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HomeMy WebLinkAbout20240269 Ver 1_ePCN Application_20240213DW R DHlsloo 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. 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 Version# * 20240269 1 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 1a. Name of project: Weldon 1a. Who is the Primary Contact?* Deborah Shirley 1b. Primary Contact Email:* dshirley@sandec.com Date Submitted 2/13/2024 Nearest Body of Water Beaverdam Creek Basin Neuse Water Classification C;NSW Site Coordinates Latitude: 35.825116 A. Processing Information Is this project connected with ARPA funding? Yes No County (or Counties) where the project is located: Wake Is this a NCDMS Project Yes No Longitude: -78.467612 What amount is owed?* $240.00 $323.00 Select Project Reviewer* Zachary Thomas:zachary.thomas 1c. Primary Contact Phone:* (919)846-5900 $570.00 $767.00 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: Nationwide Permit (NWP) Number: NWP Numbers (for multiple NWPS): NWP 18-SCM fill 1d. Type(s) of approval sought from the DWR: 401 Water Quality Certification - Regular Non-404 Jurisdictional General Permit Individual 401 Water Quality Certification 29 - Residential Developments 18 - Minor Discharges 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 fig. 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 401 Water Quality Certification - Express Riparian Buffer Authorization 1d. 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: Dement Farms, LLC 2b. Deed book and page no.: DB:017010, DP:02347 2c. Contact Person: Russell W. Dement III 2d. Address Street Address 717 N. 1 st Ave Address Line 2 City Stale / Province / Region Knightdale NC Postal/Zip Code Country 27545 USA Yes No Yes No 2e. Telephone Number: 2f. Fax Number: (919)297-2973 2g. Email Address:* rrojas@drbgroup.com 3. Applicant Information (if different from owner) 3a. Name: Ric Rojas 3b. Business Name: DRB Group North Carolina, LLC 3c.Address Street Address 3000 RDU Center Dr Address Line 2 Suite 202 city State / Province / Region Morrisville NC Postal / Zip Code Country 27560 USA 3d. Telephone Number: 3e. Fax Number: (919)297-2973 3f. Email Address:* rrojas@drbgroup.com 4. Agent/Consultant (if applicable) 4a. Name: Deborah Shirley 4b. Business Name: Soil & Environmental Consultants, Inc. 4c.Address Street Address 8412 Falls of Neuse Road Address Line 2 Suite 104 City State / Province / Region Raleigh NC Postal / Zip Code Country 27516 USA 4d. Telephone Number: 4e. Fax Number: (919)846-5900 (919)846-9467 4f. Email Address:* dshirley@sandec.com C. Project Information and Prior Project History 1. Project Information 1b. Subdivision name: (if appropriate) 1c. Nearest municipality / town: Knightdale 2. Project Identification 2a. Property Identification Number: 1755-75-7607 2b. Property size: Approximately 44 acres O 2c. Project Address Street Address 0 Lucas Road Address Line 2 city Knightdale Postal / Zip Code 27545 3. Surface Waters 3a. Name of the nearest body of water to proposed project: Beaverdam Creek 3b. Water Resources Classification of nearest receiving water: QNSW 3c. What river basin(s) is your project located in?* Neuse 3d. Please provide the 12-digit HUC in which the project is located. 030202010705 4. Project Description and History State / Province / Region NC Country USA 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 one parcel that is primarily wooded. There are two streams, A is Beaverdam Creek, B and six wetlands (W1, W3-W7) within the project boundary. This property is north of Horton Road. General land use in the vicinity consists 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 0.932 acres 4g. List the total estimated linear feet of all existing streams on the property: Approximately 2,679 linear feet 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 multi -family & single-family residential development (i.e. 37 townhomes, 109 single family homes) with 15,000 SF of commercial space, and the construction of roadway infrastructure, utilities, residential lots, mailbox kiosk, greenways and Stormwater Control Measures (SCM). Specifically, there are two proposed road crossings, fill for an SCM, one utility crossing and buffer impacts associated with greenway construction, bypass discharge, SCM, and road grading. 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: SAW-2022-01734 5c. If 5a is yes, who delineated the jurisdictional areas? Name (if known): Joshua Harvey Agency/Consultant Company: Soil R Environmental 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 USACE: SAW-2022-01734 email verified by Samantha Dailey on August 9, 2022. Note that per the Sackett decision, an updated AJD has been submitted to Matthew Martin with the USACE. NCDWR: NBRRO #22-319 Buffer determination made on September 14, 2022 by Chris Smith. 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? 