20180542 Ver 1_PCN Form Submission_20180417

Action History (UTC-05:00) Eastern Time (US & Canada)
�brrrit by Anonymous User 4/17/2018 3:12:20 PM (Start Event)
Accept by Carpenter,Kristi 4/17/2018 3:27:12 PM (DOT Initial Review)
. The task was assigned to Carpenter,Kristi. The due date is: April 20, 2018 5:00 PM
4/17/2018 3:14 PM

�� �
6fvlslaa of Water Resources
Pre-Construction Notification (PCN) Form
For Nationwide Permits and Regional General Permits
(along with corresponding Water Quality Certifications)
January 31, 2018 Ver 2.3
*
Please note: fields marked with a red asterisk below are required. You will not be able to submit the form until all mandatory questions are ans�red.
Also, if at any point you wish to print a copy of the E-PCN, all you need to do is right-click on the document and you can print a copy of the form.
Below is a link to the online help file.
https://edocs. deq. nc.gov/WaterResources/0/edoc/624704/PCN%20Help%20File%202018-1-30. pdf
A. Processing Information
County(or Counties) where the project is located:*
Beaufort
Is this project a public transportation project?*
�' Yes C' No
This is any publicly funded by rrunicipal,state or federal funds road, rail, airport transportation project.
Is this a NCDOT Project?*
�' Yes C' No
(NCDOT only) T.I.P. or state project number:
WBS #
17BP.2. R.85
(for NCDOT use only)
1a. Type(s) of approval sought from the Corps:*
rJ Section 404 Permit (wetlands, streams and waters, Clean Water Act)
fJ Section 10 Permit (navigable waters, tidal waters, Rivers and Harbors Act)
1b. What type(s) of permit(s) do you wish to seek authorization?*
�J Nationwide Permit (NWP)
r Regional General Permit (RGP)
� Standard (IP)
This form may be Corps to initiate the standard/individual permit process. Please contact your Corps representative for submittal of standard permits.
All required items that are not provided in the E-PCN and be added to the miscellaneous upload located at the bottom of this form.
Nationwide Permit (NWP) Number: 03 - Maintenance
NWP Number Other:
List all MN nurrbers you are applying for not on the drop dow n list.
1c. Type(s) of approval sought from the DWR:*

check all that apply
ri 401 Water Quality Certification - Regular r 401 Water Quality Certification - E�ress
r Non-404 Jurisdictional General Permit �J Riparian Buffer Authorization
r Individual Permit
�
1d. Is this notification solelyfor the record because written approval is not required?
For the record only for DWR 401 Certification: �' Yes C•' No
For the record only for Corps Permit: f 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
�' Yes �' No
Acceptance Letter Attachment
Qick the upload button or drag and drop files here to attach docurrEnt
I SR 1336 - Bridge 249 - Division 2- Buffer - TP 04.pdf 71.23KB
F1LE lYFE MJST BE FDF
1f. Is the project located in anyof NC's twentycoastal counties?*
C� Yes �' No
1g. Is the project located within a NC DCM Area of Environmental Concern (AEC)?*
G Yes C' No C' Unknown
1h. Is the project located in a designated trout watershed?*
C' Yes �' No
Link to trout information: http://v�uwv.saw.usace.army.mil/Missions/Regulatory-Permit-Program/Agency-Coordination/Trout.aspx
B. Applicant Information
1a. Who is the Primary Contact?*
NCDOT (attn: Heather Lane)
1b. Primary Contact Email:*
[e-mail]
1c. PrimaryContact Phone:*
(xxx)xxx-xxxx
[phone]
1d. Who is applying for the permit?
�J Owner rJ Applicant (other than owner) �J Agent/Consultant
(Check all that apply)
' 2. Owner I nformation
2a. Name(s) on recorded deed:
NCDOT
2b. Deed book and page no.:
2c. Responsible party:
(for Corporations)
2d.Address

