20161199 Ver 2_PCN Form Submission_20180919

Action History (UTC -05:00) Eastern Time (US & Canada)
Submit by Anonymous User 9/19/2018 11:54:09 PM (Start Event)
Accept by Montalvo, Sheri A 9/24/2018 10:17:31 AM (Non DOT Initial Review)
The task was assigned to Montalvo, Sheri A. The due date is: September 24, 2018 5:00 PM
9/19/2018 11:55 PM

DWR
Dfutslon 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.gov/WaterResources/0/edoc/624704/PCN%20Help%20File%202018-1-30. pdf
A. Processing Information
County (or Counties) where the project is located:*
Cumberland
Harnett
Is this project a public transportation project?*
r Yes G No
This is any publicly funded by rrunicipal,state or federal funds road, rail, airport transportation project.
1a. Type(s) of approval sought from the Corps:*
rJ Section 404 Permit (wetlands, streams and waters, Clean Water Act)
r Section 10 Permit (navigable waters, tidal waters, Rivers and Harbors Act)
1b. What type(s) of permit(s) do you wish to seek authorization?*
rJ 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: 03 - Maintenance
NWP Number Other:
List all WV nun hers you are applying for not on the drop dow n list.
1c. Type(s) of approval sought from the DWR:*
check all that apply
401 Water Quality Certification - Regular r 401 Water Quality Certification - Express
r` Non -404 Jurisdictional General Permit r 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:
For the record only for Corps Permit:
b Yes b No
O Yes a No
1e. Is payment into a mitigation bank or in -lieu fee program proposed for mitigation of impacts?
V so, attach the acceptance letter from mitigation bank or in -lieu fee program
r Yes r No
1f. Is the project located in anyof NC's twenty coastal counties?*
r Yes r No
1h. Is the project located in a designated trout watershed?*
r Yes r No
Link to trout information: http://wuwv.saw.usace.army.miI/Missions/Regulatory-Permit-Program/Agency-Coordination/Trout.aspx
B. Applicant Information
1a. Who is the Primary Contact?*
Justin Williamson, NC State Parks
1b. Primary Contact Email:*
[e-mail]
1c. Primary Contact Phone:*
(XXX)XXX-XXXX
1d. Who is applying for the permit?
Pr Owner r- Applicant (other than owner) r Agent/Consultant
(Check all that apply)
2. Owner Information
2a. Name(s) on recorded deed:
State of NC (State Parks; transferred from The Nature Conservancy)
2b. Deed book and page no.:
Deed Book 08425 Page 0533, Parcel ID # 0503-80-5253
2c. Responsible party:
(for Corporations)
2d. Address
Street Address
121 West Jones Street, Raleigh NC (USE Mail Service Ctr address below for U.S. Mail)
Address Line 2
1615 Mail Service Center,
City
State / Province / Pegion
Raleigh
NC
Rbstal / Zip Code
Country
27699-1615
USA
2e. Telephone Number:
(XXX)XXX-XXXX
2f. Fax Number:
(xxx)xxx-xxxx
2g. Email Address:*

[e-mail]
C. Project Information and Prior Project History
1. Project Information
1a. Name of project:*
Long Valley Farm Dam Repair at Carvers Creek State Park
1b. Subdivision name:
(if appropriate)
NA
1c. Nearest municipality/ town:
Spring Lake, NC
1d. Driving directions*
If it is a new project and can not easily be found in a GFS napping system Rease provide directions.
From Spring Lake, go north on NC -87-24, turn right (east) on Manchester Rd, then go 0.7 mile to the park entrance road (Long Valley Rd)
on Left. From Lillington, go south on NC -210 for 15 miles, turn right (east) on Manchester Rd, then go 1.7 miles to the park entrance road
(Long Valley Rd) on the Right. Park entrance on Manchester Rd is @ 35.1969, -78.9750. The park office is 0.3 mile north of the entrance,
and the dam repair project area is 0.7 mile north of the park office.
2. Project Identification
2a. Property Identification Number:
(tax RN or parcel ID)
Parcel ID # 0503-80-5253
2b. Property size:
(in acres)
976 acres
2c. Project Address
Street Address
Carvers Creek State Park
Address Line 2
2505 Long Valley Rd
City
State / Province / legion
Spring Lake
NC
Postal / Zip Code
Country
28390
US
2d. Site coordinates in decimal degrees
Please collect site coordinates in decimal degrees. Use between 4-6 digits (unless you are using a survey -grade GPS device) after the decimal place as
appropriate, based on howthe location was determined. (For example, most mobile phones with GPS provide locational precision in decimal degrees to
map coordinates to 5 or 6 digits after the decimal place.)
Latitude:* Longitude:*
35.2117 -78.9769
ex: 34.208504 -77.796371
3. Surface Waters
3a. Name of the nearest body of water to proposed project:*
Jump and Run Creek (Long Valley Farm Lake)

