20170887 Ver 1_PCN Submission Form_20180912

Action History (UTC -05:00) Eastern Time (US & Canada)
Submit by Anonymous User 9/12/2018 2:54:38 PM (Start Event)
Accept by Montalvo, Sheri A 9/18/2018 11:23:27 AM (Non DOT Initial Review)
The task was assigned to Montalvo, Sheri A. The due date is: September 17, 2018 5:00 PM
9/12/2018 2:56 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:*
Chatham
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: 27 - Restoration
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 r 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
f Yes C No
1f. Is the project located in anyof NC's twentycoastal counties?*
r Yes C No
1h. Is the project located in a designated trout watershed?*
f Yes f• No
Link to trout information: http://vmw.saw.usace.army.mil/Missions/Regulatory-Permit-ProgranVAgency-Coordination/Trout.aspx
B. Applicant Information
1a. Who is the Primary Contact?*
Jeff Keaton
1b. Primary Contact Email:*
[e-mail]
1c. Primary Contact Phone:*
(XXX)XXX-XXXX
[phone]
1d. Who is applying for the permit?
❑ owner V Applicant (other than owner) r- Agent/Consultant
(Check all that apply)
2. Owner Information
2a. Name(s) on recorded deed:
M. Darryl Lindley Trustee
2b. Deed book and page no.:
Book: 1537 Page: 881-885, Book: 1554 Page: 159-161
2c. Responsible party:
(for Corporations)
Wildlands Holding IV, LLC (Wildlands Engineering, Inc.) contact: Jeff Keaton
2d. Address
Street Address
1430 South Mint Street, Suite 104
Address Line 2
aty
Charlotte
Fbstal / Zip Code
28203
2e. Telephone Number:
(XXX)XXX-XXXX
[phone]
2f. Fax Number:
[phone]
(XXX)XXX-)O=
2g. Email Address:*
[e-mail]
3. Applicant Information (if different from owner)
State/ Province/ Fbgion
North Carolina
Country
United States

3a. Applicant is:
f Agent
f• Other Bank Sponsor
If other please specify.
3b. Name:
3c. Business Name:
(if applicable)
Wildlands Engineering, Inc.
3d. Address
Street Address
312 West Millbrook Road, Suite 225
Address Line 2
aty
Raleigh
Postal / Zip Code
27609
3e. Telephone Number:
[phone]
(XXX)XXX-XXXX
3f. Fax Number:
(xXX)xxx-xxxx
3g. Email Address:*
[e-mail]
State / Province / Ibgion
North Carolina
Country
United States
C. Project Information and Prior Project History
1. Project Information
1a. Name of project:*
Cane Creek Umbrella Mitigation Bank- Bethel Branch Site
1b. Subdivision name:
(if appropriate)
1c. Nearest municipality/ town:*
Snow Camp, NC
1d. Driving directions*
ff it is a new project and can not easily be found in a GPS rrapping system Please provide directions.
From Raleigh- Take US -64 W to e)at 381 and turn right onto NC -87 N. In 1.8 miles, turn left onto Silk Hope Gum Spring Road. Travel 8.1
miles and turn right onto Silk Hope Lindley Mill Road. Travel 2.9 miles and turn left onto Moon Lindley Road. Continue straight on Moon
Lindley Road for 1 mile. Turn right onto R E Wright Road and the project site will be on the left.
2. Project Identification
2a. Property Identification Number:
(tax PIN or parcel ID)
1073, 1053, 1054 (parcel ID)
2b. Property size:
(in acres)
125.43
2c. Project Address

Street Address
277 R E Wright Road
Address Line 2
City State / Province / Fbgion
Snow Camp North Carolina
Postal / Zip (ode Country
27349 United States
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:*
35.82833 -79.36722
ex: 34.208504 -77.796371
3. Surface Waters
3a. Name of the nearest body of water to proposed project:*
South Fork Cane Creek
3b. Water Resources Classification of nearest receiving water:*
WS V; NSW
Surface Water Lookup
3c. What river basin(s) is your project located in?*
Cape Fear
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 Bethel Branch site is located in a rural watershed in northern Chatham County. Watershed land use consists
of forest and agriculture. Land immediately surrounding the project streams is forested or maintained as pasture.
Project site streams are accessible by cattle and characterized by incision and eroding banks.
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
Topo Map.pdf 701.33KB
File type rust 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 document
Soils Map.pdf 2.16MB
File type must be pdf
4d. List the total estimated acreage of all existing wetlands on the property:
1.417
4e. List the total estimated linear feet of all existing streams on the property:
(interntttent and perennial)
6380
4f. Explain the purpose of the proposed project:*