Street Address
1037 W.H. Smith Boulevard
Address Line 2
C7ty
Greenville
Fbstal / Zip Code
27835
2e. Telephone Number:
(xxx)xxx-xxxx
[phone]
2f. Fax Number:
(xxx)xxx-xxxx
2g. Email Address:*
[e-mail]
3. Applicant Information (if different from owner)
3a. Applicant is:
C' Agent
C� Other .���.
If other please specify.
3b. Name:
NCDOT (attn: Heather Lane)
3c. Business Name:
(if applicable)
3d.Address
Street Address
1037 W.H. Smith Boulevard
Address Line 2
��
Greenville
Fbstal / Zip Code
27835
3e. Telephone Number:
[phone]
(xxx)xxx-xxxx
3f. Fax Number:
(xxx)xxx-xxxx
3g. Email Address:*
[e-mail]
4. Agent/Consultant (if applicable)
4a. Name:
Robert Turnbull
4b. Business Name:
(if applicable)
Environmental Services, Inc.
State / R-ovince / I�gion
NC
Country
USA
State / FYovince / F�gion
NC
Country
USA

4c. Address
Street Address
4901 Trademark Drive
Address Line 2
Qty
Raleigh
Fbstal / Zip Code
27610
4d. Telephone Number:
[phone]
(xxx)xxx-xxxx
4e. Fax Number:
[phone]
(xxx)xxx-xxxx
4f. Email Address:*
[e-mail]
State / Rovince / F�gion
NC
Country
USA
AgentAuthorization Letter*
Rease provide the Agent Authorization Letter if you are subrritting this docurrent.
Beaufort 249_ESI_Agent Authorization Form.pdf 236.98KB
FlLE NF� M.JST BE FDF
C. Project Information and Prior Project History
1. Project Information
1a. Name of project:*
Beaufort County Bridge 249
1b. Subdivision name:
(if appropriate)
1c. Nearest municipality/town:*
Bath
1d. Driving directions*
If it is a new project and can not easily be found in a GPS rrapping system Rease provide directions.
SR 1336 (Hawkins Beach Road) over Duck Creek, west of Bath in Beaufort County.
2. Project Identification
2a. Propertyldentification Number:
(tax RN or parcel ID)
2b. Propertysize:
(in acres)
1.2 acres
2c. Project Address

Street Address
SR 1336 (Hawlcins Beach Road)
Address Line 2
aty
Bath
Fbstal / Zip Code
27808
2d. Site coordinates in decimal degrees
State / R-ovince / I�gion
NC
Country
USA
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:*
35.46271
ex: 34.208504
3. Surface Waters
Longitude:*
-76.85440
-77.796371
3a. Name of the nearest body of water to proposed project:*
Duck Creek
3b. Water Resources Classification of nearest receiving water:*
SC; NSW
Surface Water Lookup
3c. What river basin(s) is your project located in?*
Tar-Pamlico
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:*
The project study area and vicinity consist primarily of silvicultural and agricultural land, with some rural residential
areas. A small boat ramp is present in the northwest quadrant of this project. The proposed project and
associated impacts are within and immediately adjacent to NCDOT right-of-way.
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)
qick the upload button or drag and drop files here to attach docurrent
Beaufort249_USGS.pdf 1.07M6
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)
Qick the upload button or drag and drop files here to attach docurrEnt
i Beaufort249_soils.pdf 1.26M6
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4d. List the total estimated acreage of all existing wetlands on the property:
1.0 acre
4e. List the total estimated linear feet of all existing streams on the property:
(interrrittent and perennial)
350 feet

