20161131 Ver 2_PCN Form Submission_20171010

Action History (UTC-05:00) Eastern Time (US & Canada)
�brrrit by Anonymous User 10/10/2017 8:08:37 AM (Start Event)
Accept by Carpenter,Kristi 10/10/2017 2:21:51 PM (DOT Initial Review)
• The task was assigned to Carpenter,Kristi . The due date is: October 13, 2017 5:00 PM
10/10/2017 8:09 AM

�� �
6fvlslaa of Water Resources
Pre-Construction Notification (PCN) Form
For Nationwide Permits and Regional General Permits
(along with corresponding Water Quality Certifications)
June 28, 2017 Ver 1.8
*
Please note: fields marked with a red asterisk below are required. You will not be ab/e to submit the form until all mandatory questions are ans�red.
Below is a link to the DRAFT online help file. http://edocs.deq.nc.gov/WaterResources/0/doc/549884/Page1.aspx
A. Processing Information
County (or Counties) where the project is located:*
Guilford
Is this a NCDOT Project?*
C� Yes �' No
(NCDOT only) T.I.P. or state project number:
B-5345 - Replacement of Bridge No. 456 over Brush Creek on SR 2136
(Fleming Road)
WBS #
46059.1.1
(for NCDOT use only)
1a. Type(s) of approval sought from the Corps:*
�J Section 404 Permit (wetlands, streams and waters, Clean Water Act)
r Section 10 Permit (navigable waters, tidal waters, Rivers and Harbors Act)
1b. What type(s) of permit(s) do you wish to seek authorization?*
r% Nationwide Permit (NWP)
� Regional General Permit (RGP)
Nationwide Permit (NWP) Number:
I NWP Number Other:
List all MNnurrbers you are applying for not on the drop down list.
03 - Maintenance
1c. Type(s) of approval sought from the DWR:*
check all that apply
fJ 401 Water Quality Certification - Regular
r Non-404 Jurisdictional General Permit
r 401 Water Quality Certification - Express
I� Riparian Buffer Authorization
1d. Is this notification solelyfor the record because written approval is not required?
i For the record only for DWR 401 Certification:
*
C' Yes C•' No
For the record only for Corps Permit: �' Yes C� No

1e. Is payment into a mitigation bank or in-lieu fee program proposed for mitigation of impacts?
If so, attach the acceptance letter from rritigation bank or in-lieu fee program
C' Yes C' No
Acceptance Letter Attachment
Qick the upload button or drag and drop files here to attach docurrent
3_B-5345 - Buffer - CF 02.pdf 88.44KB
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1f. Is the project located in any of NC's twenty coastal counties?*
C' Yes �' No
B. Applicant Information
1a. Who is the Primary Contact?*
NCDOT
I 1b. Primary Contact Email:*
[e-mail]
1c. PrimaryContact Phone:*
(xxx)xxx-xxxx
[phone]
1d. Who is applying for the permit?
I7 Owner r Applicant (other than owner) r AgenUConsultant
(Check all that apply)
2. Owner I nformation
2a. Name(s) on recorded deed:
2b. Deed book and page no.:
I 2c. Responsible party:
(for Corporations)
2d.Address
Street Address
Address Line 2
��
Fbstal / Zip Code
2e. Telephone Number:
(xxx)xxx-xxxx
2f. Fax Number:
(xxx)xxx-xxxx
2g. Email Address:*
[e-mail]
State / Rovince / F�gion
Country
C. Project Information and Prior Project History
1. Project Information

1a. Name of project:*
I B-5345 - Replacement of Bridge No. 456 over Brush Creek on SR 2136
(Fleming Road)
1b. Subdivision name:
(if appropriate)
1c. Nearest municipality/town:*
Greensboro
1d. Driving directions*
If it is a new project and can not easily be found in a C� rrepping system Rease provide directions.
From Raleigh - Take I-40W to Ebt 2126 in Greensboro (I-73N); Continue to E�t 3 on I-73N (signs for Bryan Blvd/PTI Airport); Keep right at
the fork, follow signs for Bryan Blvd E/Downtown and merge onto Joseph M Bryan Blvd; Take the Fleming Rd Exit off of Bryan Blvd, turn left;
Continue on Fleming Rd —2.5 miles to bridge location over Brush Creek (just past Brass Eagle Loop on right).
2. Project Identification
2a. Property Identification Number:
(tax RN or parcel ID)
2b. Propertysize:
(in acres)
2c. Project Address
Street Address
Address Line 2
�Y
Fbstal / Zip Code
State / FYovince / F�gion
Country
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 howthe location was determined. (For e�mple, most mobile phones with GPS provide locational precision in decimal degrees to
map coordinates to 5 or 6 digits after the decimal place.)
i Latitude:*
36.140239
ex:34208504
3. SurFace Waters
Longitude:*
-79.913884
-77.796371
3a. Name of the nearest body of water to proposed project:*
i Brush Creek
3b. Water Resources Classification of nearest receiving water:*
WS-III NSW
Surface Water Lookup
3c. What river basin(s) is your project located in?*
Cape Fear
RiverBasin Lookup
4. Project Description

