HomeMy WebLinkAbout20230761 Ver 1_ePCN Application_20230525DWR
Division of Water Resources
Pre -Construction Notification (PCN) Form
For Nationwide Permits and Regional General Permits
(along with corresponding Water Quality Certifications)
April 13, 2022 Ver 4.3
Initial Review
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.
Pre -Filing Meeting Date Request was submitted on:
3/1/2023
BIMS # Assigned
20230761
Is a payment required for this project?*
No payment required
Fee received
Fee needed - send electronic notification
Reviewing Office*
Raleigh Regional Office - (919) 791-4200
Information for Initial Review
la. Name of project:
Halifax County Solar Site
1a. Who is the Primary Contact?*
Mackenzie Richards, PWS (Kimley-Horn)
1b. Primary Contact Email: *
mackenzie.richards@kimley-horn.com
Date Submitted
5/25/2023
Nearest Body of Water
Beaverdam Swamp
Basin
Tar -Pamlico
Water Classification
C; Sw; NSW
Site Coordinates
Latitude:
36.249915
A. Processing Information
Is this project connected with ARPA funding?
Yes No
County (or Counties) where the project is located:
Halifax
Is this a NCDMS Project
Yes No
Longitude:
-77.694210
Version#*
1
What amout is owed?*
$240.00
$570.00
Select Project Reviewer*
Zachary Thomas:zachary.thomas@ncdenr.gov
1c. Primary Contact Phone: *
(919)678-4154
O
Is this project a public transportation project?*
Yes No
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?*
Yes
No
1b. What type(s) of permit(s) do you wish to seek authorization?
Nationwide Permit (NWP)
Regional General Permit (RGP)
Standard (IP)
1c. Has the NWP or GP number been verified by the Corps?
Yes No
Nationwide Permit (NWP) Number:
NWP Numbers (for multiple NWPS):
1d. Type(s) of approval sought from the DWR:
401 Water Quality Certification - Regular
Non-404 Jurisdictional General Permit
Individual 401 Water Quality Certification
51 - Land -based Renewable Energy
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
1g. Is payment into a mitigation bank or in -lieu fee program proposed for mitigation of impacts?
Yes No
1g. Is payment into a mitigation bank or in -lieu fee program proposed for mitigation of impacts?
Yes No
1h. 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
1d. Who is applying forthe permit?
Owner Applicant (other than owner)
le. Is there an Agent/Consultant for this project?
Yes No
2. Owner Information
2a. Name(s) on recorded deed:
Halifax County Solar, LLC (via lease and purchase)
2b. Deed book and page no.:
2c. Contact Person:
Patrick Green
2d.Address
Street Address
292 Madison Avenue
Address Line 2
15th Floor
city
New York
Postal / Zip Code
10017
401 Water Quality Certification - Express
Riparian Buffer Authorization
State / Province / Region
New York
Country
United States
Yes No
Yes No
2e. Telephone Number: 2f. Fax Number:
(585)975-9787
2g. Email Address:*
patrick.green@aes.com
3. Applicant Information (if different from owner)
3a. Name:
Patrick Green
3b. Business Name:
Halifax County Solar, LLC (via lease and purchase)
3c.Address
Street Address
292 Madison Avenue
Address Line 2
15th Floor
City
State / Province / Region
New York
New York
Postal / Zip Code
Country
10017
United States
3d. Telephone Number: 3e. Fax Number:
(585)975-9787
3f. Email Address:*
patrick.green@aes.com
4. Agent/Consultant (if applicable)
4a. Name:
Mackenzie Richards, PWS
4b. Business Name:
Kimley-Horn
4c.Address
Street Address
421 Fayetteville Street
Address Line 2
Suite 600
City
State / Province / Region
Raleigh
North Carolina
Postal / Zip Code
Country
27601
United States
4d. Telephone Number: 4e. Fax Number:
(919)678-4154
4f. Email Address:*
mackenzie.richards@kimley-horn.com
C. Project Information and Prior Project History
1. Project Information
1b. Subdivision name:
(if appropriate)
1c. Nearest municipality / town:
Enfield
2. Project Identification
2a. Property Identification Number:
Parcel IDS: 0403887, 0403659, 0402946, 2b. Property size:
0400469,0401923 872
a
2c. Project Address
Street Address
See Figure 1: Vicinity Map
Address Line 2
City State / Province / Region
North Carolina
Postal / Zip Code Country
United States
3. Surface Waters
3a. Name of the nearest body of water to proposed project:
Beaverdam Swamp
3b. Water Resources Classification of nearest receiving water:
C; Sw; NSW
3c. What river basin(s) is your project located in?*
Tar -Pamlico
3d. Please provide the 12-digit HUC in which the project is located.