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 L Impact 2 2a1 Reason (?) Road Crossing 2b. Impact type* (?) P 2c. Type of W. Fttomiand Hardwood Forest 2d. W. name W3, W4 & W5 2e. Forested" Yes 2f. Type of Jurisdicition * ?) Both 2g• Impact area 0.004 (acres) Impact 3 T M Fill P Headwater Forest W1 �Ye=f-th ItEl_ 2g. Total Temporary Wetland Impact 0.000 2g. Total Wetland Impact 0.044 21. Comments: Total permanent loss wetland impacts = 1,938 SF/0.044 acres 3. Stream Impacts 2g. Total Permanent Wetland Impact 0.044 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 A Perennial Both 154 Culvert & Headwalls Average (feet) (linear feet) g2 Impact - Road Crossing - Permanent Other Stream A Perennial Both 4 52 Permanent No Permanent Average (feet) (linear feet) Loss - Riprap Dissipater Pad S3 Impact 1 - Road Crossing - Temporary Other Stream A Perennial Both 5 16 Temporary Construction Aveage (feet) (linear feet) Access S4 Impact 2 - Road Crossing- Permanent Culvert Stream B Intermittent Both 82 Culvert & Headwalls Average (feet) (linear feet) S5 Impact 2 - Road Crossing - Permanent Other Stream B Intermittent Both 6 39 Permanent No Permanent Average (feet) (linear feet) Loss - Riprap Dissipater Pad S6 Impact 2 - Road Crossing - Temporary Other Stream B Intermittent Both 6 26 Temporary Construction Ave age (feet) (linear feet) Access S7 Impact 9 - Sanitary Sewer Temporary Other Stream A Perennial Both 8 30 Crossing - Temporary ::1 Average (feet) (linear feet) Construction Access 3i. Total jurisdictional ditch impact in square feet: 0 3i. Total permanent stream impacts: 327 3i. Total stream and ditch impacts: 399 3i. Total temporary stream impacts: 72 3j. Comments: Permanent Stream Impacts = 236 LF (0.027 acres); Permanent No Permanent Loss Impacts = 91 LF (0.009 acres); Temporary Stream Impacts = 72 LF (0.010 acres). 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 requiredT 6f. Zone 1 impact 6g. Zone 2 impact Impact 1 - Road Crossing P Stream A No 9,186 5,069 Impact 2 - Road Crossing P Stream B No 8,219 4,453 Impact 3 - SCM Grading P Stream A & B No 0 6,536 Impact 4A - Stormwater Bypass P Stream B No 1,352 303 Impact 413 - Sewer Easement P Stream B Yes 293 0 Impact 5 - Road Retaining Wall & Grading P Stream A Yes 0 854 Impact 7C - SCM Grading P Stream A No 0 1,630 Impact 8C - Greenway P Stream A No 0 2,770 Impact 913 - Sewer Easement P Stream A No 120 1,069 Impact 9C - Greenway P Stream A No 521 6,499 6h. Total buffer impacts: Zone 1 Zone 2 Total Temporary impacts: 0.00 0.00 Zone 1 Zone 2 Total Permanent impacts: 19,691.00 29,183.00 Zone 1 Zone 2 Total combined buffer impacts: 19,691.00 29,183.00 6i. Comments: Deemed Allowable Riparian Buffer Impacts not included within table above. All deemed allowable impacts called out with "deemed allowable" notes on impact exhibits. Deemed allowable impacts include: Impacts 4B (Zone 2), 6, 7A, 7B, 8A, 813 & 9A. E. Impact Justification and Mitigation 1. Avoidance and Minimization L 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 entire property in order to identify natural resources so that impacts could be avoided & minimized to the maximum extent practicable. Impact 1 is a proposed road crossing of a perennial stream. Proposed impacts include permanent (i.e. culvert & headwalls), permanent -no permanent loss (i.e. riprap dissipator), temporary (i.e. construction access) stream impacts, and associated riparian buffer impacts. This road crossing is required by the Town of Knightdale per their Transportation Plan and it is also providing access to the northern portion of the property. Stream and riparian buffer impacts have been minimized by utilizing headwalls and retaining walls on both sides of the crossing, and by designing the crossing at a near perpendicular angle. Stream mitigation is proposed at a 2:1 ratio to compensate for the permanent stream loss. Temporary stream impacts will be brought back to pre -construction stream bed elevations and the stream banks will be stabilized. Impact 2 is a proposed road crossing of an intermittent stream and wetlands. Proposed impacts include permanent (i.e. culvert & headwalls), permanent -no permanent loss (i.e. riprap dissipator), temporary (i.e. construction access) stream impacts, permanent wetland impacts (i.e. culvert & fill), and associated riparian buffer impacts. This road crossing is necessary to provide access to the northwestern portion of the property and lots. Stream and riparian buffer impacts have been minimized by utilizing headwalls and retaining walls on both sides of the crossing, and by designing the crossing at a near perpendicular angle. Stream mitigation is proposed at a 2:1 ratio to compensate for the permanent stream loss. Temporary stream impacts will be brought back to pre -construction stream bed elevations and the stream banks will be stabilized. Impact 3 is proposed fill necessary for a Stormwater Control Measure (SCM). Proposed impacts include permanent wetland loss and Zone 2 riparian buffer. This SCM has been located at the lowest point of this drainage basin to allow for minimum cover over the storm drainage pipe and allow for regulated minimum separations between storm drainage, waterline, and sanitary sewer piping. Relocating the SCM from this location in upland areas would not allow the site storm drainage to meet minimum cover requirements and would also create vertical separation issues between the storm drainage, waterline, and sanitary sewer piping. Additionally, low