20231395 Ver 1_ePCN Application_20231012

DWR
Division of Water Resources
Pre -Construction Notification (PCN) Form
For Nationwide Permits and Regional General Permits
(along with corresponding Water Quality Certifications)
October 2, 2023 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:
4/4/2023
Does this project involve maintenance dredging funded by the Shallow Draft Navigation Channel Dredging and Aquatic Weed Fund or involve the distribution or transmission of energy or
fuel, including natural gas, diesel, petroleum, or electricity?
Yes No
BIMS # Assigned *
20231395
Is a payment required for this project?*
No payment required
Fee received
Fee needed - send electronic notification
Reviewing Office*
Raleigh Regional Office - [phone]
Information for Initial Review
1a. Name of project:
Parker Ridge
1a. Who is the Primary Contact?*
Deborah Shirley
1b. Primary Contact Email: *
[e-mail]
Date Submitted
10/12/2023
Nearest Body of Water
Harris Creek
Basin
Neuse
Water Classification
QNSW
Site Coordinates
Latitude:
35.914483
A. Processing Information
Is this project connected with ARPA funding?
Yes No
County (or Counties) where the project is located:
Wake
.....................
Longitude:
-78.462634
Version#*
1
What amount is owed?*
$240.00
$323.00
Select Project Reviewer*
Joseph Myers:joseph.myers
1c. Primary Contact Phone: *
[phone]
$570.00
$767.00
`I
Is this a NCDMS Project
Yes No

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: 29 - Residential Developments
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
401 Water Quality Certification - Express
Riparian Buffer Authorization
le. Is this notification solely for the record because written approval is not required?
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?
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:
Parker, W H Parker, Doris Faye Harold Parker / Parker, W Harold Jr / Rolesville Development LLC
Glennon Bittan Investments
2b. Deed book and page no.:
DB:005409, DP:00926 / DB:018732, DP:01014 / DB:009243, DP:01196
2c. Contact Person:

2d. Address
Street Address
149 Stonebridge Dr / 149 Stonebridge Dr / PO Box 30803
Address Line 2
City
State / Province / Region
New London / New London / Greenville
Wake
Postal / Zip Code
Country
28127 / 28127 / 27833
USA
2e. Telephone Number:
2f. Fax Number:
[phone]
2g. Email Address:*
[e-mail]
3. Applicant Information (if different from owner)
3a. Name:
Michael Taylor
3b. Business Name:
Lennar Carolinas — Raleigh Division
3c.Address
Street Address
1100 Perimter Park Drive, Ste. 112
Address Line 2
City
State / Province / Region
Morrisville
NC
Postal / Zip Code
Country
27560
USA
3d. Telephone Number:
3e. Fax Number:
[phone]
3f. Email Address:*
[e-mail]
4. Agent/Consultant (if applicable)
4a. Name:
Deborah Shirley
4b. Business Name:
Soil & Environmental Consultants, PA
4c.Address
Street Address
8412 Falls of Neuse Rd., Ste. 104
Address Line 2
city
State / Province / Region
Raleigh
NC
Postal / Zip Code
Country
27615
USA
4d. Telephone Number: 4e. Fax Number:
[phone]
0. Email Address:*
[e-mail]
C. Project Information and Prior Project History
1. Project Information
1b. Subdivision name:
(if appropriate)
1c. Nearest municipality / town:
Rolesville
2. Project Identification
O