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:*
Fleming Rd. is classified as a Rural Major Collector in the Statewide Functional Classification System and is not a
National Highway System Route. Land use within the vicinity primarily consists of forested land and medium density
residential.
4b. Attach an 8 1/2 X 11 excerpt from the most recent version of the USGS topographic map indicating the location of the project site. (for
DWR)
aick the upload button or drag and drop files here to attach docurrent
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4c. Attach an 8 1/2 X 11 excerpt from the most recent version of the published County NRCS Soil Survey map depicting the project site.
(for DWR)
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4d. List the total estimated acreage of all existing wetlands on the property:
0.23
4e. List the total estimated linear feet of all existing streams on the property:
(interrrittent and perennial)
213 (Brush Creek and a UT of Brush Creek [SB])
4f. Explain the purpose of the proposed project:
I To replace a structurally deficient and functionally obsolete bridge.
4g. Describe the overall project in detail, including the type of equipment to be used:
The project will consist of replacing the existing three-span, 75-foot structure with a one-span, 85-foot structure on
the existing alignment. An on-site detour will be employed. Standard road building equipment, such as trucks,
dozers, and cranes will be used.
4h. Please upload project drawins for the proposed project.
C7ick the upload button or drag and drop files here to attach docurrent
5_B-5345_Permit Drawings_20161108_Revised by JSM.pdf
6_B-5345_Permit Drawings_BUFFER_20161108.pdf
7_B-5345 Roadway Plans_11x17.pdf
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5. Jurisdictional Determinations
3.64M6
757.88KB
2.36M6
5a. Have the wetlands or streams been delineated on the propertyor proposed impact areas?*
C� Yes C' No �' Unknown
Comments:
Site visit on April 10, 2012 by Thomas Brown (USACE); no JD issued.
5b. If the Corps made a jurisdictional determination, what type of determination was made? *
r Preliminary
Corps AID Number:
c' Approved
Exarrple: SAV�2017-99999
SAW-2012-00600 (from original NWP 3 issuance)
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known):
Agency/Consultant Company:
Othe r:
C' Unknown
Dwayne Huneycutt
Michael Baker Engineering

5d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
Site visit 4/10/12.
5d1. Jurisdictional determination upload
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6. Project History
6a. Have permits or certifications been requested or obtained for this project (including all prior phases) in the past?*
C�' Yes �' No �' Unknown
6b. If yes, please give the DWR Certification number or the Corps Action ID (exp. SAW-0000-00000).
i USACE Action ID SAW-2012-00600 (NWP 3); e�ired 3/18/2017; work will not commence until after the 1-year
grace period for this permit has ended. DWR Project No. 20161131 (WQC 3883 and Jordan Lake Buffer
Authori�tion).
Project History Upload
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7. Future Project Plans
7a. Is this a phased project?*
C' Yes r 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 activit�/? This includes other separate and distant crossing for linear projects that require Department of the
Army authorization but don't require pre-construction notification.
D. Proposed I m pacts I nventory
1. Impacts Summary
1a. Where are the impacts associated with your project? (check all that apply):
fJ Wetlands fJ Streams-tributaries r7 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.
2a. Site # - Reason for
impact
2 -Perm. Fill
N�p label (e.g. I�ad Qossing 1)
2-Mechanized Clearing
N�p label (e.g. Road Qassing 1)
3-Perm. Fill
N�p label (e.g. Id�ad Q'ossing 1)
3-Mechanized Clearing
N�p label (e.g. f�ad Qossing 1)
2b. Impact type * 2c. Type of wetland
P Bottomland Hardwood
F�rrranent (P� or Terrporary FOreSt
��
P Bottomland Hardwood
F2rrranent (P� or Terrporary Forest
��
P Bottomland Hardwood
F2rrranent (F) or Terrporary FoPest
��
P Bottomland Hardwood
F2rrraner� (�j or Terrporary Forest
��
2d. Wetland name 2e. Forested 2f. 2g. Impact
Jurisdiction area
type
WD Yes Corps 0.080
(404, 10) or CANR (acres)
(401, other)
WD Yes Corps 0.005
(404, 10) or d�NR (acres)
(401, other)
WB Yes Corps 0.100
(404, 10) or D�NR (acres)
(401, other)
WB Yes Corps 0.030
(404, 10) or C7�NR (acres)
(401, other)