030201020404;030201020402
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 Halifax County Solar Site ('Site") is located along Beaverdam Road and Neville Farm Road, west of Beaverdam Swamp, within Halifax County, North Carolina. The Site is
approximately 872 acres situated in a rural landscape and is primarily composed of agricultural land, undeveloped forested riparian corridors, planted pine of varying stand age that is
utilized for silviculture, internal gravel and dirt access roads that appear to be utilized for hunting and silviculture operations, and two large easements that transect the Site: an overhead
powerline easement and the Atlantic Coast natural gas pipeline easement. Land use within the vicinity of the Site is primarily composed of agricultural land, undeveloped forested riparian
corridors, roadway and easement corridors, and scattered residential and commercial developments.
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:
121.2
4g. List the total estimated linear feet of all existing streams on the property:
12,523
4h. Explain the purpose of the proposed project:*
The purpose of the proposed Project is to construct a solar photovoltaic (PV) generation facility between Beaverdam Road and Beaverdam Swamp to provide renewable energy for the
surrounding electrical grid.
4i. Describe the overall project in detail, including indirect impacts and the type of equipment to be used:
The project proposes to construct a solar PV generation facility that includes the installation of solar arrays oriented around the Site to best utilize available solar energy and work with
natural land topography to the extent practicable, the construction of several internal access roads, and the construction of a substation. As part of the proposed project, the new internal
road network constructed to facilitate access throughout the solar array layout will result in impacts to one jurisdictional wetland (Impact Site 1) and one jurisdictional ditch (Impact Site 2).
All underground medium voltage electric utility lines will be installed via HDD at a minimum depth of 6 feet below the surface to avoid impacts to both jurisdictional and non -jurisdictional
features. Additionally, the easements associated with these underground medium voltage electric utility lines will not result in impacts to any jurisdictional or non -jurisdictional features. The
corridors above the underground medium voltage electric utility lines will not be cleared or grubbed, there will be no dredge/fill or maintenance mowing, no current or future maintenance is
intended, and no other disturbance is anticipated. Temporary sediment basins will be installed throughout the project during construction, where outfalls are located within the Limits of
Disturbance (LOD) and outside of the Tar -Pamlico River Basin riparian buffer zones 1 and 2. Typical site development and construction equipment will be utilized including dump trucks,
graders, bulldozers, excavators, and concrete trucks.
5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the property or proposed impact areas?*
Yes No O Unknown
Comments:
The Site was previously delineated by Terracon Consultants, Inc.
5b. If the Corps made a jurisdictional determination, what type of determination was made?
Preliminary Approved Not Verified Unknown N/A
Corps AID Number:
SAW-2019-00676
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known):
Agency/Consultant Company: Terracon Consultants, Inc.
Other:
5d. List the dates of the Corp jurisdiction determination or State determination if a determination was made by the Corps or DWR
The Approved Jurisdictional Determination (AJD) request for the Site was issued by Ms. Samantha Dailey of the US Army Corps of Engineers (USACE) on March 10, 2020 (SAW-2019-
00676). Additionally, a Buffer Determination was issued for the Site by Erin Deck of the NC Division of Water Resources (NCDWR) on June 28, 2019 (DWR# RRO #19-122).
Documentation of each is attached as part of this permit application.
6. Future Project Plans
6a. Is this a phased project?"
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?
N/A
D. Proposed Impacts Inventory
1. Impacts Summary
1a. Where are the impacts associated with your project? (check all that apply):
Wetlands Streams -tributaries Buffers
Open Waters Pond Construction
2. Wetland Impacts
O
2a1 Reason (?)
