HomeMy WebLinkAboutPre-Construction Notification (PCN) Form_WESLEY DOWNS_UPDATED 5-15-2023.pdfDWR
oirlslna of ware, 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
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://edocs.deq.nc.gov/WaterResources/0/edoc/624704/PCN % 20Help % 20File % 202018-1-30.pdf
A. Processing Information
Pre -Filing Meeting Date Request was submitted on:
9/8/2022
If this is a courtesy copy, please fill in this with the submission date.
Is this project connected with ARPA funding?*
Yes No
County (or Counties) where the project is located:
Durham
Is this a NCDMS Project*
Yes No
Click Yes, only if NCDMS is the applicant or co -applicant.
DO NOT CHECK YES, UNLESS YOU ARE DMS OR CO -APPLICANT.
Is this project a public transportation project?*
Yes No
This is any publicly funded by municipal,state or federal funds road, rail, airport transportation 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?*
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)
1c. Has the NWP or GP number been verified by the Corps?*
Yes No
Nationwide Permit (NWP) Number:
29 - Residential Developments
NWP Numbers (for multiple NWPS):
List all NW numbers you are applying for not on the drop down list.
1d. Type(s) of approval sought from the DWR:
check all that apply
401 Water Quality Certification - Regular
Non-404 Jurisdictional General Permit
Individual 401 Water Quality Certification
1e. Is this notification solely for the record because written approval is not required?
*
401 Water Quality Certification - Express
Riparian Buffer Authorization
For the record only for DWR 401 Certification: Yes No
For the record only for Corps Permit: Yes No
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?
If so, attach the acceptance letter from mitigation bank or m-lieu fee program.
Yes No
Acceptance Letter Attachment
Click the upload button or drag and drop files here to attach document
FILE TYPE MUST BE PDF
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
Link to trout information: http://www.saw.usace.army.mil/Missions/Regulatory-Permit-Program/Agency-Coordination[Frout.aspx
B. Applicant Information
1a. Who is the Primary Contact?*
Deborah Shirley
1c. Primary Contact Phone:
1b. Primary Contact Email: pax)xxx-xxxx
dshirley@sandec.com (919)846-5900
1d. Who is applying for the permit?*
Owner Applicant (other than owner)
(Check all that apply)
le. Is there an Agent/Consultant for this project?"
Yes No
2. Owner Information
2a. Name(s) on recorded deed:*
Holder Dollie Estelle Holder Steve Holder Charles D Heirs
2b. Deed book and page no.:
DB:002279,DP:00403; D13:000402, DP:000227
2c. Contact Person:
(for Corporations)
2d.Address"
Street Address
4814 Holder Rd
Address Line 2
N/A
City
State / Province / Region
Durham
NC
Postal / Zip Code
Country
27703-950
United States of America
2e. Telephone Number:*
(919)236-3052
2f. Fax Number:
(xxx)xxx-xxxx
2g. Email Address:
charlie.yokley@lennar.com
2a. Name(s) on recorded deed:
Holder Frank M
2b. Deed book and page no.:
D13:009105, DP:000505
2c. Contact Person:
(for Corporations)
2d. Address*
Street Address
409 Broach Rd
Address Line 2
N/A
City
State / Province / Region
Durham
NC
Postal / Zip Code
Country
27703-950
United States of America
2e. Telephone Number:
(—bxx-xxxx
(919)236-3052
2f. Fax Number:
(.xx)xxx-xxxx
2g. Email Address:
charlie.yokley@lennar.com
2a. Name(s) on recorded deed:
Holder Richard Wayne Holder Teresa M
2b. Deed book and page no.:
DB:001553, DP:000867
2c. Contact Person:
(for Corporations)
2d.Address*
Street Address
325 Broach Rd
Address Line 2
N/A
City
State / Province / Region
Durham
NC
Postal / Zip Code
Country
27703-950
United States of America
2e. Telephone Number:*
("XbXx-xxxx
(919)599-0639
2f. Fax Number:
2g. Email Address: *
charlie.yokley@lennar.com
3. Applicant Information (if different from owner)
3a. Name:*
Charlie Yokley
3b. Business Name:
(if applicable)
Lennar Corportion-Raleigh Division
3c. Address
Street Address
1100 Perimeter Park Drive
Address Line 2
Suite 112
City
State / Province / Region
Morrisville
NC
Postal / Zip Code
Country
27560
United States of America
3d. Telephone Number:*
(919)236-3052
3e. Fax Number:
3f. Email Address:*
charlie.yokley@lennar.com
4. Agent/Consultant (if applicable)
4a. Name:*
Deborah Shirley
4b. Business Name:
(if applicable)
Soil & Environmental Consultants, PA
4c. Address
Street Address
8412 Falls of Neuse Road
Address Line 2
Suite 104
City
Raleigh
Postal / Zip Code
27615
4d. Telephone Number:
(919)846-5900
4f. Email Address: *
dshirley@sandec.com
