20180152 Ver 2_401 Application_20180418

DWR
Division 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 answered.
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.govMaterResources/0/edocl6247041PCN%20Help%20File%202018-1-30.pdf
A. Processing Information
County (or Counties) where the project is located:*
Wake
Is this project a public transportation project?*
f Yes f• No
This is any publicly funded by nunicipal,state or federal funds road, rail, airport transportation project.
1a. Type (s) of approval sought from the Corps:*
V Section 404 Permit (wetlands, streams and waters, Clean Water Act)
F Section 10 Permit (navigable waters, tidal waters, Rivers and Harbors Act)
1b. What type(s) of permit(s) do you wish to seek authorization?*
IJ Nationwide Permit (NWP)
r Regional General Permit (RGP)
r 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: 29 - Residential Developments
NWP Number Other:
List all IWV nurrbers you are applying for not on the drop down list.
1c. Type(s) of approval sought from the DWR:*
check all that apply
IJ 401 Water Quality Certification - Regular r 401 Water Quality Certification - Express
F Non -404 Jurisdictional General Permit IJ Riparian Buffer Authorization
r Individual Permit
*
1d. Is this notification solely for the record because written approval is not required?
For the record only for DWR 401 Certification:
O Yes O No
For the record only for Corps Permit: O Yes O 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 mitigation bank or in -lieu fee program
r Yes r No
Acceptance Letter Attachment
dick the upload button or drag and drop files here to attach docurrent
Savaan Subdivision - Revised WMU SOA4-19-18.pdf 102.62KB
FILE TYP E MHF BE FDF
1f. Is the project located in any of NC's twenty coastal counties?*
f Yes r No
1h. Is the project located in a designated trout watershed?*
r Yes r No
Link to trout information: http://v wv.saw.usace.army.mil/Missions/Regulatory-Permit-ProgranVAgency-Coordination/Trout.aspx
B. Applicant Information
1a. Who is the Primary Contact?*
Sean Clark
1b. Primary Contact Email:*
[e-mail]
1c. Primary Contact Phone:*
(xxx)xxx-xxxx
[phone]
1d. Who is applying for the permit?
V Owner r Applicant (other than owner) r Agent/Consultant
(Check all that apply)
2. Owner Information
2a. Name(s) on recorded deed:
Arroyo Capital I, LLC
2b. Deed book and page no.:
DB 017006; DP 01819
2c. Responsible party:
(for Corporations)
Leigh Austin
2d. Address
Street Address
100 W Broadway, Suite 680
Address Line 2
aty
Long Beach
Postal / Zip Code
90802-4463
2e. Telephone Number:
(xxx)xxx-xxxx
[phone]
2f. Fax Number:
(XXX)XXX-XXXX
2g. Email Address:*
[e-mail]
State / Province / P egion
CA
Country
USA

C. Project Information and Prior Project History
1. Project Information
1a. Name of project:*
Ferrell Farm
1b. Subdivision name:
(if appropriate)
Savaan Subdivision
1c. Nearest municipality/ town:*
Cary
1d. Driving directions*
If it is a new project and can not easily be found in a CPS rrapping system Reese provide directions.
From 1-40 take the Aviation Pkwy exit (285) southwest to the Hwy 54 intersection. Stay on the same road bed which becomes Morrisville
Carpenter Road and continue for approximately 1.5 miles. The Site is on the right and immediately north of Morrisville Carpenter Road.
2. Project Identification
2a. Property Identification Number:
(tax RN or parcel ID)
0745-25-2410
2b. Property size:
(in acres)
+/- 74.25 acres
2c. Project Address
Street Address
1132 Morrisville Carpenter Road
Address Line 2
City State/ Province/ Flagion
Cary NC
Fbstal / Zip (ode Country
27560 USA
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 how the 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:*
35.8263° N -78.8575° E
ex: 34.208504 -77.796371
3. Surface Waters
3a. Name of the nearest body of water to proposed project:*
UT to Crabtree Creek
3b. Water Resources Classification of nearest receiving water:*
C; NSW
Surface Water Lookup

