources did you use to determine whether your site would impact an Essential Fish Habitat?* The USFWS IPaC report and the National Marine Fisheries Service Essential Fish Habitat Mapper (https://vfflm.habitat.noaa.gov/protection/efh/efhmapper/) 7. Historic or Prehistoric Cultural Resources (Corps Requirement) Link to the State Historic Preservation Office Historic Properties Map (does not include archaeological data: http://gis.neder.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 preservation status (e.g., National Historic Trust designation or properties significant in North Carolina historyand archaeology)?* r Yes r• No 7b. What data sources did you use to determine whether your site would impact historic or archeological resources?* The North Carolina State Historic Preservation Office web mapping tool HPOWEB (https://www.neder.gov/about/history/division-historical- resources/gis-maps-and-data). The nearest historic resource was identified as the Mount Energy Historic District. This District is listed on the National Register and is located approximately 0.45 miles NE of the site. The site was previously disturbed for installation of the culvertand for the installation of the epsting sewer line. No impacts to historic resources are anticipated and a figure depicting the location of the Mount Energy Historic District in relation to the site is attached. 8. Flood Zone Designation (Corps Requirement) Link to the FEMAFIoodplain Maps: https://rrse.fema.gov/portal/search 8a. Will this project occur in a FEMA-designated 100-year floodplain? r Yes (-- No 8c. What source(s) did you use to make the floodplain determination?* The project engineer and the FEMA firm maps 3720170800J and 3720170700J, both dated May 2, 2006. The FEMA firmette is attached. Miscellaneous Comments Please use the space below to attach all required documentation or any additional information you feel is helpful for application review. Documents should be combined into one file when possible, with a Cover Letter, Table of Contents, and a Cover Sheet for each Section preferred. Oickthe upload button a drag and drop files here to attach docurrent USACE Email.pdf 331.51 KB 210107 Creedmoor Ferbow St Drainage 2084.pdf 623.71 KB FEMA firmette.pdf 703.63KB NCNHP Report.pdf 1.13MB USFWS IPaC Report.pdf 216.9KB SHPO.pdf 790.19KB Exhibit-A_2084-CU.pdf 787.35KB Creed moor 2021 _Agent Authorization Form for Ferbow Street_SME.pdf 151.75KB File must be FLF a IQvI7 Signature V By checking the box and signing below, I certify that: • The project proponent hereby certifies that all information contained herein is true, accurate, and complete to the best of my knowledge and belief'; and • The project proponent hereby requests that the certifying authority review and take action on this CWA401 certification request within the applicable reasonable period of time. • 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:* Willard Walter Cole, III Signature * ww/lp -P r C'3al Date 9/30/2021