C. Project Information and Prior Project History
1. Project Information
1 a. Name of project:*
Wesley Downs
1 b. Subdivision name:
(if appropriate)
1c. Nearest municipality / town:
Durham
2. Project Identification
State / Province / Region
NC
Country
United States of America
4e. Fax Number:
(xxx)xxx-xxxx
2a. Property Identification Number:
(tax PIN or parcel ID)
0850-36-28-2845, 0850-37-72-4094, 0850-46-
37-8567, 085046-36-6064, 0850-46-34-8132,
2b. Property size:
085046424997, 0850-46-64-2594 & 0850-
(in acres)
46-77-2810
60.27
2c. Project Address
Street Address
344 Broach Rd
Address Line 2
N/A
City
State / Province / Region
Durham
NC
Postal / Zip Code
Country
27703
United States of America
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 how the 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:
35.966384-78.820042
ex34.208504-77.796371
3. Surface Waters
3a. Name of the nearest body of water to proposed project:
Little Lick Creek
3b. Water Resources Classification of nearest receiving water:
WS-IV;NSW
Surface Water Lookup
U
lk.:"J
3c. What river basin(s) is your project located in?*
Neuse
3d. Please provide the 12-digit HUC in which the project is located."
030202010504
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: *
Existing conditions consist of 8 parcels on the east and west sides of Broach Road. The land is partially wooded with agricultural fields and an existing utility easement running parallel with
the western perennial stream. There are two streams (A & B), four wetlands (W1 [Isolated],W2, W3, & W4) and two ponds (Pond 1 [Isolated/upland] & Pond 2) within the project boundary.
The general land use in the vicinity consist of rural residential, wooded and agricultural land.
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:
Approximately 2.02 acres of wetlands
4g. List the total estimated linear feet of all existing streams on the property:
(intermittent and perennial)
Approximately 2,062 LF of Streams
4h. Explain the purpose of the proposed project:
The project purpose is to construct a mixed single family and multi -family residential development and its necessary infrastructure.
4i. Describe the overall project in detail, including indirect impacts and the type of equipment to be used: *
The overall project consists of a residential development consisting of 226-units (102 single family and 124 townhome) to include, but not limited to the construction of roadway
infrastructure, utilities, lots, amenities and Stormwater Control Measures (SCM's). Specifically, there are stream, riparian buffer, wetland and open water impacts associated with road
crossings, utilities, and lot fill. Equipment typically used for construction and earthwork such as backhoes, bulldozers, excavators, graders, pavers, etc. will be utilized for this project.
5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the property or proposed impact areas?
Yes No Unknown
Comments:
5b. If the Corps made a jurisdictional determination, what type of determination was made?
Preliminary Approved Not Verified Unknown N/A
Corps AID Number:
Example: SAW-2017-99999
SAW-2021-00741
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known): Steven Ball
Agency/Consultant Company: Soil & Environmental Consultants, PA.
Other:
5d. List the dates of the Corp jurisdiction determination or State determination if a determination was made by the Corps or DWR.
USACE verification on 10/22/2021 -April Norton (SAW-2021-00741)
DWR Buffer Determination Letter issued on 05/03/2021 - Erin Deck (DWR RRO #21-103)
6. Future Project Plans
6a. Is this a phased project?*
Yes No
6b. If yes, explain.
This is a phased project during construction, all proposed phases are currently shown.
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? This includes other
separate and distant crossing for linear projects that require Department of the Army authorization but don't require pre -construction notification.
It is my understanding that there are no intended future phases beyond the property boundaries shown. Therefore, no additional NWP, Regional General Permits, or IP are anticipated.
D. Proposed Impacts Inventory
1. Impacts Summary
1a. Where are the impacts associated with your project? (check all that apply):
Wetlands Streams -tributaries O Buffers
Open Waters Pond Construction
2. Wetland Impacts
If there are wetland impacts proposed on the site, then complete this question for each wetland area impacted.
"W." will be used in the table below to represent the word "wetland".
2a1 Reason * (?)
2b. Impact type*(?)
