20221257 Ver 1_ePCN Application_20220908

DWR
Division of Water Resources
Initial Review
Pre -Construction Notification (PCN) Form
For Nationwide Permits and Regional General Permits
(along with corresponding Water Quality Certifications)
June 1, 2021 Ver 4.1
Has this project met the requirements for acceptance in to the review process?*
Yes
No
Is this project a public transportation project?*
Yes No
Change only if needed.
BIMS # Assigned* Version#*
20221257 1
Is a payment required for this project?*
No payment required
Fee received
Fee needed - send electronic notification
Reviewing Office*
Winston-Salem Regional Office - (336) 776-
9800
Information for Initial Review
la. Name of project:
Fiddlers Creek Outfall Replacement
la. Who is the Primary Contact?*
Linda Diebolt
What amout is owed? *
$240.00
$570.00
Select Project Reviewer*
Sue Homewood:eads\slhomewood
1 b. Primary Contact Email:* lc. Primary Contact Phone:*
[e-mail] [phone]
Date Submitted
9/8/2022
Nearest Body of Water
Fiddlers Creek
Basin
Yadkin-PeeDee
Water Classification
C
Site Coordinates
Latitude:
36.047763
A. Processing Information
Longitude:
-80.196720
County (or Counties) where the project is located:
Forsyth
Is this a NCDMS Project
Yes No
Is this project a public transportation project?*
Yes No
Pre -Filing Meeting Information

Is this a courtesy copy notification? *
Yes No
ID# Version
Pre -fling Meeting or Request Date
9/27/2021
Attach documentation of Pre -Filing Meeting Request here:
Click the upload button or drag and drop files here to attach document
Signed Agent Authorization Form.pdf
File type must be PDF
la. 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?*
Yes
No
1 b. What type(s) of permit(s) do you wish to seek authorization?
Nationwide Permit (NWP)
Regional General Permit (RGP)
Standard (IP)
lc. Has the NWP or GP number been verified by the Corps?
Yes No
589.87KB
Nationwide Permit (NWP) Number: 58 - Utility Line Activities for Water and Other Substances (frequently used)
NWP Numbers (for multiple NWPS):
Id. Type(s) of approval sought from the DWR:
401 Water Quality Certification - Regular
Non-404 Jurisdictional General Permit
Individual 401 Water Quality Certification
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:
1f. Is this an after -the -fact permit application?*
Yes No
lg. Is payment into a mitigation bank or in -lieu fee program proposed for mitigation of impacts?
Yes No
lg. Is payment into a mitigation bank or in -lieu fee program proposed for mitigation of impacts?
Yes No
1 h. Is the project located in any of NC's twenty coastal counties?
Yes No
1j. Is the project located in a designated trout watershed?
Yes No
B. Applicant Information
ld. Who is applying for the permit?
Owner Applicant (other than owner)
1e. Is there an Agent/Consultant for this project? *
Yes No
2. Owner Information
2a. Name(s) on recorded deed:
City/County Utilities Commission
401 Water Quality Certification - Express
Riparian Buffer Authorization
Yes No
Yes No
2b. Deed book and page no.:
Utility easement

2c. Contact Person:
Derek Stroud
2d. Address
Street Address
P.O. Box 2511
Address Line 2
City State / Province / Region
Winston-Salem North Carolina
Postal / Zip Code Country
27102 United States
2e. Telephone Number: 2f. Fax Number:
[phone]
2g. Email Address: *
[e-mail]
4. Agent/Consultant (if applicable)
4a. Name:
Linda Diebolt
4b. Business Name:
Hazen and Sawyer
4c. Address
Street Address
4011 WestChase Boulevard, Suite 500
Address Line 2
City
Raleigh
Postal / Zip Code
27607
4d. Telephone Number:
[phone]
4f. Email Address: *
I d iebolt@ hazena nd sawyer. com
C. Project Information and Prior Project History
State / Province / Region
NC
Country
United States
4e. Fax Number:
1. Project Information
1b. Subdivision name:
(if appropriate)
lc. Nearest municipality / town:
Winston-Salem
2. Project Identification
2a. Property Identification Number:
n/a - easement
2c. Project Address
Street Address
Address Line 2
City
Winston Salem
Postal / Zip Code
3. Surface Waters
3a. Name of the nearest body of water to proposed project: *
Fiddlers Creek
3b. Water Resources Classification of nearest receiving water: *
C
2b. Property size:
19
State / Province / Region
NC
Country
USA
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.