2a. Property Identification Number:
1758884270, 1758988411, 1758983710 &
2b. Property size:
1768091558
+/_ 88 acres
2c. Project Address
Street Address
0 & 82 School Street and 201 Redford Place Drive
Address Line 2
City
State / Province / Region
Rolesville
NC
Postal / Zip Code
Country
27571
USA
3. Surface Waters
3a. Name of the nearest body of water to proposed project:
Harris Creek
3b. Water Resources Classification of nearest receiving water:"
C,NSW
3c. What river basin(s) is your project located in?*
Neuse
3d. Please provide the 12-digit HUC in which the project is located.
030202010703
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 four parcels that are separated by Redford Place Drive. The land is primarily wooded with existing utility easements with sanitary sewer, existing structures
and trails. There are eight streams (A, B, D, G, H, I, K & L), one pond (pond 1), one pond with buffers than encroach on -site (Pond 2), and seventeen wetlands (W1, W2, W3, W5, W6, W7,
W8, W9, W10, W11, W12, W13, W14, W15, W16, W17, & W18) within the property boundaries. General land use in the vicinity consist of residential and commercial use.
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 1.79 acres
4g. List the total estimated linear feet of all existing streams on the property:
Approximately 4,529 LF
4h. Explain the purpose of the proposed project:
The purpose of the project is to construct a 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 mixed multi -family and single-family residential development and it's necessary infrastructure such as roadway infrastructure, utilities, residential lots,
amenity center, and stormwater control measures (SCM). Specifically there are stream, wetland and riparian buffer impacts associated with road and greenway crossings, and riparian
buffer impacts associated with utilities and stormwater discharge. 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 O 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:
SAW-2021-02532 (email concurrence)
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known): Kevin Murphrey
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: Email concurrence by April Norton on January 4, 2022 (SAW-2021-02532);
NCDWR: Buffer determinations made by Chris Smith on April 13, 2023 (NBRRO #21-422)
*Note that Preliminary was checked to allow this data box to be available

6. Future Project Plans
6a. Is this a phased project?*
Yes O No
6b. If yes, explain.
Yes this is a phased project for construction purposed. There are no intended phases beyond the site plan.
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?
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 p Buffers
Open Waters Pond Construction
2. Wetland Impacts
O
2a1 Reason (?)
2b. Impact type* M
2c. Type of W.*
2d. W. name
2e. Forested*
2f. Type of Jurisdicition *
(?)
2g.Impact
area *
Impact 2B
Road Crossing
P
Headwater Forest
W2
Yes
Both
0.035
(acres)
Impact 3A
Road Crossing
P
Headwater Forest
W13
Yes
Both
0.028
(acres)
Impact 3B
Lot Fill
P
Headwater Forest
W13
Yes
Both
0.019
(acres)
Impact 4
Culvert Removal
T
Headwater Forest
W18
Yes
Both
0.002
(acres)
ff7]Rcacl
Crossing
P
Headwater Forest
W16
Yes
Both
0.026
(acres)
2g. Total Temporary Wetland Impact
0.002
2g. Total Wetland Impact
0.110
2g. Total Permanent Wetland Impact
0.108
2i. Comments:
Total permanent loss wetland = 0.108 acres; Total temporary wetland = 0.002 acres. Temporary wetland impacts will be brought back to pre -construction
contours and the existing adjacent wetland source will assist in the restoration of the wetland vegetation.
3. Stream Impacts
F
3a. Reason for impact (?)
3b.lmpact type*
3c. Type of impact*
3d. S. name*
3e. Stream Type*
3f. Type of
3g. S. width
3h. Impact
?)
Jurisdiction*
length*
S1
Impact 1-Road Crossing
Permanent
Culvert
Stream I
Intermittent
Both
63
Average (feet)
(linear feet)
32
Impact 1-Permanent-No
Permanent
Other
Stream I
Intermittent
Both
8
46
Permanent Loss (Riprap
Average (reet)
(rinear feet)
dissipator)
S3
Impact 1-Road Crossing-
Temporary
Other
Stream I
Intermittent
Both
24
Construction Access
Average (feat)
(linear feet)
gq
Impact 2A-Road Crossing
Permanent
Culvert
Stream B
Intermittent
Both
78
Average (feet)
(linear feet)
S5
Impact 2A-Permanent-No
Permanent
Other
Stream B
Intermittent
Both
6
45
Permanent Loss (Riprap
Average (reet)
(rnearfeet)
dissipator)
S6
Impact 2A-Road Crossing-
Temporary
Other
Stream B
Intermittent
Both
15
Construction Access
Average (feel)
(linear feet)
g7
Impact 4-Permanent-No
Permanent
Other
Stream I
Intermittent
Both
10
43
Permanent Loss (Riprap
Average (feet)
(linear feet)
dissipator)
gg
Impact 5-Road Crossing
Permanent
Culvert
Stream A
Perennial
Both
50
Average (feet)
(linear feet)

