20180937 Ver 1_401 Application_20180703

Action History (UTC -05:00) Eastern Time (US & Canada)
Submit by Anonymous User 7/3/2018 3:04:03 PM (Start Event)
Accept by Montalvo, Sheri A 7/9/2018 10:19:12 AM (Non DOT Initial Review)
• The task was assigned to Montalvo, Sheri A. The due date is: July 6, 2018 5:00 PM 7/3/2018 3:05 PM

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:*
Durham
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
Nationwide Permit (NWP) Number: 14 - Linear transportation
NWP Number Other:
List all MN nunbers you are applying for not on the drop down list.
1c. Type(s) of approval sought from the DWR:*
check all that apply
V 401 Water Quality Certification - Regular r 401 Water Quality Certification - Express
r Non -404 Jurisdictional General Permit IJ Riparian Buffer Authorization
F- Individual Permit
*
1d. Is this notification solelyfor the record because written approval is not required?
For the record onlyfor DWR 401 Certification: r Yes G No

For the record only for Corps Permit:
r Yes r No
1e. Is payment into a mitigation bank or in -lieu fee program proposed for mitigation of impacts?
ff so, attach the acceptance letter from n itigation bank or in -lieu fee program
f Yes r No
1f. Is the project located in anyof NC's twenty coastal counties?*
O Yes r No
1h. Is the project located in a designated trout watershed?*
f Yes r No
Link to trout information: http://wvvw.saw.usace.army.mil/Missions/Regulatory-Permit-ProgranVAgency-Coordination/Trout.aspx
B. Applicant Information
1a. Who is the Primary Contact?*
Deborah Shirley
1b. Primary Contact Email:*
[e-mail]
1c. Primary Contact Phone:*
()XXX -max
[phone]
1d. Who is applying for the permit?
r Owner V Applicant (other than owner) rJ Agent/Consultant
(Check all that apply)
2. Owner Information
2a. Name(s) on recorded deed:
Grover F. Yancey
2b. Deed book and page no.:
2012-E;000786
2c. Responsible party:
(for Corporations)
2d. Address
Street Address
603 Florham Dr.
Address Line 2
aty
High Point
Postal / Zip Code
27262
2e. Telephone Number:
(XXX)XXX-XXXX
2f. Fax Number:
(xxx)xxx-xxxx
2g. Email Address:*
[e-mail]
2a. Name(s) on recorded deed:
Hyang Sook Kim c/o Yongsoo Lee
2b. Deed book and page no.:
State / Province / Fbgion
NC
Country

006388;000887
2c. Responsible party:
(for Corporations)
2d. Address
Street Address
3112 Blue Hill Ln.
Address Line 2
Oty
State / Rovince / legion
Durham
NC
Fbstal / Zip Code
Country
27703
2e. Telephone Number:
(XXX)XXX-XXXX
2f. Fax Number:
()=)XXX -)o=
2g. Email Address:*
[e-mail]
3. Applicant Information (if different from owner)
3a. Applicant is:
r Agent
r Other Developer
If other please specify.
3b. Name:
William Sutphin
3c. Business Name:
(if applicable)
HH Hunt Homes
3d. Address
Street Address
1404 Sunday Drive, Ste. 109
Address Line 2
City State / Province/ Fbgion
Raleigh NC
Postal / Zip Code Country
27607
3e. Telephone Number:
[phone]
(XXX)XXX-xxxx
3f. Fax Number:
(XXX)XXX-XXXX
Email Address:*
[e-mail]
4. Agent/Consultant (if applicable)
4a. Name:
Deborah Shirley

4b. Business Name:
(if applicable)
Soil & Environmental Consultants, PA
4c. Address
Street Address
8412 Falls of Neuse Rd., Ste. 104
Address Line 2
qty State / Province / Fbegion
Raleigh NC
Postal / Zip Code Country
27515
4d. Telephone Number:
[phone]
(XXX)XXX-XXXX
4e. Fax Number:
[phone]
(xXX)xxx-xxxx
4f. Email Address:*
[e-mail]
Agent Authorization Letter*
Rease provide the Agent Authorization Letter if you are submitting this document.
aaf.pdf.
70.42KB
S&EC signed form.pdf
605.55KB
SEC Agen Auth_Yongsoo Sook.pdf
325.55KB
S_Pov,er of Attorney recorded.pdf
111.23KB
RLE TYPE U ST BE RDF
C. Project Information and Prior Project History
1. Project Information
1a. Name of project:*
Enclave at Leesville
1b. Subdivision name:
(if appropriate)
1c. Nearest municipality/ town:*
Durham
1d. Driving directions*
f it is a new project and can not easily be found in a GPS napping system Rease provide directions.
From Raleigh, take the northern Leesville Exit off Interstate 540, drive west, project location within the southwestern quadrant of Leesville
Rd. and Shady Grove Rd., just north of Blue Grass Rd.
2. Project Identification
2a. Property Identification Number:
(tax RN or parcel ID)
0769-03-91-3934, and portion of 0769-04-81-1744
2b. Property size:
(in acres)
52.54 acres (Total project + disturbed area)