4f. Explain the purpose of the proposed project:*
I Replace existing Bridge 249 on SR 1336 (Hawkins Beach Road) over Duck Creek. The sufficiency rating of the
ebsting bridge is 4.0.
4g. Describe the overall project in detail, including indirect imapacts and the type of equipment to be used:*
The proposed project will replace the bridge on SR 1336 (Hawkins Beach Road) over Duck Creek in Beaufort
County. The project will replace the existing timber floor bridge with a cored slab bridge at the same location. The
project will also include 0.11 mile of roadway improvement. To facilitate the construction of the proposed bridge, a
one-lane onsite detour is proposed on the downstream side of SR 1336. The project work will consist of grading,
widening, drainage improvements, temporary detour construction and removal, bridge replacement, and pavement
markings. This work will be conducted using standard road construction equipment. An in-water construction
moratoria will apply to this project from April 1- September 30. Access to the boat ramp in the northwest quadrant
will be maintained during construction.
4h. Please upload project drawings for the proposed project.
Qick the upload button or drag and drop files here to attach docurrEnt
17BP.2. R.85_BP249_hyd_permit_package. pdf 3.03M6
Fle type rrust be pdf
5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the propertyor proposed impact areas?*
C' Yes C' No C' Unknown
Comments:
Sb. If the Corps made a jurisdictional determination, what type of determination was made? *
C� Preliminary C' Approved C' Unknown C' fWA
Corps AID Number:
5carrple: SAV�2017-99999
Sc. If 5a is yes, who delineated the jurisdictional areas?
Name (if known):
Agency/Consultant Company:
Othe r:
Robert Turnbull
Environmental Services, Inc.
Sd. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
Documentation not available.
5d1. Jurisdictional determination upload
C7ick the upload button or drag and drop files here to attach docurrent
Fle type rrust be FDF
6. Project History
6a. Have permits or certifications been requested or obtained for this project (including all prior phases) in the past?*
C' Yes
7. Future Project Plans
7a. Is this a phased project?*
C' Yes �' No
C•' No
C' Unknown
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):
rJ Wetlands r Streams-tributaries rJ Buffers
rJ 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* 2b. Impact type * 2c. Type of wetland *
W1 - Excavation
fv�p label (e.g. Finad Qossing 1- CLlvert,
dewatering, etc)
W1 - Fill
fV�p label (e.g. f�ad Qossing 1- Qalvert,
dewatering, etc)
W1 - Hand Clearing
Nfip label (e.g. F�ad Qossing 1- CLlvert,
dewatering, etc)
W2 - Excavation
fv�p label (e.g. Fd�ad Qossing 1- CLlvert,
dewatering, etc)
W2 - Fill
fV�p label (e.g. fd�ad CYossing 1- Qalvert,
dewatering, etc)
W3 - Fill
Nfip label (e.g. fmad C7ossing 1- CLlvert,
dewatering, etc)
W3 - Fill
N�p label (e.g. Finad Qossing 1- Qilvert,
dewatering, etc)
W4 - Fill
fv�p label (e.g. Fd�ad Qossing 1- CUlvert,
dewatering, etc)
W2 - Temporary Detour Fill
fV�p label (e.g. F�ad Qossing 1- Qalvert,
dewatering etc)
W4 - Temporary Detour Fill
fv�p label (e.g. Fd�ad Qossing 1- Qilvert,
dewatering, etc)
W4 - Temporary Detour Fill
N�p label (e.g. I�ad Qossing 1- CUlvert,
dewatering, etc)
P
F�rrranent (F�) or
Terrporary (�
P
F�rrranent (F�j or
Terrporary (�
P
F2rrranent (P� or
Terrporary (�
P
F2rrranent (� or
Terrporary (�
P
F�rrranent (F) or
Terrporary (�
P
F2rrranent (P� ar
Terrporary (�
P
F2rrranent (Fj or
Terrporary (�
P
F�rrrenent (F) or
Terrporary (�
T
F2rrranent (� or
Terrporary (�
T
F2rrranent (F) or
Terrporary (�
T
F�rrrenent (F) or
Terrporary (�
2g. Total Temporary Wetland Impact
0.092
2g. Total Permanent Wetland Impact
0.030
2g. Total Wetland Impact
0.122
2h. Comments:
Salt/Brackish Marsh
Salt/Brackish Marsh
Salt/Brackish Marsh
Salt/Brackish Marsh
Salt/Brackish Marsh
Salt/Brackish Marsh
Riverine Swamp
Forest
Riverine Swamp
Forest
Salt/Brackish Marsh
Salt/Brackish Marsh
Riverine Swamp
Forest
2d. Wetland name *2e. 2f. Type of 2g. Impact
Forested* Jurisdicition* area*
W1 No Corps 0.000
(404, 10) or W�R(401, (acres)
other)
W1 No Corps 0.005
(404, 10) or C!✓UR(401, (acres)
other)
W1 No Corps 0.005
(404, 10) or D✓�iR(401, (acres)
other)
W2 No Corps 0.000
(404, 10) or �J�R(401, (acres)
other)
W2 No Corps 0.016
(404, 10) or C!✓UR(401, (acres)
other)
W3 No Corps 0.000
(404, 10) or DJUR(401, (acres)
other)
W3 Yes Corps 0.001
(404, 10) or D✓UR(401, (acres)
other)
W4 Yes Corps 0.003
(404, 10) or [7✓UR(401, (acres)
other)
W2 No Corps 0.042
(404, 10) or D✓�R(401, (acres)
other)
W4 No Corps 0.002
(404, 10) or D✓�R(401, (acres)
other)
W4 Yes Corps 0.048
(404, 10) or G/UR(401, (acres)
other)