2a. Site #- Reason for 2b. Impact type * 2c. Type of wetland
impact
4-Mechanized Clearing P Bottomland Hardwood
N�p label (e.g. I�ad Q'ossing 1) F2rrranent (� or Terrporary Fo1'est
��
5-Mechanized Clearing P Bottomland Hardwood
N�p label (e.g. f�ad C7ossing 1) F�rrranent (P� or Terrporary FOrest
i�
2g. Temporary Wetland Impact
0.000
2g. Permanent Wetland Impact
0.230
2g. Total Wetland Impact
0.230
i 2h. Comments:
Sites 2 and 3 are associated with the on-site detour.
2d. Wetland name 2e. Forested 2f. 2g. Impact
Jurisdiction area
type
WC Yes Corps 0.010
(404, 10) or C7JVR (acres)
(401, other)
WA Yes Corps 0.005
(404, 10) or C7�NR (acres)
(401, other)
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.
i 3a. Site #- 3b.lmpact 3c. Type of 3d. Stream 3e. Stream 3f. 3g. Stream 3h. Impact
Reason for type impact name Type Jurisdiction width length
impact type
Row 1 1-Temp. T Fill Brush Perennial Corps Average 52
Causeways F�rrranent (� or Cree k F2rennial (�) or 25 (linear feet)
i (#1 8nd #2) Terrporary (� interrrittent (IN� (feet)
Row 2
Row 3
Row 4
Row 5
N�p label (e.g.
RDad Qossing 1)
7-Bank P Bank Brush
Stabilizatio F2rrranent(Fjor Stabilizatio Creek
n (DET.) Terrporary (� n
N�p label (e.g.
Raad Q'ossing 1)
1-Temp. T Bank Brush
Bank �rrranent(Fjor Stabilizatio Creek
Stabilizatio Terrporary (� n
n (DET.)
N�p label (e.g.
RDad (7ossing 1)
1-Bank P Bank Brush
Stabilizatio F2rrrsnent(F'jor Stabilizatio Creek
n Terrporary (� n
N�p label (e.g.
Raad Q'ossing 1)
1-Temp. T Bank Brush
Bank F�rrranent(�jor Stabilizatio Creek
Stabilizatio Terrporary (� n
n
N�p label (e.g.
I�ad Qossing 1)
Perennial Corps
F2rennial (� or
interrrittent (IN�
Perennial Corps
F2rennial (Fff� or
interrrittent (IIV�
Perennial Corps
F2rennial (FB� or
interrrittent (IN�
Perennial Corps
F2rennial (FH� or
interrrittent (IfV�
*' All Perennial or Intermittent streams must be verified by DWR or delegated local government.
3i. Total jurisdictional ditch impact in square feet:
0
Average 16
25 (linear feet)
(feet)
Average 10
25 (linear feet)
(feet)
Average 21
25 (linear feet)
(feet)
Average 10
25 (linear feet)
(feet)

3i. Total permanent stream impacts:
37
3i. Total temporary stream impacts:
72
3i. Total stream and tributary impacts:
109
3j. Comments:
Total area of temporary causeway impacts is 0.04 acres.
Causeway #1 blocks more than 50% of the channel. Therefore, 1@ 30" temporary pipe to be installed with
causeway to help convey the average daily flow.
Causeways #1 and #2 should not be in place at the same time. There is an overlap in impact area between the
causeways. However, the Total Temporary Surface Water Impacts remain 0.04 acres due to the minimal overlap
area.
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.
5. Pond or Lake Construction
If pond or lake construction is proposed, then complete the chart below.
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.
r Neuse
� Catawba
r Goose Creek
r Other
6b. Impact Type
r Tar-Pamlico
r Randleman
fJ Jordan Lake
6c. Per or 6d. Stream name
Te mp
I 1- Bridge P Brush Creek
Location and C errpt, Allowable, allowable w/ rritigation F2rrranent (F) or
Terrporary (�
1-Road Crossing P Brush Creek
Location and 6cerrpt, Allowable, allowable w/ rritigation F2rrranent (F� or
Terrporary (�
2-Impacts Other Than Road P Brush Creek
Crossings F�rrranent (f'� or
Location and 6cerrpt, Allowable, allowable w/ rritigation Terrporary (�
6h. Total buffer impacts:
Zone 1 Zone 2
Temporary impacts: 0.00 0.00
6e. Buffer 6f. Zone 1 6g. Zone 2
mitigation impact impact
required?
No 5,387 1,203
(squarefeet) (squarefeet)
No
Yes
1,902 3,008
(squarefeet) (squarefeet)
263 (square feet)
(square feet)