030401011307
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 proposed project extends from immediately southwest of Old Lexington Road (NC SR 2743) to immediately northeast of Willard Road (NC SR 2700) along Fiddlers Creek in Winston-
Salem, Forsyth County, North Carolina and consists of replacement of two existing gravity sewer pipes. The gravity pipe main corridor is primarily comprised of mixed hardwood forests. In
addition, the proposed project traverses actively maintained roadway and two existing utility easements. The gravity pipe replacement extends parallel to Fiddlers Creek and crosses
Fiddlers Creek five times. The actively maintained roadways within the project corridor include NC SR 2743, Teague Road, Thomasville Road, Meadowview Drive SE, and NC SR 2700.
The gravity pipe corridor will intersect with 128-foot existing easement maintained by Duke Energy and a 50-foot existing easement maintained by Piedmont Natural Gas. Additionally,
there are single family and multi -family residential housing developments as well as commercial buildings adjacent to the proposed project area.
4b. Have Corps permits or DWR certifications been obtained for this project (including all prior phases) in the past?*
Yes No Unknown
4f. List the total estimated acreage of all existing wetlands on the property:
0.42 acre
4g. List the total estimated linear feet of all existing streams on the property:
525 feet (perennial)
4h. Explain the purpose of the proposed project: *
Replacement of the current gravity sewer pipe is required to meet the demands of projected growth in Forsyth County. The existing gravity sewer pipe has reached the end of its lifespan
and no longer provides sufficient capacity to convey wastewater within the project's service area. The proposed project consists of replacement of approximately 3.5 miles of gravity sewer
pipe and abandonment of the existing gravity sewer pipe, manholes, and other related appurtenances per applicable regulations.
4i. Describe the overall project in detail, including indirect impacts and the type of equipment to be used: *
The proposed Fiddlers Creek Outfall Replacement project consists of replacement and abandonment of the existing gravity sewage pipe to meet current and projected growth within the
project's service area. Specifically, the proposed project consists of installation of approximately 13,000-feet of 36-inch sanitary sewer piping, 3,000-feet of sanitary sewer collectors
ranging from 8-inches to 18-inches, 73 manholes, 760-feet of 54-inch steel casing, and 50-feet of 54-inch PVC casing. Erosion and sediment control measures will be installed prior to
commencing land -disturbing activities. Limits of disturbance encompass approximately 19 acres.
Construction -phase access to the project corridor will be provided via either new corridor associated with the conveyance line, or an existing access corridor associated with two existing
transmission lines that intersect a portion of the new pipe corridor. Four dragline mat access points across Fiddlers Creek will be assessable throughout the projects limits of disturbance.
One permanent gravel access road is proposed north of Thomasville Road to the new corridor to ensure proper maintenance of the proposed conveyance line following construction
completion. Additional details pertaining to the temporary and permanent gravel access roads associated with the proposed project can be found in the attached Fiddlers Creek Gravity
Outfall Replacement design plans.
Installation of the transmission line in jurisdictional areas (wetlands and streams) will be achieved using both open cut and non -open -cut techniques. Non -open -cut techniques will take
place under Old Lexington Road, Teague Road, Thomasville Road, Willard Road, and three proposed stream crossing locations. Further details related to non -open -cut techniques is
available in the attached Fiddlers Creek Outfall Replacement design plans. With the exception of one crossing, stream crossings involving open -cut techniques will be performed within 15
degrees perpendicular. A man-made ditch crossed by the pipe is not within 15 degrees of perpendicular. Anti -seep collars will be installed along the transmission line per applicable
regulations. Crossing of the streams and wetlands by the pipe will not result in the net loss of jurisdictional waters of the U.S.; however, conversion of forested wetlands to non -forested
wetlands will occur in several areas along the project corridor. The areas of conversion are very small and very few trees are anticipated to be removed.
Pipe installation, where feasible, will be performed from the abutting stream banks. All stream work will be performed in the dry. During construction activities, temporary stone dams will be
placed upstream and downstream of the area of disturbance and the stream will be pumped around the dammed area. One permanent ford will be installed at a stream crossing (S1).
Equipment anticipated to be used during installation of the proposed transmission lines includes, but is not limited to, excavators, backhoes, front-end loaders, dump trucks, and cranes.
Details of proposed activities, such as temporary stream bypass structures and anti -seep collars, are provided on the design drawings submitted in conjunction with this permit application.