2c. Project Address
Street Address
7218 Leesville Rd.
Address Line 2
City State / Province / Fbgion
Durham NC
Fbstal / Zip Code Country
27703
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:*
35.9254 -78.7715
ex: 34.208504 -77.796371
3. Surface Waters
3a. Name of the nearest body of water to proposed project:*
UT to Little Brier 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:*
Main parcel: existing conditions consist of wooded land with agricultural fields, one perennial and two intermittent
streams in the NW corner of the parcel, all buffered; three isolated wetland areas; and one jurisdictional wetland
area. Offsite parcel (easement for offsite road connection): wooded with a perennial stream on the western
property boundary.
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 docunent
USGS_Map.pdf 1.07MB
File type mast 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)
Click the upload button or drag and drop files here to attach docunent
USGS_Map.pdf 1.07MB
SoilSurveyMap.pdf 221.72KB
File type mast be pdf
4d. List the total estimated acreage of all existing wetlands on the property:
0.02 acres jurisdictional
4e. List the total estimated linear feet of all existing streams on the property:
(intermttent and perennial)
997 linear feet

4f. Explain the purpose of the proposed project:*
The purpose of the proposed project is to provide a road connection and utilities for a residential subdivision.
4g. Describe the overall project in detail, including indirect impacts and the type of equipment to be used:*
The overall project consists of a single family residential, an amenity area and associated infrastructure.
Specifically, the proposed develop will in include road infrastructure, single-family lots, utilities and stormwater
control devices. Proposed impacts will include one road crossing and one sanitary sewer crossing to provide
access and utilities to a residential subdivision. Equipment typically used for construction and earthwork such as
backhoes, bulldozers, excavators, graders, pavers etc. will be utilized for this project.
4h. Please upload project drawings for the proposed project.
Qick the upload button or drag and drop files here to attach docurrent
04 - TUC17000 - C-4 - Overall Site Plan.pdf 1.82MB
File type mist 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:
Original site verification completed by Eric Alsmeyer, however later agreed
to by Ross Sullivan
5b. If the Corps made a jurisdictional determination, what type of determination was made?*
( Preliminary r Approved r Unknown r N/A
Corps AID Number:
Exarrple: SAW -2017-99999
SAW -2017-02482
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known):
Agency/Consultant Company:
Other:
Steven Ball
Soil & Environmental Consultants, PA
5d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
USACE- Eric Alsmeyer with the Corps verified jurisdictional areas on December 10, 2014. Ross Sullivan coordinated with the EPA to verify
Isolated wetland determinations (AID# SAW -2017-02482); NCDWR-Cherri Smith with the NCDWR field verified the riparian buffers on
October 9, 2014 (NBRRO #14-370)
MI. Jurisdictional determination upload
Qick the upload button or drag and drop files here to attach document
DWR buffer letter.pdf 1.18MB
File type mist be RDF
6. Project History
6a. Have permits or certifications been requested or obtained for this project (including all prior phases) in the past?*
( Yes r No r Unknown
7. Future Project Plans
7a. Is this a phased project?*
r Yes r No
7b. If yes, explain.
The project will be phased for construction purposes, but no anticipated additional phases beyond what is
identified on the Overall Site Plan.