See attached wetland and surface water impacts summary table. Three of these impacts are very small and state
"0.000" due to rounding:
W1 (Excavation) - 19 square feet
W2 (Excavation) - 20 square feet
W3 (Fill in SalUBrackish Marsh) - 8 square feet
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 type * 4c. Name of waterbody*
impact *
W2 - Fill P Duck Creek
N�p label (e.g. Fd�ad Qossing 1) F2rrranent (�j or (if applicable)
Terrporary (�
W2 - Fill T Duck Creek
fV�p label (e.g. Rnad Qossing 1) F�rrranent (� or (if applicable)
Terrporary (�
4g. Total temporary open water Impacts:
0.01
4g. Total permanent open water impacts:
0.00
4g. Total open water impacts:
0.01
4h. Comments:
See attached wetland and surface water impacts summary table.
4d. Activitytype * 4e. Waterbodytype *4f. Impact
area*
Causeway Tributary 0.00
(acres)
Causeway Tributary 0.01
(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.
6a. Project is in which protect basin(s)?*
Check all that apply.
r Neuse rJ Tar-Pamlico
r Catawba r Randleman
r Goose Creek r Jordan Lake
I r Other
6b. Impact Type *
61 - Allowable
Location and Exerrpt, Allowable, allowable w/
rritigation
B2 - Allowable w/ mitigation
Location and 6cerrpt, Allowable, allowable w/
rritigation
B3 - Allowable
Location and 6cerrpt, Allowable, allowable w/
rritigation
64 - Allowable
Location and 6cerrpt, Allowable, allowable w/
rritigation
6c. Per or 6d. Stream name *
Temp*
P Duck Creek
F2rrranent (� or
Terrporary (�
P Duck Creek
F�rrranent (F) or
Terrporary (�
P Duck Creek
F�rrranent (� or
Terrporary (�
P Duck Creek
F2rrranent (F) w
Terrporary (�
6e. Buffer mitigation
required? *
No
Yes
No
No
6f. Zone 1
impact*
595
(square feet)
1,101
(squarefeet)
564
(square feet)
204
(square feet)
6g. Zone 2
impact*
271
(square feet)
163
(square feet)
325
(square feet)
160
(square feet)

62 - Allowable T
Location and 6cerrpt, Allowable, allowable w/ F2rrranent (� or
rritigation Terrporary (�
64 - Allowable T
Location and 6cerrpt, Allowable, allowable w/ F2rrranent (Frj or
rrdigation Terrporary (�
6h. Total buffer impacts:
Zone 1
Temporary impacts: 4,458.00
Permanent impacts:
Total buffer impacts:
6i. Comments:
Zone 1
2,464.00
Zone 1
6,922.00
Duck Creek No
Duck Creek No
Supporting Documentation - i.e. Impact Maps, Plan Sheet, etc.
Qick the upload button or drag and drop files here to attach docurrent
176P.2. R.85_BP249_hyd_permit_package. pdf
Fle rrust be FDF
Zone 2
1,011.00
Zone 2
919.00
Zone 2
1,930.00
E. Impact Justification and Mitigation
1. Avoidance and Minimization
3.03MB
3,282 237
(squarefeet) (squarefeet)
1,176 774
(square feet) (square feet)
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:*
The proposed bridge location will occur as much as practicable within the footprint of the existing bridge. The
proposed on-site detour will be constructed as close to SR 1336 as practicable. Permanent impacts will result only
from the new bridge causeway; all impacts associated with the on-site detour are temporary. The on-site detour is
the preferred option because SR 1336 is a dead-end road with no available off-site detours. The proposed
location of the on-site detour was chosen to minimize impacts as much as practicable.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:*
A phase constructed on-site detour was selected to minimize wetland impacts. The on-site detour will be removed
after construction of the new bridge. All necessary sediment and erosion control BMPs will be installed and
maintained through construction. Disturbed ground will be restored and stabilized with permanent vegetative
cover. NCDOT Best Management Practices will be implemented throughout construction. An in-water construction
moratoria will apply from April 1- September 30.
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?
C' Yes C•' No
2b. If this project DOES NOT require Compensatory Mitigation, explain why:
� Proposed impacts to coastal wetlands are less than 1,000 square feet; therefore, DCM is not requiring compensatory mitigation for impacts
resulting from this project.
I F. Stormwater Management and Diffuse Flow Plan (required by DWR)