2b. Impact type" (?)
2c. Type of W.
2d. W. name
2e. Forested"
2f. Type of Jurisdicition"
(?)
2g• Impact
area
Road Crossing/Culvert
nstallo
P
Headwater Forest
p9ct Site 1: Wetland
Yes
Both
0(0 f s)
2g. Total Temporary Wetland Impact
0.000
2g. Total Wetland Impact
0.077
2g. Total Permanent Wetland Impact
0.077
2i. Comments:
At Impact Site 1, unavoidable permanent impacts to wetland W19 (0.077 acres) will result from the proposed culvert and riprap installation and
permanent grading associated with the internal access road crossing which will be constructed to facilitate access to the northwestern portion of the
solar facility. The culvert has been designed to be situated along the low point of the wetland to allow for natural aquatic connectivity throughout the
wetland.
3. Stream Impacts
F 1
S1
3a. Reason for impact (?)
Road Crossing/Culvert
Installation
3b.lmpact type*
Permanent
3c. Type of impact"
Culvert
3d. S. name*
Impact Site 2: Jurisdictional
Ditch D4(A)
3e. Stream Type'
?)
Jurisdictional Ditch
3f. Type of
Jurisdiction*
Corps
3g. S. width
3
Average (feet)
3h. Impact
length*
56
(�inearfeet)
g2
Road Crossing/Culvert
Installation
Temporary
Culvert
Impact Site 2: Jurisdictional
Ditch D4(A)
Jurisdictional Ditch
Corps
Averege (feet)
24
(linearfeet)
3i. Total jurisdictional ditch impact in square feet:
240
3i. Total permanent stream impacts:
56
3i. Total stream and ditch impacts:
80
3i. Total temporary stream impacts:
24
3j. Comments:
At Impact Site 2, unavoidable permanent impacts to jurisdictional ditch D4(A) (56 linear feet; 0.004 acres) will result from the proposed internal access
road which will be constructed to facilitate access to the southwestern portion of the solar facility. The crossing at Impact Site 2 does not provide
connectivity to the rest of the facility. It was not feasible for the project to utilize the existing access road for this crossing since the existing access road
is located within the required property line setback and the associated existing culvert ouffalls offsite, on the adjacent property to the south. Therefore,
the new internal access road is proposed to be situated north of the existing access road at Impact Site 2. Permanent impacts to jurisdictional ditch
D4(A) are proposed as a result of the installation of the culvert and riprap dissipater pads for culvert inlet/outlet protection and the permanent grading
associated with the internal access road crossing. To allow for construction access and installation of the culvert and riprap and construction of the
internal access road, unavoidable temporary impacts are also proposed to jurisdictional ditch D4(A) (24 linear feet; 0.002 acres) at Impact Site 2. All
temporarily disturbed areas will be returned to pre -construction contours after completion of the project.
E. Impact Justification and Mitigation
O
1. Avoidance and Minimization
la. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:
Impacts to streams and riparian buffers within the project have been avoided entirely and impacts to the wetlands and jurisdictional ditches have been
minimized to the greatest extent practical by intentional design. No stream impacts or Tar -Pamlico River Basin riparian buffer impacts are proposed as
part of the solar project. The proposed solar arrays and substation have been situated entirely within upland areas. As part of the proposed project, the
new internal road network constructed to facilitate access throughout the solar array layout will result in impacts to one jurisdictional wetland (Impact Site
1) and one jurisdictional ditch (Impact Site 2). Impacts to the jurisdictional features were minimized by aligning the internal access road crossings and
underground medium voltage electric utility lines crossings to be as close to perpendicular as possible. All underground medium voltage electric utility
lines will be installed via HDD at a minimum depth of 6 feet below the surface to avoid impacts to both jurisdictional and non -jurisdictional features.