3c. What river basin(s) is your project located in?*
Neuse
River Basin 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 Site is roughly L-shaped and is currently operated as a pasture and pumpkin farm.
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)
Click the upload button or drag and drop files here to attach docurrent
4 - Figure1 (USGS Site Vicinity Map).pdf
File type mist be pdf
1.03MB
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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5 - Figure2 (Soils Site Vicinity Map).pdf 1.37MB
File type mist be pdf
4d. List the total estimated acreage of all existing wetlands on the property:
+/- 4.6 acres
4e. List the total estimated linear feet of all existing streams on the property:
(interniftent and perennial)
+/- 1,455 LF
4f. Explain the purpose of the proposed project:*
The purpose of the proposed project is to construct a residential subdivision and associated utilities to meet the
demand for housing in this part of Wake County.
4g. Describe the overall project in detail, including indirect imapacts and the type of equipment to be used:
The overall project is a single-family residential subdivision with residential streets and utilities that will connect to
eAsting adjacent roads and utilities in the area. The developer plans to construct 158 detached residential lots
and 140 condo/ townhome units. The proposed impacts result from road construction, and lot fill. Heavy equipment
typically used for utility installation projects (e.g. back hoes, bull -dozers, etc) will be utilized.
4h. Please upload project drawings for the proposed project.
Click the upload button or drag and drop files here to attach docurrent
File type mut be pdf
5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the property or proposed impact areas?*
O Yes r No r Unknown
Comments:
Wetlands and streams were delineated by Sage Ecological Services in
2017.
5b. If the Corps made a jurisdictional determination, what type of determination was made?*
F Preliminary r Approved r Unknown r N/A
Corps AID Number:
Bcarrple: SAV %2017-99999
SAW -2015-00557
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known): Sean Clark

Agency/Consultant Company:
Other:
Sage Ecological Services, Inc.
5d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
The site meeting with the NCDWR was held on March 12, 2014 and a letter (NBRRO# 15-075) issued on March 18, 2015. A site meeting
with the USACE has held on July 11, 2017. A PJD had not yet been issued.
5d1. Jurisdictional determination upload
Click the upload button or drag and drop files here to attach docunent
Ferrell Farm DWR Buffer Determination Letter_3.18.2015.pdf 434.82KB
File type mist be FDF
6. Project History
6a. Have permits or certifications been requested or obtained for this project (including all prior phases) in the past?*
f• Yes r No f Unknown
6b. If yes, please give the DWR Certification number or the Corps Action ID (exp. SAW -0000-00000).
DWR #18-0152 refers to the 401 and buffer approval issued for the site on March 9, 2018. The impact locations
and overall layout are same, however the town determined that they were uncomfortable with the use of retaining
walls being used to minimize impacts which increased the proposed wetland and buffer impacts slightly. After
discussing the situation with Ms. Stephanie Goss of NCDWR it was determined that a new application should be
submitted. No construction has occurred on the site.
Project History Upload
(lick the upload button or drag and drop files here to attach document
Savaan 401 and buffer approval (DWR #18-0152).pdf 702.96KB
File type must be FDF
7. Future Project Plans
7a. Is this a phased project?*
f 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 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):
V Wetlands V Streams -tributaries V Buffers
r 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* 2d. Wetland name *2e. 2f. Type of 2g. Impact
Forested* Jurisdicition* area*
Wetland Impact 1 P NON-NCWAM TYPES Wetland WB No Both 0.395
Ivhp label (e.g. Finad Crossing 1 - Oilvert, Permanent (P) or (404, 10) or DAR (401, (acres)
dewatering, etc) Temporary (T) other)
2g. Total Temporary Wetland Impact
0.000
2g. Total Permanent Wetland Impact
0.395