S9
Impact 5-Permanent-No
Permanent
Other
Stream A
Perennial
Both
1
20
Permanent Loss (Riprap
Average (feet)
(linear feet)
dissipator)
S10
Impact 5-Road Crossing-
Construction Access
Temporary
Other
Stream A
Perennial
Both
Average (feet)
41
(linear feet)
3i. Total jurisdictional ditch impact in square feet
0
31. Total permanent stream impacts: 3i. Total temporary stream impacts:
345 80
3i. Total stream and ditch impacts:
425
3j. Comments:
Total permanent loss stream = 191 (0.029 acres); Total Permanent -no permanent loss stream = 154 LF (0.023 acres); Total temporary stream = 80 LF
(0.010 acres); Temporary stream impacts will be brought back to pre -construction stream bed elevations and the stream banks will be stabilized.
6. Buffer Impacts (for DWR)
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 1-Road Crossing
P
Stream I
No
5,976
3,872
Impact 2A-Road Crossing
P
Stream B
No
5,472
3,998
Impact 4-Greenway
P
Stream I
No
2,060
2,486
Impact 5A-Greenway
P
Stream A
No
4,363
2,979
6h. Total buffer impacts:
Zone 1 Zone 2
Total Temporary impacts: 0.00 0.00
Zone 1 Zone 2
Total Permanent impacts: 17,871.00 13,335.00
Zone 1 Zone 2
Total combined buffer impacts: 17,871.00 13,335.00
61. Comments:
Per 15a NCAC 02b .0714(11)(kk)(i), 15a NCAC 02b .0714(11)0)(i) and 15a NCAC 02b .0714(9)(a)(i) Impacts 5B, 5C, 5D, 6, 8, 9 and 10 are considered
"deemed allowable".
E. Impact Justification and Mitigation
1. Avoidance and Minimization
a