The maintained corridor within 404 jurisdictional areas will be 30 feet or less in width. Replacement of the existing gravity sanitary sewer outfalls will temporarily impact Fiddlers Creek, as
will installation of stream stabilization materials (riprap or RECM) and dragline mats. Permanent impact to Fiddlers Creek will occur from installation of a permanent maintenance crossing
at S1. Wetlands will be temporarily impacted by pipe replacement with no net loss of wetlands occurring. Following construction, 0.005 acre of wetlands within the proposed maintained
corridor of three wetland areas will undergo conversion impacts from forested to non -forested wetlands with very few trees being removed. Indirect impacts associated with installation of
the conveyance are anticipated to be negligible since construction of the proposed project will not induce growth but is required to meet the future wastewater demands of the service area.
5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the property or proposed impact areas?*
Yes
Comments:
No Unknown
5b. If the Corps made a jurisdictional determination, what type of determination was made?*
Preliminary Approved Not Verified Unknown N/A
Corps AID Number:
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known):
Agency/Consultant Company:
Other:
6. Future Project Plans
6a. Is this a phased project?*
Linda Diebolt and Keven Arrance
Hazen and Sawyer
Yes 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?

D. Proposed Impacts Inventory
1. Impacts Summary
la. Where are the impacts associated with your project? (check all that apply):
Wetlands
Open Waters
2. Wetland Impacts
Streams -tributaries
Pond Construction
Buffers
u
2a. Site #* (?)
2a1 Reason (?)
2b. Impact type* (?)
2c. Type of W.*
2d. W. name*
2e. Forested*
2f. Type of Jurisdicition*
(?)
2g. Impact
area*
W1 Pipe
Crossing 1
Construction access
T
NON-NCWAM TYPES
Wetland A
Yes
Both
0.060
(acres)
W2 Pipe
Crossing 1
Pipe installation
T
NON-NCWAM TYPES
Wetland A
No
Both
0.005
(acres)
W3 Pipe
Crossing 2
Pipe installation
T
NON-NCWAM TYPES
Wetland D
No
Both
0.010
(acres)
W4 Pipe
Crossing 3
Pipe installation
T
NON-NCWAM TYPES
Wetland E
No
Both
0.180
(acres)
W5 Pipe
Crossing 4
Pipe installation
T
Riverine Swamp Forest
Wetland F
Yes
Both
0.006
(acres)
W6 Pipe
Crossing 4
Maintained corridor
P
Riverine Swamp Forest
Wetland F
Yes
Both
0.007
(acres)
W7 Pipe
Crossing 5
Pipe installation
T
Riverine Swamp Forest
Wetland G
Yes
Both
0.005
(acres)
W8 Pipe
Corridor 6
Maintained corridor
P
Riverine Swamp Forest
Wetland G
Yes
Both
0.005
(acres)
W9 Pipe
Crossing 6
Pipe installation
T
Riverine Swamp Forest
Wetland H
Yes
Both
0.004
(acres)
W10 Pipe
Corridor 7
Pipe installation
T
Riverine Swamp Forest
Wetland I
Yes
Both
0.030
(acres)
W11 Pipe
Crossing 7
Maintained corridor
P
Riverine Swamp Forest
Wetland I
Yes
Both
0.005
(acres)
2g. Total Temporary Wetland Impact
0.300
2g. Total Wetland Impact
0.317
2i. Comments:
3. Stream Impacts
2g. Total Permanent Wetland Impact
0.017
3a. Reason for impact (?)
3b.lmpact type*
3c. Type of impact*
3d. S. name*
3e. Stream Type*
(?)