2g. Total Wetland Impact
0.395
2h. Comments:
Proposed wetland impacts have increase from the previously approved 0.34 acre to the current 0.395 acre due to
the required removal of retaining walls.
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. Reason for impact*3b.lmpact
3c. Type of impact*3d. Stream name*
3e. Stream
3f. Type of
Average
type*
(feet)
Type*
Jurisdiction*
S1 Stream Impact 1
P
Culvert UT to Crabtree
Perennial
Both
ivbp label (e.g. Poad Crossing
Permanent (P) or
Creek
Perennial (PER or
1)
Temporary (T)
P
intermittent (INT)
No
S2 Stream Impact 2
T
Dewatering UT to Crabtree
Perennial
Both
ivep label (e.g. Road Crossing
Ferrranent (F� or
Creek
Perennial (FBS or
T
1)
Temporary (T)
Location and Exempt, Allowable, allowable w/
intermittent (INT)
** 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:
107
3i. Total temporarystream impacts:
19
3i. Total stream and tributary impacts:
126
3j. Comments:
Stream impacts will remain the same as those previously approved.
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.
V Neuse r Tar -Pamlico
F' Catawba r- Randleman
r- Goose Creek r Jordan Lake
F Other
6b. Impact Type *
6c. Per or
6d. Stream name *
6e. Buffer mitigation
Average
Temp*
(feet)
required?*
1 -allowable w/mitigatoin
P
UT to Crabtree Creek
Yes
Location and Exenpt, Allowable, allowable w/
Permanent () or
mitigation
Temporary (T)
2 -allowable
P
UT to Crabtree Creek
No
Location and Exempt, Allowable, allowable w/
Permanent (F' or
mitigation
Temporary (T)
3 -allowable
T
UT to Crabtree Creek
No
Location and Exempt, Allowable, allowable w/
Permanent (F' or
mtigation
Temporary (T)
3g. Stream 3h. Impact
width *
length*
6
107 1
Average
(linear feet)
(feet)
6
19
Average
(linear feet) '
(feet)
6f. Zone 1 6g. Zone 2
impact* impact*
12,944 5,880
(square feet) (square feet)
1,462 1,686
(square feet) (square feet)
1,037 361
(square feet) (square feet)

6- allowable P
Location and Exenpt, Allowable, allowable w/ Fbrrrenent (P) or
rritigation Terrporary (T)
8- allowable P
Location and Exenpt, Allowable, allowable w/ Permanent (P) or
rritigation Tenporary (T)
6h. Total buffer impacts:
Zone 1
Temporary impacts: 1,037.00
UT to Crabtree Creek No
UT to Crabtree Creek No
Zone 2
361.00
Zone 1
Zone 2
Permanent impacts: 14,564.00
8,553.00
Zone 1
Zone 2
Total buffer impacts: 15,601.00
8,914.00
6i. Comments:
Only the impacts associated with the proposed road crossing (Impact 1) have changed. All other buffer impacts
have remained the same.
Supporting Documentation - i.e. Impact Maps, Plan Sheet, etc.
Click the upload button or drag and drop files here to attach docurrent
2018.4.10 Savaan Subdivision Zone 1 &2 Buffer Impacts.pdf 2.79MB
2018.4.10 Savaan Subdivision stream wetland Impacts.pdf 1.99MB
File mist be FDF
E. Impact Justification and Mitigation
1. Avoidance and Minimization
158 745
(square feet) (square feet)
0 242
(square feet) (square feet)
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:*
Stream crossings were designed to be as perpendicular as possible to reduce impacts. Proposed subdivision
roads were aligned so as to avoid impacts to streams and wetlands as much as possible while avoiding eAsting
utilities and property line buffers. Retaining walls were originally designed and proposed for the road crossing to
reduce wetland and buffer impacts however the Town of Cary required that the crossing design remove them.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:*
General techniques include the use of construction fencing to define the construction corridor and prevent any
accidental additional impacts. Silt fencing and temporary basins will also be used to prevent sediment runoff into
the streams and wetlands. Headwalls will be constructed in several locations so as to further reduce impacts.
Cross drainage pipes will be installed during a period of two dry days. Pumping of water will not begin until bypass
is built.
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 r No
2c. If yes, mitigation is required by (check all that apply):
r- DWR V Corps
2d. If yes, which mitigation option(s) will be used for this project?
V Mitigation bank r- Payment to in -lieu fee program r Permittee Responsible Mitigation
3. Complete if Using a Mitigation Bank