Additionally, the easements associated with these underground medium voltage electric utility lines will not result in impacts to any jurisdictional or non -
jurisdictional features. The corridors above the underground medium voltage electric utility lines will not be cleared or grubbed, there will be no dredge/fill
or maintenance mowing, no current or future maintenance is intended, and no other disturbance is anticipated. Additionally, the proposed culverts will be
buried to maintain baseflow and allow movement of aquatic species. Riprap at the culvert inlet and outlet will be installed to provide protection and
stabilization. Temporary sediment basins have been located in uplands throughout the Site to maintain pre-existing drainage areas and outlets have
been located within the LOD and outside of protected riparian buffers.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:
Impacts to streams, wetlands, open waters, and riparian buffers within the project will be minimized to the extent practical throughout the construction
process by avoiding these features with equipment, materials, and access corridors where practicable. All underground medium voltage electric utility
lines will be installed via HDD at a minimum depth of 6 feet below the surface to avoid impacts to both jurisdictional and non -jurisdictional features.
Additionally, bore pit locations for the HDD are proposed in uplands within the LOD. Where feasible, staging and construction access routes will be
located in upland areas throughout the project and silt fencing will be installed around the permitted LOD to ensure all equipment is located within the
permitted areas. Sediment control measures will be used to reduce stormwater impacts to receiving waters and minimize runoff from the construction
sites.
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:
Compensatory mitigation has not been proposed as part of this application due to the minimal permanent wetland impacts (<0.1 acre) that would result from the proposed project.
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
What type of SCM are you providing?
Level Spreader
Vegetated Conveyance (lower SHWT)
Wetland Swale (higher SHWT)
Other SCM that removes minimum 30 % nitrogen
Proposed project will not create concentrated stormwater flow through the buffer
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:
The project is located in an unincorporated area in Halifax County. Per NCDWR Post -Construction Stormwater Permitting Map, there is no designated post-stormwater permitting required
for the area where the project tis located in Halifax County. Temporary sediment basins will be installed throughout the project during construction, where ouffalls are located within the
LOD and outside of the Tar -Pamlico River Basin buffer zones 1 and 2.
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
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)
L
0
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.
The proposed project is a single and complete project. No additional development is anticipated as a result of the proposed project.
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
5c. If yes, indicate the USFWS Field Office you have contacted.
Raleigh
5d. Is another Federal agency involved?
Yes No
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
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.?
Yes No
5j. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?
As of May 25, 2023 the US Fish and Wildlife (USFWS) Information for Planning and Consulting (IPaC) tool lists four federally protected species as
known to occur within the vicinity of the Site: tricolored bat, Neuse River waterdog, Carolina madtom, and Atlantic pigtoe. The bald eagle (Haliaeetus
Ieucocephalus) also has potential to occur in the project vicinity and is protected under the Bald and Golden Eagle Protection Act (BGPA). Kimley-Horn
submitted a Project Review Request letter to the USFWS on April 12, 2023 and received a response letter from Ms. Kathy Matthews of the USFWS on
May 17, 2023. The USFWS response letter states that the Service concurs with Kimley-Horn's determinations that based on the current project design,
the proposed solar farm will result in "No Effect" to Carolina madtom and bald eagle and the project "May Affect, Not Likely to Adversely Affect" Neuse
River waterdog and Atlantic pigtoe. Documentation of the USFWS response letter to Kimley-Horn for the Site has been attached as part of this permit
application package. Additionally, a review of the NC Natural Heritage Program (NCNHP) database records (updated April 2023) indicates that there are
no known occurrences of any federally protected species in or within 1.0 mile of the Site.
The Tricolored bat is currently proposed for listing and is not currently protected under the Endangered Species Act (ESA). A review of the NCNHP
database records (updated April 2023) indicates that there are no known occurrences of the tricolored bat in or within 1.0 mile of the Site. If listed prior to
construction of the project, Halifax County Solar, LLC will coordinate with the USFWS as appropriate.
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?
The NOAA Essential Fish Habitat Mapper was reviewed on May 25, 2023. No essential fish habitat was identified within the Site or within the vicinity of
the Site.
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?"
A review of the State Historic Preservation Office (NCSHPO) HPOWEB GIS Service database performed on May 25, 2023 identified no National
Register, Study List, or Determined Eligible sites or historic districts were identified within the Site or direct vicinity.