Permanent impacts:
Total buffer impacts
6i. Comments:
Zone 1
7,552.00
Zone 1
7,552.00
Zone 2
4,211.00
Zone 2
4,211.00
For impacts associated with Site 1, there are Wetlands in Buffers totaling 155 square feet in Zone 1 and 0 square
feet in Zone 2 within the Bridge buffer impacts.
For impacts associated with Site 1, there are Wetlands in Buffers totaling 158 square feet in Zone 1 and 1,862
square feet in Zone 2 within the Road Crossing buffer impacts.
For impacts associated with Site 2, there are 115 square feet of Wetlands in Buffers in Zone 1. The wetland impact
supercedes the buffer impact and will be counted in the wetland mitigation. Therefore, only 148 square feet on
Zone 1 impacts at Site 2 will be considered for mitigation.
Supporting Documentation - i.e. Impact Maps, Plan Sheet, etc.
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E. Impact Justification and Mitigation
1. Avoidance and Minimization
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:*
The proposed bridge is 10 feet longer than the existing bridge; Standard V ditches, Lateral V ditches,and Special
Cut ditches will be employed on the detour for stormwater management; Lateral V ditches and a grassed swale will
be employed on the L-line; bank stabili�tion will be installed where one of the V ditches ties into Brush Creek on
the detour and where the grassed swale ties into the creek on the L-line to prevent scouring and erosion; no
additional permanent fill will occur in Brush Creek.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:*
Due to the projecYs location within the Jordan Lake Watershed, Design Standards in Sensitive Watersheds will be
employed; NCDOT Best Management Practices for Construction and Maintenance Activities and Best
Management Practices for the Protection of Surface Waters will be employed.
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?
G Yes
C' No
2c. If yes, mitigation is required by (check all that apply):
rJ DWR
rJ Corps
2d. If yes, which mitigation option(s) will be used for this project?
� Mitigation bank r% Payment to in-lieu fee program
4. Complete if Making a Payment to In-lieu Fee Program
4a. Approval letter from in-lieu fee program is attached.
� Yes
4b. Stream mitigation requested:
Qinear feet)
0
4c. If using stream mitigation, stream temperature:
r7 Permittee Responsible Mitigation

4d. Buffer mitigation requested (DWR only):
(squarefeet)
148 square ft., Zone 1@ 3:1 = 444 square ft.
4e. Riparian wetland mitigation requested:
(acres)
0.23 ac. @ 2:1 = 0.46 ac.
4f. Non-riparian wetland mitigation requested:
(acres)
0
4g. Coastal (tidal) wetland mitigation requested:
(acres)
0
4h. Comments
DMS letter covers the mitigation required for impacts to 148 square ft of Zone 1 buffers. Please see the attached
Permittee Responsible Mitigation Plan to offset impacts to 0.23 acres of riparian wetland impacts.
5. Complete if Using a Permittee Responsible Mitigation Plan
5a. If using a permittee responsible mitigation plan, provide a description of the proposed mitigation plan including mitigation credits
generated.
Please see the attached Permittee Responsible Mitigation Plan to offset impacts to 0.23 acres of riparian wetland
impacts.
5b. Mitigation Plan Upload
C7ick the upload button or drag and drop files here to attach docurrent
4_B-5345 Updated Debit Ledger_FINAL.pdf
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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.
C•' Yes
C' No
6b. If yes, then identify the square feet of impact to each zone of the riparian buffer that requires mitigation
calculate the amount of mitigation required in the table below.
Zone 1
Zone 2
6c. Reason for impact 6d. Total impact Multiplier
(square feet)
Impacts Other Than Road Crossings 148 3
6f. Total buffer mitigation required
� 444
0 1.5
6e. Required
mitigation (square
feet)
444
0
6g. If buffer mitigation is required, is payment to a mitigation bank or NC Division of Mitigation Services proposed?
�' Yes C' No
6h. Attach the acceptance letter from the mitigation bank or NC Division of Mitigation Services.
(FDF only)