3a. Name of Mitigation Bank:
Falling Creek Stream and Wetland Mitigation Bank
3b. Credits Purchased/Requested (attach receipt and letter)
Type: Quantity:
Riparian wetland 0.79
Riparian buffer 47,652
Attach Receipt and/or letter
nick the upload button or drag and drop files here to attach docurrent
Savaan Subdivision - Revised WMU SOA4-19-18.pdf 102.62KB
Savaan Subdivision - BMU SOA 01-30-18.pdf 123.08KB
RLETYPEM-67BEFDF
3c. Comments
F. Stormwater Management and Diffuse Flow Plan (required by DWR)
— Recent changes to the stormwater rules have required updates to this section .*"
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?
f• Yes r No
1b. 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?
F- Level Spreader
r Vegetated Conveyance (lower SHWT)
r- 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.
Diff us Flow Documentation
Oick the upload button or drag and drop files here to attach docurrent
File type mist be RDF
2. Stormwater Management Plan
2a. Is this a NCDOT project subject to compliance with NCDOT's Individual NPDES permit NCS000250?*
f Yes C No
2b. Does this project meet the requirements for low density projects as defined in 15A NCAC 02H .1003(2)?*
t' Yes
r No
To look up low density requirement click here 15A NCAC 02H.1003(2).
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?*

r Yes
r No
Fant: projects that have vested rights, exemptions, or grandfathering from state or locally implemented storrrwater programs or projects that satisfy state or locally -implemented stornwater programs
through use of comrunity in -lieu programs should answer no to this question.
2d. Which of the following stormwater management program(s) apply (check all that apply):*
rJ Local Government
F State
Local Government Stormwater Programs*
r% Phase II
r- NSW
r- USMP
r- Water Supply
Please identifywhich local government stormwater program you are using.*
Town of Cary
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? *
f Yes r 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)?*
f Yes r No
2b. Is this an after -the -fact permit application?*
r Yes r 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?*
r Yes r No
3b. If you answered "no," provide a short narrative description.
This project is surrounded by similar residential projects and will not be providing any additional utilities that are
not already in the area.
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project?*
f• Yes r Nor 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.
Sewer lines from this project will tie into existing Town of Cary sewer lines that currently exist on the Site.
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? *
r Yes r No
5b. Have you checked with the USFWS concerning Endangered Species Act impacts?*

f Yes r No
5d. Is another Federal agency involved?*
r Yes r No r Unknown
5e. Is this a DOT project located within Division's 1-8?*
f Yes r No
5f. Will you cut anytrees in order to conduct the work in waters of the U.S.?
f Yes r No
5g. Does this project involve bridge maintenance or removal?
O Yes r No
Link to the NLEB SLOPES document: http://saw reg.usace.army.mil/NLEB/1-30.17-signed_NLEB-SLOPES&apps.pctf
5h. Does this project involve the construction/installation of a wind turbine(s)?*
f Yes O No
5i. Does this project involve (1) blasting, and/or (2) other percussive activities that will be conducted by machines, such as jackhammers,
mechanized pile drivers, etc.?
r Yes r No
5j. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?
The NC Natural Heritage Data Base (2017) was referenced and a report (dated July 13, 2017) was received from
NCNHP identified no recorded federally listed species on the project site or within a 1 -mile radius.
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as an Essential Fish Habitat?*
f Yes r No
6b. What data sources did you use to determine whether your site would impact an Essential Fish Habitat?*
https://www.fishe ries. noaa. gov/resou rce/map/essential-fish-habitat-mapper
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/hpoveb/
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 history and archaeology)?*
r Yes r No
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?*