2c. Type of W.*
2d. W. name'
2e. Forested �'
2f. Type of Jurisdicition*
2g. Impact
area
Impact C
Sanitary Sewer
Connection (Permanent-
No permanent loss)
P
Bottomland Hardwood Forest
W2
Yes
Both
0.033
acres)
2g. Total Temporary Wetland Impact
0.000
2g. Total Permanent Wetland Impact
0.033
2g. Total Wetland Impact
0.033
2i. Comments:
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*
[3u Type of
3Swidth*
3h. I(?)
risdiction*
length*
S1
Impact A -Road Crossing -
Permanent
Culvert
Stream A
Perennial
Both
107
Culvert
Average (feet)
(linear feet)
S2
Impact A -Road Crossing-
Temporary
Other
Stream A
Perennial
Both
6
76
Temporary construction
access
Average (feet)
(linear feet)
S3
Impact A -Road Crossing
Permanent
Other
Stream A
Perennial
Both
7
32
Riprap dissipator Pad -
Average (feet)
linear feet)
(Permanent - No permanent
loss)
** All Perennial or Intermittent streams must be verified by DWR or delegated local government.
31. Total jurisdictional ditch impact in square feet:
0
31. Total permanent stream impacts:
139
31. Total temporary stream impacts:
76
31. Total stream and ditch impacts:
215
3j. Comments:
Total permanent loss stream = 107 (0.018 acres); Total Permanent -no permanent loss stream = 32 LF (0.013 acres); Total temporary stream = 76 LF
(0.010 acres); Temporary stream impacts will be brought back to pre -construction stream bed elevations and the stream banks will be stabilized.
4. Open Water Impacts
If there are proposed impacts to lakes, ponds, estuaries, tributaries, sounds, the Atlantic Ocean, or any other open water of the U.S. then individually list all open
water impacts below.
Impact B
4a1. Impact Reason
Road Crossing
4b. Impact type*(?)
P
4c. Name of waterbody (?)
Pond 2
4d. Activity type*
Fill
4e. Waterbody type*
Pond
4f. Impact
area*
0.09
(acres)
Impact B
Lot Fill IF
lff2
Fill
Pond
0.17
acres)
4g. Total temporary open water Impacts:
0.00
4g. Total permanent open water impacts:
0.26
4g. Total open water impacts:
0.26
4h. Comments:
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.
Neuse Tar -Pamlico
Catawba Randleman
Goose Creek Jordan Lake
Other
6b. Impact Type* (')
6c. Per or Temp* (?)
6d. Stream name*
6e. Buffer mitigation required?"
6f. Zone 1 impact*
6g. Zone 2 impact*
Impact A -Road Crossing
P
Stream A
No
9,705
(square feet)
4,680
(square feet)
6h. Total buffer impacts:
Total Temporary impacts:
Total Permanent impacts:
Total combined buffer impacts:
6i. Comments:
Zone 1 Zone 2
0.00 0.00
Zone 1 Zone 2
9,705.00 4,680.00
Zone 1 Zone 2
9,705.00 4,680.00
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: *
S&EC completed a wetland delineation and Neuse River Buffer evaluation for the entire property in order to identify natural resources so that impacts
could be avoided and minimized to the maximum extent practicable. Impact A is proposed road crossing to a perennial stream. Proposed impacts
include permanent (culvert), permanent -no permanent loss (dissipator pad), and temporary (construction access/dewatering) stream impacts and
riparian buffer impacts. Per the City of Durham, this road crossing is necessary to provide interconnectivity to the existing Bristlewood Drive Road stub to
the west. Impacts have been minimized by utilizing headwalls and wing walls and crossing the stream and riparian buffer at a near perpendicular angle.
Temporary stream impacts will be brought back to pre -construction stream bed elevations and the stream banks will be stabilized. Impact B is proposed
open water impacts for a road crossing and lot fill. Proposed impacts include permanent open water impacts. Per the project engineer, these "fill"
impacts are necessary per the City of Durham rezoning review and a committed road connection directly to the east at the property boundary. This
connection is needed per City of Durham's code requirements. If the pond and its dam was to remain with this necessary public road connection, the
dam of the pond would become a hazard for the road. The road needs to be downstream of the pond due to existing topographic constraints. Impact C is
a proposed sanitary sewer connection to an existing City of Durham 25' wide sanitary sewer easement. Proposed impacts include permanent -no
permanent loss wetland impacts (i.e. change of wetland function) and "deemed allowable' Zone 2 buffer impacts. This impact has been minimized by
connecting perpendicular to the wetland and impacting Zone 2 only.
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques: *
There is a proposed a stream diversion channel and a cofferdam as a part of the erosion and sedimentation plan to install the proposed culvert. Silt
fence with silt fence outlets will be installed all around the perimeter of the project with diversion ditches that maintain the majority of drainage from the
site to sediment basins during construction activities until the permanent storm system will be installed.
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:
Permanent loss stream impacts are less than 0.02 acres, permanent loss wetland impacts are less than 0.10 acres. Impacts have been avoided to the maximum extent practicable.
Therefore compensatory mitigation in the form of mitigation payment has not been proposed.
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
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
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 flow will 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?
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
(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?"