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.
No
D. Proposed Impacts Inventory
1. Impacts Summary
1a. Where are the impacts associated with your project? (check all that apply):
r- Wetlands V Streams -tributaries V Buffers
r- Open Waters r- Pond Construction
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 3g. Stream 3h. Impact s
type* Type* Jurisdiction* width* length*
S1 #1 -Road Crossing P Culvert UT to Little Brier Perennial Both 10 104 1
Nbp label (e.g. Road Crossing FBrrmnent (F� or Creek Perennial (Ft3P� or Average (linear feet)
1) Tenporary (T) interniltent (INT) (feet) n
S2 #1 -Road Crossing
P Rip Rap Fill
UT to Little Brier
Perennial Both
11
27 2
Dissipater
F2rnanent(P)or
Creek
Perennial (FB:�or
Average
(linear feet) 9
(Permanent -No
Tenporary(T)
internittent(INT)
(feet)
7
Permanent Loss)
[Vbp label (e.g. Road Grossing
1)
S3 #1 -Road Crossing-
T Other
UTto Little Brier
Perennial Both
11
12 1
Temp Construction
Fbrrrarrent(P)or
Creek
Fbrennial (FER or
Average
(linear feet) 3
[Vbp label (e.g. Road Grossing
Temporary (T)
intermttent (INT)
(feet)
2
1)
S4 #2 -Sanitary Sewer
T Excavation
UT to Little Brier
Perennial Both
14
30 4
Crossing
Fbrrrenent(P)or
Creek
Fbrennial(FB�or
Average
(linear feet) 2
[Vbp label (e.g. Road Grossing
Temporary (T)
intermttent (INT)
(feet)
0
1)
** 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:
131
3i. Total temporary stream impacts:
42
3i. Total stream and tributary impacts:
173
3j. Comments:
Impact S2, the Road crossing Dissipater will be a permanent -no permanent loss impact. Per the project engineer
and note on sheet 2 of 3, "the rip -rap to be constructed such that the top of the rip -rap does not exceed the
preconstruction stream elevation". All temporary stream impacts will be brought back to pre -construction
elevations and the stream banks will be stabilized.
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
6f. Zone 1
6g. Zone 2
Temp*
required?*
impact*
impact*
#1 -Stream Crossing -Allowable
P
UT to Little Brier Creek
No
4,075
2,305
Location and Bcenpt, Allowable, allowable w/
Permanent (F) or
(square feet)
(square feet)
rritigation
Temporary (T)
#1 -San itarySewer-Parallel-
P
UT to Little Brier Creek
No
0
588
Allowable
Ferrrenent(F� or
(square feet)
(square feet)
Location and Bcempt, Allowable, allowable w/
Temporary (T)
mitigation
#2 -Sanitary Sewer Crossing-
P
UT to Little Brier Creek
No
1,894
1,808
Allowable
Flarrranent()or
(square feet)
(square feet)
Location and Bcempt, Allowable, allowable w/
Temporary (T)
nitigation
6h. Total buffer impacts:
Zone 1 Zone 2
Temporary impacts: 0.00 0.00
Zone 1 Zone 2
Permanent impacts: 5,969.00 4,701.00
Zone 1 Zone 2
Total buffer impacts: 5,969.00 4,701.00
6i. Comments:
Supporting Documentation - i.e. Impact Maps, Plan Sheet, etc.
Click the upload button or drag and drop files here to attach document
TLIC 17000-CD-IM1-XC. pdf 1.03MB
TLIC 17000-CD-IM1-OPIE. pdf 599.56KB
TLIC 17000-CD-IM1-IA1.pdf 295.49KB
TLIC 17000-CD-IM1-IA2.pdf 216.84KB
File rrust be FBF
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:*

Initial site design included impacts to jurisdictional wetlands for a stormwater BMP on the southern side of the site,
through modification of the site design, that impact has now been avoided. The City of Durham is requiring the
offsite road connection, this road connection was set by a previous stub road designed on the site to the west (i.e.
Andrews Chapel). Additionally this road connection is necessary for a waterline connection and the City does not
allow cross-country waterlines and requires that they are constructed in a street. This road crossing has been
modified through site plan review to minimize impacts to the stream and the riparian buffer. The sanitary sewer is
proposed to be open -cut because of the likely presence of bedrock in the area. The sanitary sewer crossing was
designed at a perpendicular angle, therefore minimizing stream and riparian buffer impacts. The temporary stream
impacts associated with the construction activities at the stream crossing and at the sanitary sewer crossing will be
brought back to pre -construction elevations and the stream banks will be stabilized. All onsite streams and riparian
buffers have been avoided.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:*
Per the project engineer: For the proposed roadway connection to Andrews Chapel our erosion control plans with
incorporate a temporary bypass channel system with cofferdams to divert the stream around the impact zone while
the proposed culvert is installed along with temporary check dams and silt fence to prevent sedimentation within
the ebsting steam network. For the proposed sanitary sewer outfall our erosion control plans will incorporate silt
fence and temporary check dams both upstream and downstream of the proposed sewer line to prevent
sedimentation within the eAsting steam network.
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
2b. If this project DOES NOT require Compensatory Mitigation, explain why:
Permanent stream loss impacts are below the typical 150 LF mitigation threshold.
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 f 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?
rJ 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
Click the upload button or drag and drop files here to attach docurrent
3.05 TUC17000-POST DA.pdf 1018.43KB
File type mist be FDF
2. Stormwater Management Plan
2a. Is this a NCDOT project subject to compliance with NCDOT's Individual NPDES permit NCS000250?*
f Yes 0 No
2b. Does this project meet the requirements for low density projects as defined in 15A NCAC 02H .1003(2)?*