The purpose of this project is to provide stream and wetland mitigation credits as well as buffer and nutrient credits
in the Cape Fear River Basin 03030002 (Cape Fear 02) service area. Mitigation will include buffer restoration and
stream restoration, stream enhancement II activities, as well as wetland rehabilitation, re-establishment, and
enhancement.
4g. Describe the overall project in detail, including indirect impacts and the type of equipment to be used:
Stream restoration will involve excavation of a new channel that is designed to be functional and stable. Stream
dimension, pattern, and profile have been designed to provide a cross-sectional area sized for frequent overbank
flows, a stable bed with variable bed forms using in -stream structures, well -vegetated bank slopes, a well-
connected floodplain, and imporvements to aquatic habitat and water quality. Enhancement II reaches are
relatively stable, and the existing channel will be left in place with localized improvements. Hydrology will be
improved in wetland rehabilitation areas by raising the stream bed and spreading out flow from adjacent hillslopes
and seeps. No grading is proposed to cut down to relict hydric soils. Wetland Enhancement areas will be planted
with native wetland vegetation. All project reaches will be placed in a conservation easement to protect the project
in perpetuity. The easement will be fenced to exclude livestock where necessary Native trees, shrubs, and
herbaceous plants will be planted on the streambanks and floodplain. Excavators will be used for channel
construction and grading, and off-road dump trucks ill be used for hauling soil.
4h. Please upload project drawings for the proposed project.
Click the upload button or drag and drop files here to attach document
Cane Creek - Bethel Branch 60% Plans - IRT Submittal.pdf 6.07MB
File type must be pdf
5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the propertyor proposed impact areas?*
O Yes f No r Unknown
Comments:
It was agreed upon by Wildlands and USACE that the Preliminary
Jurisdictional Determination will be approved in conjunction with the Pre -
Construction Notification.
5b. If the Corps made a jurisdictional determination, what type of determination was made?*
r Preliminary f Approved f Unknown (N/A
Corps AID Number:
Example: SAW -2017-99999
2016-02365
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known):
Agency/Consultant Company:
Other:
Win Taylor
Wildlands Engineering, Inc.
5d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
December 13-14, 2016
5d1l. Jurisdictional determination upload
Click the upload button or drag and drop files here to attach document
Bethel Branch PJD Final Submittal 11.30.2017.pdf 8.95MB
File 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?*
f Yes r No O Unknown
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 fJ 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* 2b. Impact type * 2c. Type of wetland * 2d. Wetland name *2e. 2f. Type of 2g. Impact
Forested* Jurisdicition* area*
Wetland J - Channel
P
Excavation
Permanent (P) or
Ivbp label (e.g. Fbad Crossing 1 - Culvert,
Terporary (T)
dewatering, etc)
Wetland J - Floodplain
T
Grading
F2rrranent (Fj or
Ivbp label (e.g. Fbad Crossing 1 - Calvert,
Temporary (T)
dewatering, etc)
Bottomland Hardwood
Wetland I - Channel
P
Excavation
Fbrn-anent (F9 or
Ivbp label (e.g. Fbad Crossing 1 - Calvert,
Temporary (T)
dewatering, etc)
(404, 10) orD✓R(401,
Wetland I - Floodplain
T
Grading
Permanent (P1 or
Ivbp label (e.g. Fbad Crossing 1 - Calvert,
Terrporary (T)
dewatering, etc)
Wetland I
Wetland H - Channel
P
Excavation
Permanent (F) or
Ivbp label (e.g. Road Crossing 1 - Calvert,
Terrporary (T)
dewatering, etc)
(acres)
Wetland H - Floodplain
T
Grading
Permanent (F) or
Ivbp label (e.g. Road Crossing 1 - Calvert,
Tenporary (T)
dewatering, etc)
No
Wetland G - Channel
P
Excavation
Ferrranent (F) or
Ivbp label (e.g. Road Crossing 1 - Calvert,
Terrporary (T)
dewatering, etc)
Wetland F - Channel
P
Excavation
Ferrranent () or
Ivbp label (e.g. Fbad Crossing 1 - Calvert,
Temporary (T)
dewatering, etc)
Both
Wetland F - Floodplain
T
Grading
Permanent (F� or
Ivbp label (e.g. Fbad Crossing 1 - Calvert,
Terrporary (T)
dewatering, etc)
Wetland E - Channel
P
Excavation
F2rnanent (P) or
Ivbp label (e.g. Fbad Crossing 1 - Calvert,
Temporary (T)
dewatering, etc)
0.007
Bottomland Hardwood
Wetland J
No
Both
0.017
Forest
(404, 10) orDhR(401,
(acres)
other)
Bottomland Hardwood
Wetland J
No
Both
0.013
Forest
(404, 10) orD✓R(401,
(acres)
other)
Bottomland Hardwood
Wetland I
No
Both
0.004
Forest
(404, 10) orDhR(401,
(acres)
other)
Bottomland Hardwood
Wetland I
No
Both
0.007
Forest
(404, 10) orDAR (401,
(acres)
other)
Bottomland Hardwood
Wetland H
No
Both
0.018
Forest
(404, 10) or DAR (401,
(acres)
other)
Bottomland Hardwood
Wetland H
No
Both
0.007
Forest
(404, 10) or DAR (401,
(acres)
other)
Bottomland Hardwood
Wetland G
No
Both
0.002
Forest
(404, 10) or DAR (401,
(acres)
other)
Bottomland Hardwood
Wetland F
No
Both
0.003
Forest
(404, 10) or DAR (401,
(acres)
other)
Bottomland Hardwood
Wetland F
No
Both
0.003
Forest
(404, 10) or DAR (401,
(acres)
other)
Bottomland Hardwood
Wetland E
No
Both
0.002
Forest
(404, 10) or DAR (401,
(acres)
other)

