20171365 Ver 1_PCN Form Submission_20171026

Action History (UTC-05:00) Eastern Time (US & Canada)
�brrrit by Anonymous User 10/26/2017 9:26:23 PM (Start Event)
Accept by Carpenter,Kristi 10/27/2017 11:20:03 AM (DOT Initial Review)
• The task was assigned to Carpenter,Kristi . The due date is: October 31, 2017 5:00 PM
10/26/2017 9:27 PM

�� �
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:*
Cumberland
Is this a NCDOT Project?*
C� Yes �' No
(NCDOT only) T.I.P. or state project number:
U-4405
WBS #
39049.1.1
(for NCDOT use only)
� 1a. Type(s) of approval sought from the Corps:*
rJ 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?*
fJ Nationwide Permit (NWP)
r Regional General Permit (RGP)
Nationwide Permit (NWP) Number:
Nationwide Permit (NWP) Number:
NWP Number Other:
List all MNnurrbers you are applying for not on the drop down list.
12 - Utility Lines
14 - Linear transportation
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
r Riparian Buffer Authorization
1d. Is this notification solelyfor the record because written approval is not required?
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
i U-4405 Revised - STR - RW - CF 04.pdf 64.65KB
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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?*
Chris Rivenbark
1b. Primary Contact Email:*
criven [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:*
U-4405 US 401 FROM WEST OF HAMPTON OAKS DRIVE TO EAST OF
FAIRWAY DRIVE
1b. Subdivision name:
(if appropriate)
1c. Nearest municipality/town:*
Fayetteville
1d. Driving directions*
If it is a new project and can not easily be found in a C� rrepping system Rease provide directions.
US 401 from west of Hampton Oaks Drive to east of Fairway Drive.
2. Project Identification
2a. Property Identification Number:
(t�vc RN or parcel ID)
2b. Propertysize:
(in acres)
2c. Project Address
Street Address
Address Line 2
��
Fbstal / Zip Code
State / Rovince / 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 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:*
35.042299 -78.990336
ex:34.208504 -77.796371
3. Surface Waters
3a. Name of the nearest body of water to proposed project:*
UT to Little Rockfish Creek, Beaver Creek & tributaries, and Buckhead
Creek
3b. Water Resources Classification of nearest receiving water:*
C,B
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:*
Fayetteville urban area
4b. Attach an 8 7/2 X 11 excerpt from the most recent version of the USGS topographic map indicating the location of the project site. (for
DWR)
C7ick the upload button or drag and drop files here to attach docurrent
Fle type rrust be pdF
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)
aick the upload button or drag and drop files here to attach docurrent
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4d. List the total estimated acreage of all existing wetlands on the property:
0.25
4e. List the total estimated linear feet of all existing streams on the property:
(interrrdtent and perennial)
I 982
4f. Explain the purpose of the proposed project:
Widening of existing US 401 to accommodate ebsting and future traffic.
4g. Describe the overall project in detail, including the type of equipment to be used:
The NCDOT proposes to make improvements to U.S. Highway 401 (Raeford Road) in a length of about six (6)
miles from Old Raeford Road to east of Fairway Drive in Cumberland County. Standard roadway construction
methods and equipment will be used.
4h. Please upload project drawins for the proposed project.
Qick the upload button or drag and drop files here to attach docurrent
U4405 roadway.pdf 26.74MB
U4405_Permit Drawings_20171003.pdf 8.88M6
U4405 utility drawings combined final.pdf 3.79M6
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5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the propertyor proposed impact areas?*
C' Yes C' No !' Unknown
Comme nts:
The Corps issued a Preliminary JD 8/21/12. However, the project limits have
been revised since the JD was issued, involving additional impacts.
5b. If the Corps made a jurisdictional determination, what type of determination was made? *
C� Preliminary C' Approved C' Unknown
Corps AID Number:
6carrple: SAV�2017-99999
SAW-2011-01806
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known):
Agency/Consultant Company:
Other
Environmental Services, Inc. and NCDOTStaff
5d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.