http://gis.ncdcr.gov/hpov,eb/'Records check at the State Historic Preservation Office or the Office of State
Archeology was not performed. The proposed development occupies the eastern portion of the Carpenter Historic
District (WA0787), a National Register (NR) Boundary, which occupies a late 19th -early 20th century farm
crossroads district. The C.F. Ferrell House (WA0742) is situated along the southern property boundary of the tract
along Morrisville -Carpenter Road. According to the SHPOWEB site, the status of the C.F. Ferrell House is
Surveyed Only (SO). A scoping letter was sent to SHPO in August 2017. A survey report is being completed and
provided to SHPO for review.
The project is located within the eastern portion of the Carpenter Historic District (WA0787), a National Register
(NR) Boundary, which occupies a late 19th -early 20th century farm crossroads district. The portion of the
proposed development within the Historic District has historically been used for agriculture and pasture (i.e.
regularly plowed) and contains The C.F. Ferrell House (WA0742). The C.F. Ferrell House is located along the
southern property boundary of the tract adjacent to Morrisville -Carpenter Road. According to the SHPO website,
the status of the C.F. Ferrell House is Surveyed Only (SO) and Center point of a National Register historic district
(NRHD). The house was built circa 1900 and is a one-story frame dwelling.
As part of the rezoning approval process, the Town of Cary Council and Planning Department requested that the
C.F. Ferrell House be preserved. The Town of Cary would allow preservation / relocation to be completed either
on-site or off-site. No other structures were deemed historically relevant and are not slated for preservation.
To best preserve the house in its contextual environment Ashton Woods and David Ferrell (homeowner)
determined that the home should remain on-site. The location chosen is approximately 900' southeast of its
current location and will provide an ideal setting for the relocation.
The home will be set within a conservation easement area of approximately 1.3 acres. 0.97 acres of that space is
set aside for stream and wetland buffers and reforestation areas. These areas are restricted and no development
is allowed (see attached Draft Site Plan and Ferrell House Exhibit).
The home will be restored to as near its original structure as is feasible. This includes the removal of structural
additions and the replacement or rehab of windows, roof, siding, and front porch to more closely resemble the
original structure. The interior rehab will include fireplace rehab and reclaiming the original flooring as much as
possible. The landscape planting will also see a rehab which includes planting that more closely resembles the
style and period of the house (see attached draft rehab agreement).
Capital Area Preservation met with the Town of Cary and Ashton Woods to provide guidance and direction with
regard to the location and rehabilitation of the house. Ashton Woods will work with Capital Area Preservation to
ensure that the home is returned to its original structural form and remains in a well-maintained condition. Ashton
Woods will grant a conservation easement to Capital Area Preservation to memorialize this effort and provide
further protection to this historic home and lot (see attached draft easement agreement).
Finally, a plaque will be set in a conspicuous location on the site to provide details and information relating to the
origin, design, and history of the C.F. Ferrell house (see attached draft plaque rendering).
A scoping letter was sent to NCSHPO in August of 2017, which included the action plan described above. The
NCSHPO requested a preliminary survey. Based on current SHPO guidelines the survey produced four prehistoric
sites and two historic sites, none of which will be recommended eligible for the NRHP. One of the historic sites was
associated with the Ferrell Farm house but the material appears to be incidentally dispersed. A PDF copy of the
report has been submitted to SHPO and the USACE and hard copies will be delivered next week.
7c. Historic or Prehistoric Information Upload
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File mut be FDF
8. Flood Zone Designation (Corps Requirement)
Link to the FEMA Floodplain Maps: https:Hmsc.fema.gov/portal/search
8a. Will this project occur in a FEMA -designated 100 -year floodplain?*
f Yes C No
8c. What source(s) did you use to make the floodplain determination?*
FEMA Flood Map Service Center (https://msc.fema.gov/portal/search) FEMA DFIRM Panel # 3720074500J,
effective May 2, 2006.
Miscellaneous

Miscellaneous attachments not previously requested.
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3 - Signed Agent Authorization for Sage.pdf 308.58KB
1 - Cover Letter for Savaan Subdivision.pdf 97.75KB
File rust be FDF or WE
Signature
IJ 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 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:*
Sean Clark
Signature
&�o
Initial Review
Is this project a public transportation project?*(?
f Yes f• No
Change only if needed.
Has this project met the requirements for acceptance in to the review process?*
f• Yes
f No
BIMS # Assigned*
20180152
Version#*
2
Reviewing Office*
Raleigh Regional Office - [phone]
Select Project Reviewer*
Stephanie Goss:eads\szgoss
Is a payment required for this project?*
f No payment required
f Fee received
r Fee needed - send electronic notification
What amout is owed?*
F $240.00
* $570.00