Wetland A- Channel Fill P Headwater Forest Wetland A
Nhp label (e.g. Fbad Crossing 1 - Culvert, Permanent (Fj or
dewatering, etc) Temporary (T)
Wetland B - Channel P Headwater Forest Wetland B
Excavation Perrranent (P) or
Nhp label (e.g. Fbad Crossing 1 - Culvert, Tenporary (T)
dewatering, etc)
2g. Total Temporary Wetland Impact
0.030
2g. Total Permanent Wetland Impact
0.087
2g. Total Wetland Impact
0.117
2h. Comments
No Both
0.001
(404, 10) or DAR (401,
(acres)
other)
type*
No Both
0.040
(404, 10) or DAR (401,
(acres)
other)
P Fill UTI - R1A
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
893 6
type*
Type*
Jurisdiction*
width*
length*
S1 UT1 - R1AFill
P Fill UTI - R1A
Perennial
Both
13
275
Ivhp label (e.g. Fbad Crossing
Permanent (F) or
Perennial (PER or
5
Average
(linear feet) ,
1)
Temporary (T)
internittent (INT)
S4 UT1 - 111C Fill
(feet)
UT1 - R1C Perennial Both
S2 UT1 - R1B Fill
P Fill UTI - R113
Perennial
Both
7
505
Ivbp label (e.g. Fbad Crossing
Permanent (P) or
Perennial (F6� or
intermittent (INT)
Average
(linear feet)
1)
Terrporary (T)
intermittent (INT)
(feet)
S3 UT1 - 111C Fill
P Fill
UT1 - R1C Perennial Both
7
893 6
Ivhp label (e.g. load Crossing
Permanent (F') or
Perennial (PEP� or
Average
(linear feet) ,
1)
Tenporary (T)
internittent (INT)
(feet)
2
5
1
S4 UT1 - 111C Fill
P Fill
UT1 - R1C Perennial Both
8
696 5
Ivhp label (e.g. load Grossing
Ferrrenent (P) or
Perennial (F13P� or
Average
(linear feet) ,
1)
Tenporary (T)
intermittent (INT)
(feet)
S
S5 UT2 - R2 Fill
P Fill
UT2 - R2 Perennial Both
8
1,139 9
Nhp label (e.g. load Grossing
F2rnanent (P) or
Perennial (FES or
Average
(linear feet)
1)
Tenporary (T)
internittent (INT)
(feet)
1
1
2
S6 UT2 - R2 Fill
P Fill
UT2 - R2 Perennial Both
8
145 1
Nhp label (e.g. Fbad Grossing
Permanent (P) or
Perennial (FES or
Average
(linear feet)
1)
Temporary (T)
intermittent (INT)
(feet)
1
S7 UT2 - R3 P Fill UT2 - R3 Perennial Both 10 438 9
Ivhp label (e.g. Fbad Crossing Pernanent (P) or Perennial (FER or Average (linear feet)
1) Temporary (T) internittent (INT) (feet)