points would be created within the subdivision in which storm drainage relief could not be achieved due to elevation differences and could cause potential flooding of residential homes. Impact 4A is necessary to bypass offsite stormwater. Proposed impacts include permanent Zone 1 & 2 riparian buffer impacts. Stream impacts were avoided. Impact 4B is a proposed sanitary sewer extension and manhole. Proposed impacts include permanent Zone 1 & 2 riparian buffer impacts. Zone 2 impacts are considered "deemed allowable". This impact is being required by the City of Raleigh Public Utility Department (CORPUD), CORPUD requires a manhole stub to the property boundary. Zone 1 buffer mitigation is proposed at a 3:1 ratio to compensate for the riparian buffer impacts. Impact 5 is a proposed retaining wall and grading for a road. Proposed impacts include permanent impacts to Zone 2 only. This Zone 2 buffer impact is necessary because the Town of Knightdale doesn't allow retaining wall geogrid inside the Right of Way, and this retaining wall allows for the avoidance of Zone 1 riparian buffer impacts. Zone 2 buffer mitigation is proposed at a 1.5:1 ratio to compensate for these riparian buffer impacts. Impact 7C is proposed grading into Zone 2 for a Stormwater Control Measure (SCM). Proposed impacts include permanent Zone 2 riparian buffers. Zone 1 buffer impacts have been avoided. Impact 8C is proposed impacts for a greenway. This impact is necessary for a pedestrian greenway. Riparian buffer impacts have been minimized by adding retaining walls at the back of the residential lots and shifting the greenway out of Zone 1. Impact 9B is for a sanitary sewer construction. Proposed impacts include Zone 1 and Zone 2 riparian buffer impacts. Proposed impacts have been minimized by shifting the easement to the south and also keeping a distance from the stream bank. Construction constraints include the retaining wall for the lots and the greenway. Impact 9C is proposed impacts for a greenway. This impact is necessary for a pedestrian greenway. Riparian buffer impacts have been minimized by adding retaining walls at the back of the residential lots and shifting the greenway out of Zone 1 to the maximum extent practicable. Impacts 4B (Zone 2), 6, 7A, 7B, 8A, 8B & 9A are all considered "deemed allowable". The specific use per 15 NCAC 02B .0714 has been added to the impact sheets. 1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques: Per the project engineer; Culvert crossings will utilized coffer dams, pump arounds, silt fencing and silt fencing outlets. The remainder of the site will utilize silt fencing, silt fencing outlets, diversion ditches and sediment basins. 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: EBX-Neuse I, LLC Neuse Riparian Buffer Umbrella Mitigation Bank, RES Neuse Buffer and Nutrient Offset Umbrella Mitigation Bank, RES Poplar Creek Buffer & Nutrient Offset Umbrella Mitigation Bank, EBX Upper Neuse Riparian Buffer Umbrella Mitigation Bank, RES 2021 Neuse Umbrella Mitigation Bank, and RES 2022 Phase II Umbrella Mitigation Bank 3b. Credits Purchased/Requested (attach receipt and letter) Type: Quantity: Riparian buffer 2,160 3c. Comments 4. Complete if Making a Payment to In -lieu Fee Program 4a. Approval letter from in -lieu fee program is attached. Yes No 4b. Stream mitigation requested: (linear feet) 4c. If using stream mitigation, what is the stream temperature: 472 warm 4d. Buffer mitigation requested (DWR only): 4e. Riparian wetland mitigation requested: (square feet) (acres) 4f. Non -riparian wetland mitigation requested: (acres) 4h. Comments 4g. Coastal (tidal) wetland mitigation requested: (acres) 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 6b. If yes, then identify the square feet of impact. r7l��impact 6d. Total impact (square feet) Multiplier 6e. Required mitigation (square feet) Zone 1 413: non -perpendicular utility Zone 1 293 3 879 Zone 2 5: non -perpendicular road Zone 2 854 1.5 1,281 6f. Total buffer mitigation required 2,160 6g. If buffer mitigation is required, is payment to a mitigation bank or NC Division of Mitigation Services proposed? Yes No 6j. Comments: 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 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 Knightdale 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 Weldon project is a residential development. Additionally, the project is located within the Town of Knightdale 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, City of Raleigh public utilities. 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? 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 October 20, 2023. 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? * The NC State Historic Preservation Office HPOWEB GIS Service interactive map was referenced on November 11, 2023, no historic listings or study list entries or determined eligible listings were identified within the property boundaries. Additionally, no structures exist within the property boundaries. 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_Weldon.pdf 40.47MB 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 Shirley Signature Behorah Shdel Date 2/13/2024 V