8/21/12
Sd1. Jurisdictional determination upload
aick the upload button or drag and drop files here to attach docurrent
i u4405 jd.pdf
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6. Project History
3.4MB
6a. Have permits or certifications been requested or obtained for this project (including all prior phases) in the past?*
C' Yes C' No f Unknown
7. Future Project Plans
7a. Is this a phased project?*
C' 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? 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 Impacts Inventory
1. Impacts Summary
1a. Where are the impacts associated with your project? (check all that apply):
�J Wetlands �J Streams-tributaries r Buffers
fJ Open Waters r 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-extension
N�p label (e.g. 13�ad Qossing 1)
U1-water power
N�p label (e.g. 13�ad CXossing 1)
U3-sewer line
N�p label (e.g. Fd�ad Qossing 1)
U3-sewer line
N�p label (e.g. F�ad Qossing 1)
U4-water line
fv�p label (e.g. I�ad Qossing 1)
2b. Impact type * 2c. Type of wetland
P Riverine Swamp Forest
F2rrrenent (F) or Terrporary
��
P Riverine Swamp Forest
F�rrranent (� or Terrporary
��
T Riverine Swamp Forest
F�rrranent (Fj or Terrporary
��
T Riverine Swamp Forest
F2rrrsnent (P� or Terrporary
��
P Riverine Swamp Forest
F�rrrenent (� or Terrporary
��
2g. Temporary Wetland Impact
0.023
2g. Permanent Wetland Impact
0.219
2g. Total Wetland Impact
2d. Wetland name 2e. Forested 2f. 2g. Impact
Jurisdiction area
type
WA Yes Both 0.200
(404, 10) or CNVR (acres)
(401, other)
WA Yes Both 0.007
(404, 10) or C7�NR (acres)
(401, other)
WC Yes Both 0.020
(404, 10) or C�NR (acres)
(401, other)
WC Yes Both 0.003
(404, 10) or C7JVR (acres)
(401, other)
WC Yes Both 0.012
(404, 10) or C7JVR (acres)
(401, other)

0.242
2h. Comments:
There will also be 0.02 ac of hand clearing due to utilities
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.
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- P Culvert UT Little Perennial Both Average 8
extension F�rrranent (P) or Rockfish F2rennial (�) or �f�t� (linear feet)
N�p label (e.g. Terrporary (� Creek interrrittent (IN�
13�ad Q'ossing 1)
Row 2 1- T Culvert Ut Little Perennial Both Average 43
eXtenslon F2rrranent (F) or RoCkflsh F2rennial (FB� or �f�t� (linear feet)
fv�p label (e.g. Terrporary (� C1'eek interrrittent (If�
Finad Qossing 1)
Row 3 2- P Culvert Ut Beaver Perennial Both Average 201
extenSiOn F�rrranent (P� or Creek SA F�rennial (� or �q�t� (linearfeet)
N�p label (e.g. Terrporary (� interrrittent (IfVn
RDad Qossing 1)
Row 4 2- T Culvert Ut Beaver Perennial Both Average 31
eXtenslon F2rrranent(F'jor CreekSA F2rennial(FB�or �q�t� (linearfeet)
N�p label (e.g. Terrporary (� interrrittent (IN�
F�ad Qossing 1)
Row 5 3- P Culvert Beaver Perennial Both Average 33
extension F�rrranent(P�or Creek F�rennial(�or �q�t� (linearfeet)
N�p label (e.g. Terrporary (� interrrittent (IfVn
13�ad Qossing 1)
Row 6 3- P Bank Beaver Perennial Both Average 176
extenslon F2rrranent (Pj or Stablllzatlo CI'eek F2rennial (FS2) or �q�t� (linearfeet)
N�p label (e.g. Teriporary (� n interrrittent (IN�
Road Q'ossing 1)
Row 7 3- T Bank Beaver Perennial Both Average 21
i extension F�rrranent(F'�or Stabilizatio Creek F2rennial(Fff�or �q�t� (linearfeet)
fv�p label (e.g. Terrporary (� n interrrittent (IfV�
F�ad Qassing 1)
Row 8 4- P Culvert Ut Beaver Perennial Both Average 216
extension F�rrranent (� or Creek SC F2rennial (�) or �f�t� (linearfeet)
N�p label (e.g. Terrporary (� interrrittent (IN�
Raad Q'ossing 1)
Row 9 4- T Culvert Ut Beaver Perennial Both Average 20
eXtenslon F2rrranent(Fjor CPeekSC F2rennial(FB�or �f�t� (linearfeet)
N�p label (e.g. Terrporary (� interrrittent (If�
Road Qassing 1)
Row 10 5- P Culvert Buckhead Perennial Both Average 206
extension F�rrrenem(P�or Creek FBrennial(�or �f�t� (linearfeet)
N�p label (e.g. Terrporary (� interrrittent (INT)
RDad Q'ossing 1)
Row 11 5- T Culvert Buckhead Perennial Both Average 27
eXtensiOn F2rrrsnent(P�or CPeek F2rennial(FB�or �f�t� (linearfeet)
N�p label (e.g. Terrporary (� interrrittent (IN�
Finad Qossing 1)
Row 12 U5 T Excavation Buckhead Perennial Both Average 45
I N�p label (e.g. F�rrranent (P� or Cree k F�rennial (� or �q�t� (linear feet)
I�ad CYossing 1) Terrporary (� interrrittent (IfV�

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 13 U6 T Excavation Buckhead Perennial Both Average 48
I�p label (e.g. F2rrranent (� or Cree k F2rennial (� or �q�t� (linear feet)
Finad C7ossing 1) Teriporary (� interrrittent (IN�
"" All Perennial or Intermittent streams must be verified by DWR or delegated local government.
3i. Total jurisdictional ditch impact in square feet:
0
3i. Total permanent stream impacts:
840
3i. Total temporarystream impacts:
235
3i. Total stream and tributary impacts:
1075
3j. Comments:
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.
4a. Site #- Reason for 4b. Impact 4c. Name of waterbody
i impact type
1-extension P Ut Little Rockfish Creek
N�p label (e.g. Finad Qossing 1) F2rrrsnent (P� or (if applicable)
Terrporary (�
1-extension T Ut Little Rockfish Creek
fv�p label (e.g. I�ad Qossing 1) F2rrrenent (F'j or (if applicable)
Terrporary (�
2-extension P Ut Beaver Creek SA
N�p label (e.g. I�ad Qossing 1) F�rrranent (P� or (if applicable)
Terrporary (�
2-extension T Ut Beaver Creek SA
N�p label (e.g. Road Qassing 1) F2rrranent (F) or (if applicable)
Terrporary (�
3-extension P Beaver Creek
fv�p label (e.g. I�ad Qossing 1) F2rrrenent (F'� or (if applicable)
Terrporary (�
3-extension T Beaver Creek
N�p label (e.g. F�ad Qossing 1) F�rrranent (P� or (if applicable)
Terrporary (�
4-slipline P Ut Beaver Creek SC
N�p label (e.g. Road Qassing 1) F2rrranent (P� or (if applicable)
Terrporary (�
4-slipline T Ut Beaver Creek SC
fv�p label (e.g. 13�ad Q�ossing 1) F2rrrenent (Pj or (if applicable)
Terrporary (�
5-extension P Buckhead Creek
N�p label (e.g. f�ad Qossing 1) F�rrranent (P� or (if applicable)
Terrporary (�
5-extension T Buckhead Creek
N�p label (e.g. Fd�ad Q-ossing 1) F�rrranent (P� or (if applicable)
Terrporary (Tj
4d. Activity 4e. Waterbody4f. Impact area
type type
Culverts 0.01
(acres)
Culverts
Culverts
Culverts
Culverts
Culverts
Culverts
Culverts
Culverts
Culverts
0.01
(acres)
0.03
(acres)
0.03
(acres)
0.03
(acres)
0.01
(acres)
0.07
(acres)
0.01
(acres)
0.09
(acres)
0.01
(acres)