Sg UT3 Fill P Fill UT3 Perennial Both 3 544
Ivbp label (e.g. load Crossing Permanent (P) or Perennial (PEPS or Average (linear feet)
1) Temporary (T) intermttent (INT) (feet)
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:
4,635
3i. Total temporarystream impacts:
0
3i. Total stream and tributary impacts:
3497
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 type * 4c. Name of waterbody*
impact*
Pond Removal P Pond
Ivbp label (e.g. Imad Crossing 1) Permanent (P) or (if applicable)
Temporary (T)
4g. Total temporary open water Impacts:
0.00
4g. Total permanent open water impacts:
1.07
4g. Total open water impacts:
1.07
4h. Comments:
E. Impact Justification and Mitigation
1. Avoidance and Minimization
4d. Activity type * 4e. Waterbody type *4f. Impact
area
Other Pond 1.07
(acres)
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:*
Stream restoration activities will introduce fill material to existing reaches, but are designed to have an overall
positive impact. Stream impacts will be avoided or minimized to project reaches that exhibit less instability and
incision. These reaches are generally proposed for enhancement II which will primarily involve riparian buffer
improvement, cattle exclusion, and localized bank stabilization. Stream alignments for restoration reaches were
designed to avoid existing wetlands as much as possible and minimize grading impacts. Unavoidable impacts to
wetlands are due to floodplain grading or conversion of wetland to stream channel. The project will likely result in a
net increase in wetland area as a result of raising stream beds and local water tables.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:*

Restoration will involve constructing offline channel sections which will minimize sedimentation to aquatic systems
during construction. Newly constructed channel banks will be stabilized using biodegradable coir fiber matting,
seeded and planted with native riparian species. During construction culverts and mud mats will be used for
temporary crossings. construction practices will follow guidelines from the NC Erosion and Sediment Control
Planning and Design Manual.
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?
f Yes C No
2b. If this project DOES NOT require Compensatory Mitigation, explain why:
Compensatory mitigation is not required for activities authorized under NWP 27.
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 C No
For a list of options to meet the diffuse flow requirements, click here.
If no, explain why:
The planted, protected floodplain will serve to diffuse overland flow.
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)?*
r Yes
f No
To look up low density requirement click here 15A NCAC 02H.1003(2)
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 21-11.0500), Isolated Wetland Rules (15A NCAC 21-11.1300), 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?*
f Yes r No
3b. If you answered "no," provide a short narrative description.
The stream mitigation project will not cause an increase in development nor will it negatively impact downstream
water quality. The project area will be protected in perpetuity from future development through a conservation
easement.
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project?*
f Yes f Nor N/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?*
r Yes r No
5b. Have you checked with the USFWS concerning Endangered Species Act impacts?*
r Yes r No
5c. If yes, indicate the USFWS Field Office you have contacted.
Raleigh
5d. Is another Federal agency involved?*
f 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 any trees in order to conduct the work in waters of the U.S.?
r Yes r No
5g. 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?
Wildlands utlized the USFWS and NC Natural Heritage Program databases to search for federally listed threatened
and endangered species in Chatham County, NC. The Cape Fear Shiner, Red Cockaded Woodpecker, and
Harperella are federally listed endangered species in Chatham County. The USFWS commented that the project is
not likely to adversely affect any federally listed, endangered or threatened species or their critical habitat.
Correspondence with USFWS is included in the appendix
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 NC Wildlife Resource Commission (NCWRC) was contacted for comment related to fish and wildlife issues
associated with the proposed mitigation project. The NCWRC did not respond with any specific fish and wildlife
related concerns, but recommended the use of fish and wildlife friendly construction materials. Correspondence
with the NC State Historic Preservation Office is included in the appendix

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 Department of Natural and Cultural Resources State Historic Preservation Office was contacted regarding
presence of historic and archaeological resources within the project area. Correspondence with the NC State
Historic Preservation Office is included in the appendix
7c. Historic or Prehistoric Information Upload
(lick the upload button or drag and drop files here to attach document
File mist 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 r No
8c. What source(s) did you use to make the floodplain determination?*
FEMA Flood Map Service Center were used to make flooplain determinations.
Miscellaneous
Miscellaneous attachments not previously requested.
(lick the upload button or drag and drop files here to attach document
Appendix.pdf 7.16MB
File must be FDF or KNE
Signature
V 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:*
Charles Mitchell Neaves III
Signature
6/1�- e2z=1W
Date Submitted:
9/12/2018
Initial Review

Is this project a public transportation project?*(?
r Yes r No
Change only if needed.
Has this project met the requirements for acceptance in to the review process?*
r Yes
f No
BIMS # Assigned*
20170887
Version#*
Reviewing Office*
Central Office - [phone]
Select Project Reviewer*
Mac Haupt:eads\dmhaupt
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
r $570.00