3f. Type of
Jurisdiction*
3g. S. width*
3h. Impact
length*
S1
Pipe crossing 2 - riprap
Permanent
Fill
UT TO FIDDLERS CREEK -
UT2
Perennial
Both
6
Average (feet)
25
(linear feet)
S2
Pipe crossing 2 - pipe
installation
Temporary
Excavation
UT2
Perennial
Both
6
Average (feet)
33
(linear feet)
S3
Pipe crossing 3 - stream
stabilization with RECM
Permanent
Fill
UT3
Jurisdictional Ditch
Both
3
Average (feet)
45
(linear feet)
S4
Pipe crossing 3 - pipe
nstallation
Temporary
Excavation
UT3
Perennial
Both
4
Average (feet)
105
(linear feet)
S5
Pipe crossing 4 - dragline mat
Temporary
Fill
Fiddlers Creek
Perennial
Both
8
Average (feet)
15
(linear feet)
S6
Pipe crossing 5 - pipe
installation
Temporary
Excavation
UT4
Perennial
Both
5
Average (feet)
25
(linear feet)
S7
Pipe crossing 5 - stream
stabilization with RECM
Permanent
Fill
UT4
Perennial
Both
5
Average (feet)
9
(linear feet)

S8
Pipe crossing 6 - dragline mat
Temporary
Fill
Fiddlers Creek
Perennial
Both
10
Average (feet)
15
(linear feet)
S9
Lstabilization
Pipe crossing 7 - stream
with riprap
Permanent
Fill
UT5
Perennial
Both
4
Average (feet)
16
(linear feet)
S10
Pipe crossing 7 - pipe
installation
Temporary
Excavation
UT5
Perennial
Both
4
Average (feet)
31
(linear feet)
S11
Pipe crossing 8 - pipe
installation
Temporary
Excavation
UT6
Perennial
Both
4
Average (feet)
24
(linear feet)
S12
Pipe crossing 8 - stream
stabilization
Permanent
Fill
UT6
Perennial
Both
4
Average (feet)
10
(linear feet)
S13
Pipe crossing 9 - dragline mat
Temporary
Fill
Fiddlers Creek
Perennial
Both
12
Average (feet)
25
(linear feet)
S14
Pipe crossing 10 - stream
stabilization with RECM
Permanent
Fill
UT7
Perennial
Both
6
Average (feet)
15
(linear feet)
S15
Pipe crossing 10 - pipe
installation
Temporary
Excavation
UT7
Perennial
Both
6
Average (feet)
24
(linear feet)
S16
Pipe crossing 12 - dragline
mat
Temporary
Fill
Fiddlers Creek
Perennial
Both
10
Average (feet)
12
(linear feet)
S17
Pipe crossing 13 - pipe
installation
Temporary
Excavation
UT8
Perennial
Both
4
Average (feet)
38
(linear feet)
S18
Pipe crossing 13 - stream
stabilization with riprap
Permanent
Fill
UT8
Perennial
Both
4
Average (feet)
15
(linear feet)
S19
Pipe crossing 14 - stream
stabilization with RECM
Permanent
Fill
UT9
Perennial
Both
5
Average (feet)
12
(linear feet)
S20
Pipe crossing 14 - pipe
installation
Temporary
Excavation
UT9
Perennial
Both
5
Average (feet)
40
(linear feet)
3i. Total jurisdictional ditch impact in square feet:
135
3i. Total permanent stream impacts:
147
3i. Total stream and ditch impacts:
534
3i. Total temporary stream impacts:
387
3j. Comments:
Permanent stream impacts are associated with stream stabilization or one permanent maintenance crossing. Stream stabilization consists of either
riprap (S1, S7, S9, S13) or RECM (S3, S12, S14, S19) being placed below the bed of the stream. The permanent maintenance crossing (S1) consists of
riprap below and slightly above the bed of the stream.
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:
Delineation of jurisdictional areas and identification of sensitive receptors occurred early in the design process. During design, the project corridor was
positioned to avoid regulated areas and sensitive receptors, where feasible, while using existing corridors and easements to the extent practicable.
Avoidance of all impacts is possible only with a no -build alternative, which does not meet the need of the project. Where avoidance of jurisdictional
wetlands was not possible, the limits of disturbance were reduced to the extent practicable. Project design includes anti -seep collars along the pipe
within and adjacent to jurisdictional wetland areas, per applicable requirements. Avoidance of the streams within the project corridor is not feasible.
Stream crossings were designed to minimize the limits of disturbance with crossings within 15 degrees of perpendicular, where feasible. Temporary
bridges will be used to cross jurisdictional streams and swamp mats will be used to cross jurisdictional wetlands to minimize impacts from vehicular
crossings.
lb. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:
Best management practices for erosion and sediment control measures are specified in the project design. Measures include perimeter silt fence,
minimization of tree removal, and stabilized construction entrances. The contractor shall perform weekly inspections of erosion and sediment control
devices and perform maintenance as needed to ensure maximum efficacy of all devices in use. Vehicle and equipment maintenance activities are
required to be performed outside of jurisdictional areas. Disturbed soils will be temporarily stabilized if the disturbed area will not be final graded and
permanently stabilized within a reasonable timeframe.
Impacts to jurisdictional areas during construction will be limited to the extent feasible by performing as much work as is possible from upland areas.
Disturbed areas will be returned to original grade and seeded with an appropriate native seed mix as soon as possible, not to exceed 90 days of
completion of the project. Swamp matting will be used where appropriate in wetland areas. Excavation of the pipe trench will be performed as prescribed
by the USACE in jurisdictional areas, and side casting of excavated material into abutting wetland areas will be avoided to the extent feasible.