4a. Site # - Reason for
impact
U2
N�p label (e.g. Fd�ad Q'ossing 1)
U5
fv�p label (e.g. I�ad Qossing 1)
U6
N�p label (e.g. Id�ad Qossing 1)
4b. Impact 4c. Name of waterbody
type
T Ut Beaver Creek SA
F2rrrsnent (F) or (if applicable)
Terrporary (�
T Buckhead Creek
F�rrranent (� or (if applicable)
Terrporary (�
T Buckhead Creek
F�rrranent (P� or (if applicable)
Terrporary (�
4g. Total temporary open water Impacts:
0.15
4g. Total permanent open water impacts:
0.23
4g. Total open water impacts:
0.38
4h. Comments:
5. Pond or Lake Construction
If pond or lake construction is proposed, then complete the chart below.
4d. Activity
type
Excavation
Excavation
Excavation
4e. Waterbody4f. Impact area
type
0.05
(acres)
0.01
(acres)
0.02
(acres)
, 6. Buffer Impacts (for DWR)
If project will impact a protected riparian buffer, then complete the chart below. Individually list all buffer impacts below.
, 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 storm drainage systems will maintain ebsting drainage patterns and route runoff to natural outfalls.
There are four major structures that will be extended and one energy dissipater utilized to minimize water quality
impacts. Supplemental pipes will be added to the major crossing extensions to meet FEMA MOA requirements.
Stilling basins will be utilized to install the supplemental pipes and major structure extensions. The use of 3:1
slopes in jurisdictional areas when practicable.
1b. Specificallydescribe measures taken to avoid or minimize the proposed impacts through construction techniques:*
I Erosion control devices such as silt fence, rock inlet sediment traps, slope drains, clean water diversions, and silt
bags will also be utilized to minimize water quality impacts. BMP's for Construction and Maintenance Activities will
be adhered to.
� 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?
r Yes c' No
2c. If yes, mitigation is required by (check all that apply):
r7 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 r Permittee Responsible Mitigation

4. Complete if Making a Payment to In-lieu Fee Program
4a. Approval letter from in-lieu fee program is attached.
fJ Yes
4b. Stream mitigation requested:
(linear feet)
623
4c. If using stream mitigation, stream temperature:
warm
4d. Buffer mitigation requested (DWR only):
(squarefeet)
4e. Riparian wetland mitigation requested:
(acres)
0.21
4f. Non-riparian wetland mitigation requested:
(acres)
4g. Coastal (tidal) wetland mitigation requested:
(acres)
4h. 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.
C' Yes �' 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.
6c. Reason for impact 6d. Total impact Multiplier 6e. Required
(square feet) mitigation (square
fe e t)
Zone 1
Zone 2
6f. Total buffer mitigation required
6g. If buffer mitigation is required, is payment to a mitigation bank or NC Division of Mitigation Services proposed?
C' 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:
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
r 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 C' No
5. DWR 401 Stormwater Review
5a. Is the Stormwater Management Plan (including BMP Supplemental Forms and Operation and Maintenance Agreements) attached?
C' Yes l" No
Stormwater Management Plan Upload
C7ick the upload button or drag and drop files here to attach docurrent
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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)?*
C•' Yes �' 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.)*
C� Yes C' No
NEPAor SEPAFinal Approval Letter
aick the upload button or drag and drop files here to attach docurrent
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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 G No
2b. Is this an after-the-fact permit application?*

r Yes r 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.
While the implementation of a median will alter entrance and e�t patterns, this reduction in access will not result in
indirect or cumulative effects. The project will not influence nearby land use nor stimulate growth. Therefore, a
detailed indirect and cumulative effects study will not be necessary for this project.
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)
5a. Will this project occur in or near an area with federally protected species or habitat?*
C' Yes G No
Sb. Have you checked with the USFWS concerning Endangered Species Act impacts?*
C' Yes �' No
Sc. If yes, indicate the USFWS Field Office you have contacted.
5d. Is this a DOT project located within Division's 1-8?*
�' Yes
C' No
5i. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?*
NHP data, field surveys
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?*
NMFS
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 document. In September 2013 NCDOT and HPO agreed that the Lindy's (former A& W) Drive In
and Lafayette Lanes Bowling Alley are eligible, while the Owen's Florist store and house are not
eligible. A July 2014 consultation with HPO and FHWA revealed that the project as designed at
the time imposed an adverse effect for both of the properties in question. NCDOT refined the
design and in November 2015 obtained concurrence with HPO and FHWA on "no adverse effecY'
findings for both properties. The Historic Architecture and Landscapes Assessment of Effects
Form is included in Appendix C.
7c. Historic or Prehistoric Information Upload
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12-05-0008EffectsForm.pdf 4.52M6
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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?*
r Yes l" No
8b. If yes, explain how project meets FEMA requirements:
8c. What source(s) did you use to make the floodplain determination?*
FEMA Maps
Miscellaneous attachments not previously requested.
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Signature
*
rJ 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
10/26/2017
Initial Review
Is this project a public transportation project?
�' 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?*
C� Yes
C' No
BIMS # Assigned*
20171365
Version#*
Reviewing Office *
Wilmington Regional Office - [phone]
Select Project Reviewer*
Joanne Steenhuis:eads\jhsteenhuis