6i. If no, then discuss what type of mitigation is proposed.
6j. Comments:
F. Stormwater Management and Diffuse Flow Plan (required by DWR)
1a. Does this project require a Stormwater Management Plan?
C� Yes �' No
1b. If this project DOES require a Stormwater Management Plan, then provide a brief, narrative description of the plan:
See attached Permit Drawings
1c. What is the overall percent imperviousness of this project?
%
1d. Who will be responsible for the review of the Stormwater Management Plan?*
r Certified Local Government r DEMLR Stormwater Review
� DWR 401 & Buffer Permitting Branch �7 DWR Transportation Permitting Branch
2. Diffuse Flow Plan
2a. Does the project include or is it adjacent to protected riparian buffers identified within one of the NC Riparian Buffer Protection
Rules?
C� Yes �' No
2b. All buffer impacts and high ground impacts require diffuse flow or other form of stormwater treatment. Include a plan that fully
documents how diffuse flow will be maintained.
If, due to site constraints, a BMP other than a level spreader is proposed, please provide a plan for stormwater treatment as outlined
in Chapter 8 of the NC Stormwater BMP Manual and attach a BMP Supplement Form
What documentation are you providing?
r Level Spreader
r Other BMP
(check all that apply)
Diffused Flow Documentation
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5. DWR 401 Stormwater Review
5a. Is the Stormwater Management Plan (including BMP Supplemental Forms and Operation and Maintenance Agreements) attached?
r Yes l" No
Stormwater Management Plan Upload
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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?*
C� Yes �' No

1b. If you answered "yes" to the above, does the project require preparation of an environmental document pursuant to the
requirements of the National or State (North Carolina) Environmental PolicyAct (NEPA/SEPA)?*
�' Yes l" No
1c. If you answered "yes" to the above, has the document review been finalized by the State Clearing House? (If so, attach a copy of the
NEPAor SEPAfinal approval letter.)*
r Yes l" No
NEPAor SEPAFinal Approval Letter
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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)? *
C' Yes C•' No
2b. Is this an after-the-fact permit application?*
C' Yes C•' No
2c. If you answered "yes" to one or both of the above questions, provide an explanation of the violation(s):
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?*
C' Yes C•' No
3b. If you answered "no," provide a short narrative description.
I Due to the minimal transportation impact resulting from this bridge replacement, this project will neither influence
nearby land uses nor stimulate growth. Therefore, a detailed indirect or cumulative effects study will not be
necessary.
4. Sewage Disposal (DWR Requirement)
4a. 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.
5. Endangered Species and Designated Critical Habitat (Corps Requirement)
Sa. Will this project occur in or near an area with federally protected species or habitat?*
C' Yes C•' No
5b. Have you checked with the USFWS concerning Endangered Species Act impacts?*
G Yes l' No
5c. If yes, indicate the USFWS Field Office you have contacted.
Raleigh
5d. Is this a DOT project located within Division's 1-8?*
C� Yes
C' No
Si. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?*

NC Natural Heritage Program data, USFWS website, NCDOT field surveys; No habitat present for small whorled
pogonia; no impact to bald eagle; the northern long-eared bat (NLEB) is covered by the Programmatic Biological
Opinion for Divisions 1 through 8.
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as an Essential Fish Habitat?*
C' Yes C•' No
6b. What data sources did you use to determine whether your site would impact an Essential Fish Habitat?*
I NMFS County Index
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 historyand archaeology)?*
C' Yes C•' No
7b. What data sources did you use to determine whether your site would impact historic or archeological resources? *
NEPA Documentation
7c. Historic or Prehistoric Information Upload
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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-year floodplain?*
C•' Yes �' No
8b. If yes, explain how project meets FEMA requirements:
NCDOT Hydraulics Unit coordination with FEMA
8c. What source(s) did you use to make the floodplain determination?*
FEMA Maps
Miscellaneous attachments not previously requested.
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Email to USACE regarding additional information request_12012016.pdf 157.1 KB
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Signature
*
fJ By checking the box and signing below, I certify that:
. 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 AcY');
■ I agree to conduct this transaction by electronic means pursuant to Chapter 66, Article 40 of the NC General Statutes (the "Uniform Electronic
Transactions AcY');
■ 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:*
Colin Mellor
Signature
Col� ��Ilc�r
Date
10/10/2017
Initial Review
Is this project a public transportation project?
r Yes C' No
Only change this if the project has been reassigned.
Has this project met the requirements for acceptance in to the review process?*
�' Yes
C' No
BIMS # Assigned*
20161131
Version#*
2
Reviewing Office *
Central Office - [phone]
Select Project Reviewer*
April Norton:eads\arnorton