1a. 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 onsite and offsite parcels in order to identify natural resources so that
impacts could be avoided & minimized to the maximum extent practicable. Proposed impacts include four (4) road crossings, two (2) greenway
crossings (one of which is utilizing an existing culvert), one (1) area of lot fill, and eight (8) riparian buffer impact only areas, seven (7) of which are
considered "deemed allowable". Impact 1 is a proposed road crossing. Proposed impacts include permanent (i.e. culverts), permanent -no functional loss
(i.e. riprap dissipator pads) and temporary (i.e. construction access) stream impacts, permanent wetland impacts, and associated riparian buffer impacts.
Stream and riparian buffer impacts have been minimized by designing the crossing at a near perpendicular angle, utilizing head walls and retaining
walls, in addition to utilizing an existing 30' wide sanitary sewer easement. Stream and wetland mitigation is being proposed at a 2:1 ratio to compensate
for these proposed impacts. Impact 2A is proposed road crossing. Proposed impacts include permanent (i.e. culverts), permanent -no functional loss (i.e.
riprap dissipator pads) and temporary (i.e. construction access) stream impacts, and associated riparian buffer impacts. Stream and riparian buffer
impacts have been minimized by designing the crossing at a near perpendicular angle and utilizing head walls and retaining walls. Stream mitigation is
being proposed at a 2:1 ratio to compensate for these proposed impacts. Impact 2B is proposed road crossing. Proposed impacts include permanent
wetland impacts. This impact is adjacent to the access easement that is needed to connect to East Young Street. Wetland mitigation is being proposed
at a 2:1 ratio to compensate for these proposed impacts. Impact 3A is proposed road crossing. Proposed impacts include permanent wetland impacts.
This impact is needed to access lots. Wetland mitigation is being proposed at a 2:1 ratio to compensate for these proposed impacts. Impact 3B is
proposed lot fill. Proposed impacts include permanent wetland impacts. The fill is needed to support the interior of this development. Per the engineer, if
Impact 3A was just needed, the road slopes would require this additional wetland fill. Wetland mitigation is being proposed at a 2:1 ratio to compensate
for these proposed impacts. Impact 4 is a proposed greenway crossing. Proposed impacts include permanent -no permanent functional loss stream (i.e.
riprap dissipator pad), temporary wetland impacts and associated riparian buffer impacts. This greenway was designed to utilize an existing culvert
location. The existing culvert will be removed and replaced and riprap added for erosion protection. Additionally temporary wetland impacts are needed
for construction activities. Impact 5A & 5B is a proposed greenway and sanitary sewer crossing. Proposed impacts include permanent (i.e. culverts),
permanent -no functional loss (i.e. riprap dissipator pad) and temporary (i.e. construction access) stream impacts, and associated riparian buffer impacts.
Impacts have been minimized by utilizing the same stream crossing for these two impacts, in addition to utilizing head walls and retaining walls. Stream
mitigation is being proposed at a 2:1 ratio to compensate for these proposed impacts. Impact 7 is a proposed greenway crossing. Proposed impacts
include Zone 2 riparian buffers only. Impacts have been minimized by avoiding Zone 1 of the riparian buffers. Riparian buffer Impacts 5B, 5C, 5D, 6, 8, 9
& 10 are all considered "deemed allowable' Per 15a NCAC 02b .0714(11)(kk)(i), 15a NCAC 02b .0714(11)(j)(i) and 15a NCAC 02b .0714(9)(a)(i).
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:
Per the project engineer— construction sequence to initially include bridgemats, then temporary diversion of streams for culvert installation; sediment
and silt basins, silt fencing, and inlet protection.
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
2c. If yes, mitigation is required by (check all that apply):
DWR Corps
2d. If yes, which mitigation option(s) will be used for this project?
Mitigation bank Payment to in -lieu fee program Permittee Responsible Mitigation
3. Complete if Using a Mitigation Bank
3a. Name of Mitigation Bank:
Restoration Systems: Milburnie Dam Mitigation Bank (Stream); Wildlands: Falling Creek Umbrella Mit
Bank (wetland)
3b. Credits Purchased/Requested (attach receipt and letter)
Type: Quantity:
Stream 382
Riparian wetland 0.22
3c. Comments
6. Buffer mitigation (State Regulated Riparian Buffer Rules) - required by DWR
6a. Will the project result in an impact within a protected riparian buffer that requires buffer mitigation? If yes, you must fill out this entire form - please contact DWR for more information.
Yes No
F. Stormwater Management and Diffuse Flow Plan (required by DWR)
1. Diffuse Flow Plan
1a. Does the project include or is it adjacent to protected riparian buffers identified within one of the NC Riparian Buffer Protection Rules?
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 NC DOT 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
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
2d. Which of the following stormwater management program(s) apply:
Local Government State
Local Government Stormwater Programs
Phase II NSW USMP Water Supply
Please identify which local government stormwater program you are using.
Town of Rolesville
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
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.
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 Parker Ridge project is a residential development. Additionally, the project is located within the Town or Rolesville
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. 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; per the project engineer there is sufficient capacity at the WWTP and has a maximum of 75 MGD.
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
Sc. If yes, indicate the USFWS Field Office you have contacted.
Raleigh
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
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
May 3, 2023. The USFWS has 30 days to respond from the date of the sent request. S&EC received no response from USFWS within the 30 days which
in their interpretation means that they concur with the determinations made by S&EC. 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.
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)
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?"
S&EC received a response letter (ER 23-1133) from SHPO on June 9, 2023 stating there was no comments for the offsite portion of the project;
Three letters were provided by the applicant for work that was completed before S&EC was under contract, all three letters are attached for reference:
ER 21-0083, ER-21-2810, and follow up letter from SHPO re ER-0083.
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA-designated 100-year floodplain?"
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
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 —Parker Ridge.pdf 33.19MB
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:
Deborah E. Shirley

Signature
Z6Aot,&f S- t�ti tl�r�
Date
10/12/2023