f Yes
G 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?*
t'• Yes
r No
Hnt: projects that have vested rights, exenptions, or grandfathering from state or locally irrplemanted stormwater programs or projects that satisfy state or locally-irrplerrented storrrwater prograrrs
through use of comnanity irrlieu 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*
rJ Phase II
rJ NSW
r- USMP
r- Water Supply
Please identifywhich local government stormwater programyou are using.*
City of Durham
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)?*
P Yes C No
2b. Is this an after -the -fact permit application?*
f Yes C 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?*
f Yes 6 No
3b. If you answered "no," provide a short narrative description.
We have reviewed the "Draft Internal Policy, Cumulative impacts and the 401 Water Quality Certification and
Isolated Wetlands Programs" document prepared by the NC Division of Water Quality on April 10, 2004, version
2.1. The draft states that many private developments are unlikely to cause cumulative impacts, including projects
such as urban in -fill, most residential subdivisions and small commercial developments as well as agricultural and
silvicultural operations. The Enclave at Leesville project is a residential development. Additionally, the project is
located within the City of Durham jurisdiction, therefore the adjacent properties that have potential for
development will have the following regulations to protect downstream waters: 1) the Neuse River Basin Riparian
Buffer Protection regulations, these regulations require limited development within the riparian buffer area, in
addition to "diffuse floes!' requirements and could require Best Management Practices that control nitrogen if diffuse
flow cannot be achieved; 2) the Phase II NPDES Stormwater Permit Program, this program includes permitting
requirements for Municipal Separate Storm Sewer Systems (MS4s) in addition to post -construction stormwater
management requirements. We anticipate that the DWR will advise us if any additional information is needed.

4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project?*
r 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.
Wastewater will be collected by the proposed sanitary sewer system and taken to a nearby pump station.
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?*
f Yes f No r Unknown
5e. Is this a DOT project located within Division's 1-8?*
f Yes r No
5f. Will you cut any trees in order to conduct the work in waters of the U.S.?
r Yes f No
59. Does this project involve bridge maintenance or removal?
r Yes r No
Link to the NLEB SLOPES document: http://saw-reg.usace.army.mil/NLEB/1-30-17-signed_NLEB-SLOPES&apps.pdf
5h. Does this project involve the construction/installation of a wind turbine(s)?*
f Yes r 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.?
f Yes r No
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 Explorer Search [July 3, 20181. Department of Environment and
Natural Resources, Office of Land and Water Stewardship, Raleigh, NC. http://vmw.ncnhp.org/
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?*
The NOAA Habitat Conservation/Habitat Protection: National Marine Fish Service; Essential Fish Habitat Mapper
website was referenced. No Essential Fish Habitat was identified near the project.
7. Historic or Prehistoric Cultural Resources (Corps Requirement)
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 history and archaeology)?
f Yes r No
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?
The NC State Historic Preservation Office HPOWEB GIS Service interactive map was referenced on July 3, 2018;
no historic listings or study list entries or determined eligible listings were identified within the property boundaries.

7c. Historic or Prehistoric Information Upload
Click the upload button or drag and drop files here to attach docurrent
File mut be FDF
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 r No
8b. If yes, explain how project meets FEMA requirements:
The proposed roadway connection to stub road at the Andrews Chapel property boundary to the west requires
impacts to the FEMA 100 -year floodplain. A CLOMR has already been submitted to the City of Durham for review
and will ultimately be submitted to FEMA for approval prior to construction.
8c. What source(s) did you use to make the floodplain determination?*
Per project engineer & NC Floodplain Mapping Program
Miscellaneous
...................................................................................................................................................................................................................................................................................................................................................................
Miscellaneous attachments not previously requested.
nick the upload button or drag and drop files here to attach document
File rrust be FDF or KNE
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 Act');
■ I agree to conduct this transaction by electronic means pursuant to Chapter 66, Article 40 of the NC General Statutes (the "Uniform Electronic
Transactions Act');
■ I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written signature; AND
■ I intend to electronically sign and submit the PCN form.
Full Name:*
Deborah Edwards Shirley
Signature
Pf,hhat F� f el
Date Submitted:
7/3/2018
Initial Review
.......... .................. .................. ........................................................................
Is this project a public transportation project?* M
r Yes G No
Change only if needed.
Has this project met the requirements for acceptance in to the review process?*
r Yes
r No
BIMS # Assigned *
20180937

Version #*
Reviewing Office *
Raleigh Regional Office - [phone]
Select Project Reviewer*
Stephanie Goss:eads\szgoss
Is a payment required for this project?*
r No payment required
f Fee received
r Fee needed - send electronic notification
What amout is owed?*
f $240.00
G $570.00