Yes No
2b. Does this project meet the requirements for low density projects as defined in 15A NCAC 02H .1003(2)?
Yes No
To look up low density requirement click here 15A NCAC 02H .1003(2).
2c. Does this project have a stormwater management plan (SMP) reviewed and approved under a state stormwater program or state -approved local government stormwater program?
Yes No
N/A - project disturbs < 1 acre
Hint: projects that have vested rights, exemptions, or grandfathering from state or locally implemented stormwater programs or projects that satisfy state or locally -implemented stormwater programs through use of community in -lieu programs should answer
no to this question.
2d. Which of the following stormwater management programs) apply (check all that apply):"
Local Government State
If you have a local government approval please include the SMP on their overall impact map.
Local Government Stormwater Programs*
Phase II NSW
USMP Water Supply
Please identify which local government stormwater program you are using.
City of Durham
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? *
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)
3a. Will this project (based on past and reasonably anticipated future impacts) result in additional development, which could impact nearby downstream water quality?
Yes No
3b. If you answered "no," provide a short narrative description.
We have reviewed the "Draft Internal Policy, Cumulative impacts and the 401 Water Quality Certification and Isolated Wetlands Programs" document
prepared by the NC Division of Water Quality on April 10, 2004, version 2.1. The draft states that many private developments are unlikely to cause
cumulative impacts, including projects such as urban in -fill, most residential subdivisions and small commercial developments as well as agricultural and
silvicultural operations. The Wesley Downs project is a residential development. Additionally, the project is located within the City of Durham jurisdiction,
therefore the adjacent properties that have potential for development will have the following regulations to protect downstream waters: 1) the Neuse
River Basin Riparian Buffer Protection regulations, these regulations require limited development within the riparian buffer area, in addition Best
Management Practices may be required that control nitrogen if diffuse flow cannot be achieved; 2) the Phase II NPDES Stormwater Permit Program, this
program includes permitting requirements for Municipal Separate Storm Sewer Systems (MS4s) in addition to post -construction stormwater
management requirements, and 3) the Water Supply, Watershed Protection Program which limits development densities as well as requires protective
riparian buffers. We anticipate that the DWR will advise us if any additional information is needed.
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project?*
Yes No 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.
Non -discharge. Wastewater will be treated at a local City of Durham treatment plant. The City of Durham has issued a Utility Extension Agreement that
promises sufficient capacity for this 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?
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
Link to the NILES SLOPES document: http://saw-reg.usace.army.mil/NLEB/1-30-17-signed_NLEB-SLOPES&apps.pdf
5h. Does this project involve the construction/installation of a wind turbine(s)?* *
Yes 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? *
S&EC completed a Threatened & Endangered Species Report, to include a Self -Certification letter through the US Fish & Wildlife Service (USFWS), a
query through the NC Natural Heritage Program database, and an official Species List through the iPac. A formal request was sent to the USFWS on
03/08/2021. S&EC completed a follow up survey for Michaux's Sumac on August 18, 2022, and the results were forwarded to FWS. The S&EC
determinations were that the proposed project is not likely to adversely affect any federally -listed endangered or threatened species, their formally
designated critical habitat, or species currently proposed for listing under the Endangered Species Act (ESA). Please see attached S&EC Threatened &
Endangered Species report and FWS correspondence.
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 Habitat Conservation/Habitat Protection: National Marine Fish Service; Essential Fish Habitat Mapper website was referenced. No Essential
Fish Habitat was identified near the project.
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.ncdcr.gov/hpoweb/
7a. Will this project occur in or near an area that the state, federal or tribal governments have designated as having historic or cultural preservation status (e.g., National Historic Trust
designation or properties significant in North Carolina history and archaeology)? *
Yes No
7b. What data sources did you use to determine whether your site would impact historic or archeological resources? *
The NC State Historic Preservation Office HPOWEB GIS Service interactive map was referenced on February 15, 2021. A request for Environmental
Review was submitted to SHPO requesting comments on February 17, 2021. A SHPO response letter was provided on May 20, 2021 indicating that
they are not aware of any historic resources that would be affected by the proposed project. Please see attached SHPO letter ER 21-0938.
8. Flood Zone Designation (Corps Requirement)
Link to the FEMA Floodplain Maps: https://msc.fema.gov/portal/search
8a. Will this project occur in a FEMA-designated 100-yearfloodplain?*
Yes No
8c. What source(s) did you use to make the floodplain determination?*
NC Flood Risk Information System Floodplain Mapping Program and confirmation from the project engineer.
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.
Click the upload button or drag and drop files here to attach document
PCN Attachments_ Wesley Downs.pdf 14.94MB
File must be PDF or KMZ
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:*
Deborah E. Shirley
Signature*
Date
4/18/2023