Assessment of alternative methods versus using open -cut installation was performed. Most of the areas of disturbance within jurisdictional features are
either very small or are in areas that are already disturbed, such as existing maintained transmission corridors. Due to the small size of the areas of
disturbance and the existing disturbed condition within jurisdictional areas, use of trenchless installation techniques will not be used to traverse
jurisdictional areas.
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?
Yes • No
2b. If this project DOES NOT require Compensatory Mitigation, explain why:
All wetland impacts are temporary with the exception of three very small forested areas (-0.005 acre/200 square feet each) located along the edge of the permanent access road. Very few
trees are present or will be removed within the three very small forested wetland areas. Due to the minimal area of impact within three separate wetlands, mitigation of the conversion
impacts is not proposed.
F. Stormwater Management and Diffuse Flow Plan (required by DWR)
1. Diffuse Flow Plan
la. Does the project include or is it adjacent to protected riparian buffers identified within one of the NC Riparian Buffer Protection Rules?
Yes No
If no, explain why:
The closest protected riparian buffer, Randleman Lake Buffer Area, is located approximately 5 miles east of the proposed project site according to the NC Riparian Buffer Area Map listed
on NCDEQ website.
2. Stormwater Management Plan
2a. Is this a NCDOT project subject to compliance with NCDOT's Individual NPDES permit NCS000250? *
Yes No
2b. Does this project meet the requirements for low density projects as defined in 15A NCAC 02H .1003(2)?
Yes No
Comments:
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? *
Yes 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)?*
Yes No
Comments: *
The project does not meet minimum criteria to trigger SEPA. NEPA documentation 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), or DWR Surface Water or Wetland Standards or
Riparian Buffer Rules (15A NCAC 2B .0200)?*
Yes No
3. Cumulative Impacts (DWR Requirement)
3a. Will this project result in additional development, which could impact nearby downstream water quality?*
Yes No
3b. If you answered "no," provide a short narrative description.
Development within the proposed Fiddlers Creek Outfall Replacement project is anticipated to occur. The proposed project will not promote growth but
will support the development that will occur regardless of the project and will provide state of the art municipal treatment of the wastewater generated by
development in the service area. Existing ordinances and regulations, including the Clean Water Act, erosion and sediment control regulations, and
stormwater ordinances, are expected to prevent impacts to downstream water quality due to future development in the service area.
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project?*
Yes No 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?*
Yes No
5b. Have you checked with the USFWS concerning Endangered Species Act impacts?*
Yes No

5d. Is another Federal agency involved?*
Yes No Unknown
5e. Is this a DOT project located within Division's 1-8?
Yes No
5f. Will you cut any trees in order to conduct the work in waters of the U.S.?
Yes No
5g. Does this project involve bridge maintenance or removal?
Yes No
5h. Does this project involve the construction/installation of a wind turbine(s)?*
Yes 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.?
Yes No
5j. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?
Hazen reviewed the FWS online IPaC tool to determine species and/or critical habitat within the vicinity of the proposed project in August 2022.
Additionally, Hazen biologists conducted preliminary in field review of the project area to determine potential habitat relative to listed species.
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as an Essential Fish Habitat?*
Yes No
6b. What data sources did you use to determine whether your site would impact an Essential Fish Habitat? *
Hazen reviewed the Essential Fish Habitat Mapper for the Mid -Atlantic region provided through NOAA Fisheries website to determine potential impacts
to Essential Fish Habitat anticipated by the proposed project.
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?*
Yes No
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?*
Hazen reviewed HPOWEB on July 17, 2022. No properties or structures within proximity to the project site were identified as being listed or eligible for
listing on the National Register of Historic Places.
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA-designated 100-year floodplain?*
Yes No
8b. If yes, explain how project meets FEMA requirements:
The project does not include aboveground infrastructure that will reduce the flood capacity of the SFHA.
8c. What source(s) did you use to make the floodplain determination?*
Hazen utilized North Carolina FEMA GIS data to make the floodplain determination.
Miscellaneous
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.
Click the upload button or drag and drop files here to attach document
PCN Attachments 1_Fiddlers Creek.pdf 8.19MB
PCN Attachments 2_Fiddlers Creek.pdf 16.4MB
PCN Attachments 3_Fiddlers Creek.pdf 15.18MB
PCN Attachments 4_Fiddlers Creek_Design Drawings.pdf 34.13MB
File must be PDF or KMZ
Comments
Signature
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 CWA 401 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:
Linda Diebolt
Signature
Date
9/8/2022