Terracon Consultants, Inc originally submitted a letter to NCSHPO on March 25, 2019, and then another letter once the Site was expanded on June 13,
2019. A response from NCSHPO was received on April 30, 2019 and July 18, 2019, which stated that the NCSHPO was unable to accurately assess
impacts to historic properties within the proposed Area of Potential Effect. The NCSHPO recommended that a comprehensive archaeological survey of
the project area be conducted prior to the initiation of ground disturbing activities due to potential unrecorded precolonial Native American archaeological
sites. Therefore, an archeological investigation and report was completed for the Site and submitted to NCSHPO and a response was received on
February 3, 2020. In the response, NCSHPO concurred with the archeological report findings and its recommendations and stated that they understood
the intention of the project was to avoid ground disturbing activities at the Perkins -Willey Cemetery (31 HX570) and archaeological site 31 HX581,
however, the following information was requested from NCSHPO for them to determine that the proposed project would not impact cemetery 31 HX570
and archaeological site 31 HX581:
"Project design showing that the cemetery and site will be avoided,
Description of measures to ensure that the two sites will not be subject to ground disturbance during construction, and
How access to cemetery 31 HW570 will be maintained."
Following the request for the above information from NCSHPO, the requested information was provided in a letter to NCSHPO on February 25, 2020.
NCSHPO provided a letter in response following this February 25, 2020 correspondence. Kimley-Horn reached out to NCSHPO in March of 2023 to
track down the NCSHPO response letter and confirm it was the most recent correspondence from NCSHPO for the Site. NCSHPO provided their final
letter correspondence for the Site to Kimley-Horn. In this letter, NCSHPO states the following:
"You indicate that no ground -disturbing activities will take place within 50 feet of cemetery 31 HX570 and site 31 HX581, and that these areas will be
marked off with high -visibility fencing during construction. In addition, the submitted project plans show that 31 HX570 and 31 HX581 will be located
outside the security fencing for the solar array, allowing access to cemetery 31 HX570 from Neville Farm Road. Based on the information provided, we
find that the project as designed will not impact cemetery 31 HX570 and will have no effect on any historic properties eligible for listing in the National
Register."
The proposed project has been designed to avoid these features, and no ground disturbing activity is proposed within 100' from both the cemetery and
archeological site boundary, which is farther than the 50' setback required by NCSHPO. Additionally, access to the cemetery is maintained from Neville
Farm Road, so it is anticipated the proposed project will have no impact on cultural or historical resources since the project is following the constraints
outlined by NCSHPO in their final letter. Documentation of the above -referenced final letter from NCSHPO has been attached as part of this permit
application package.
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:
No impacts are associated with Beaverdam Swamp, and therefore, no FEMA Flood Hazards or floodways are proposed to be impacted.
8c. What source(s) did you use to make the floodplain determination?*
The FEMA Digital Flood Insurance Rate Map (DFIRM) panels 3720398100J, 3720398000J, and 3720396000J (effective July 3, 2007) indicate there are
1 % Annual Chance Flood Hazard Areas (Zone AE) along Beaverdam Swamp within the Site.
Miscellaneous
O
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
01_Halifax_PCN Cover Letter.pdf
541.32KB
03_HalifaxCoSolar_USACE_KHA_Agent Authorization Forms_SignedAES.pdf
186.18KB
04_HalifaxCoSolar_Figures.pdf
3.1 MB
05_HalifaxCoSolar_lmpacts.pdf
1.13MB
06_HalifaxCoSolar - AJD.pdf
3.38MB
07_HalifaxCoSolar - Buffer Determination Letter.pdf
3.61 MB
08_20230517_Itr_FWS_KimleyHorn_HalifaxCoSolarSite.pdf
227.69KB
09_ER 19 1050_11.pdf
95.43KB
2023-05-16_HalifaxSolar40 % CivilDrawings.pdf
38.22MB
File must be PDF or KMZ
Comments
Please see attachments to aid in the review of this permit application package.
Signature
O
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:
Mackenzie Richards, PWS
Signature
/
Date
5/25/2023