"` Recent changes to the stormwater rules have required updates to this section ."*
I 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?
r Yes c" No
1 b. All buffer impacts and high ground impacts require diffuse flow or other form of stormwater treatment. If the project is subject to a
state implemented riparian buffer protection program, include a plan that fully documents how diffuse flow will be maintained.
All Stormwater Control Measures (SCM)s must be designed in accordance with the NC Stormwater Design Manual. Associated
supplement forms and other documentation shall be provided.
What type of SCM are you providing?
r Level Spreader
r Vegetated Conveyance (lower SHVVf)
� Wetland Swale (higher SHWT)
rJ Other SCM that removes minimum 30% nitrogen
(check all that apply)
For a list of options to meet the diffuse flow requirements, click here.
Diffus Flow Documentation
qick the upload button or drag and drop files here to attach docurrent
176P.2.R.85_BP249_SMP.pdf 307.35KB
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2. Stormwater Management Plan
2a. Is this a NCDOT project subject to compliance with NCDOT's Individual NPDES permit NCS000250?*
C� Yes C' No
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?*
G Yes C' 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 C•' No
Comments:*
MCDC has been completed for this project.
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 �' No
3. Cumulative Impacts (DWR Requirement)

3a. Will this project (based on past and reasonably anticipated future impacts) result in additional development, which could impact
nearby downstream water quality?*
C' Yes C•' No
3b. If you answered "no," provide a short narrative description.
The proposed project will result in minimum new impervious surface and will not result in any downstream impacts
or growth-stimulating effects. The ebsting use of Duck Creek (SC) should not change as a result of this project.
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project? *
C' Yes C•' No C' �1/A
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? *
G Yes C' No
5b. Have you checked with the USFWS concerning Endangered Species Act impacts?*
C' Yes �' No
5d. Is another Federal agency involved?*
C' Yes C� No
5e. Is this a DOT project located within Division's 1-8?*
C•' Yes C' No
!' Unknown
5j. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?
North Carolina Natural Heritage Program data and on-site evaluation by ESI staff. Suitable habitat is present for
federally endangered rough-leaved loosestrife and sensitive joint-vetch. Surveys for both species were conducted
in July 2017; no individuals of either species were observed.
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as an Essential Fish Habitat?*
C� Yes l" No
Are there submerged aquatic vegetation (SA� around the project vicinity?*
C' Yes
!' No
C•' Unknown
6b. What data sources did you use to determine whether your site would impact an Essential Fish Habitat?*
vwwv.habitat.noaa.gov/protection/efhmapper
7. Historic or Prehistoric Cultural Resources (Corps Requirement)
I 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?*
Archaeology and historic architecture reviews were conducted by NCDOT. Documentation for those reviews is
attached.
7c. Historic or Prehistoric Information Upload

C7ick the upload button or drag and drop files here to attach docurrent
Archaeology Beaufort 249 No Survey form 2017.pdf 1.38MB
Historic Architecture PA 13-10-0033_Updated_NoSurvey.pdf 2.52M6
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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?*
�' Yes �' No
8b. If yes, explain how project meets FEMA requirements:
The project is subject to MOA 1 criteria with a maximum decrease in water surface elevation of 0.1 foot.
8c. What source(s) did you use to make the floodplain determination?*
�.ncfloodmaps.com
Miscellaneous
Miscellaneous attachments not previously requested.
C7ickthe upload button or drag and drop files here to attach docurrent
FINAL Beaufort 249 MCDC.pdf 160.82KB
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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:*
Robert Turnbull
Signature
�a�°tr t�t�rCl���
Initial Review
Is this project a public transportation project? *(?)
C� Yes C' No
Change only if needed.
Has this project met the requirements for acceptance in to the review process?*
C� Yes
C' No
i BIMS#Assigned*
20180542

Version#*
Reviewing Office *
Washington Regional Office - [phone]
Select Project Reviewer*
Garcy Ward:eads\gpward
Is a payment required for this project?*
C' No payment required
C•' Fee received
C' Fee needed - send electronic notification