3b. Water Resources Classification of nearest receiving water:*
Class C
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 vicinityof the project at the time of this application:*
Long Valley Farm was bequeathed to The Nature Conservancy in 2004 upon the death of James S. Rockefeller,
who acquired the property in 1937 and built a large house beside the dam in 1938. The Nature Conservancy
transferred the property to the State of NC for use as a recreational park and nature preserve. The dam on Jump
and Run Creek was built in the mid -1800s to power a grist mill, and modified twice in the 1900s. The mill structures
and the Rockefeller house are designated historic structures.
The dam overtopped and breached during high flows in Oct 2006 (Hurricane Matthew), and the lake has remained
drained since then, with all outflow now passing through the breach, 130 feet west of the mill building. Much of the
drained pond bed has become colonized with marsh herbs and shrubs, while some areas remain as open water
pools and channels. Outflow through the breach enters the mill tailrace, a wide open -water area, which then
narrows down to a stream channel (20-30 ft wide) about 115 feet southeast of the mill building. The southwestern
edge of the open water (tailrace) area has a fringe of wetland forest. The dam's low-level drainage outlet is
located 170 ft southwest of the breach, and drains into a man-made channel which joins the primary stream about
230 feet downstream from the mill. This drainage channel no longer flows, but is ponded by backwater from Jump
and Run Creek. A picnic shelter (pavilion) is built on top of the low-level drainage outlet.
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
JD -PCN Figs-Topo USGS.pdf
File type rust be pdf
187.81 KB
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 docurent
JD -PCN Figs -Soil USDA.pdf 312.59KB
File type rrust be pdf
4d. List the total estimated acreage of all existing wetlands on the property:
Pond bed (marsh) — 30 acres. Forested wetlands below breach = 0.24 ac
4e. List the total estimated linear feet of all existing streams on the property:
(interrittent and perennial)
Approx 7,000 ft from dam downstream to park property boundary
4f. Explain the purpose of the proposed project:*
Repair a breached historic dam within a state park. Regrade the embankment and construct a new primary
spillway and drainage gate system capable of safely passing the 100 -year magnitude storm flow.
4g. Describe the overall project in detail, including indirect impacts and the type of equipment to be used:*

Stage 1: Flag limits of work for review and approval by the Engineer. Establish site access and security, provide
temporary facilities, and install Stage 1 erosion and sediment control measures. Perform site clearing and
grubbing and debris removal. Construct temporary cofferdams upstream and downstream of the new spillway.
Route base flows and storm flows through the existing, gated lovv-level outlet conduits at the pavilion. Excavate for
the new spillway, install the sheet pile cutoff, and construct the new spillway. Perform selective demolition of the
existing grist mill spillway. Complete the embankment grading on the left side of the new spillway, including around
the portions of the existing spillway to remain. Complete the embankment grading on the right side of the new
spillway up to about Station 12+70. Install the new reservoir drain gate.
Stage 2: Remove the temporary upstream and downstream Stage 1 cofferdams, and route flows through the
reservoir drain gate at the new spillway. Install the Stage 2 erosion and sediment control measures. Construct the
temporary Stage 2 cofferdam upstream of the existing, gated lovv-level outlet conduits at the pavilion. Excavate,
remove, and abandon the existing, gated low level outlet conduits at the pavilion. Backfill the excavation, remove
the temporary Stage 2 cofferdam, and complete the right embankment grading. Install the spillway bridge and
guardrails. Topsoil, mulch, and seed all disturbed areas. Once vegetation is established, remove all temporary
erosion and sediment control measures.
The Preliminary JD Features Map (attached) depicts the construction disturbance limits, including staging areas to
the north and south. Access will be provided from two locations: 1) an existing dirt road between the park office
(3,500 feet south of the dam) and the Rockefeller house and Pavilion area, and 2) an existing dirt road off Ray Rd
(Harnett Co SR -1121) 8,000 ft northeast of the dam. No waters will be affected along these two access roads, nor
in the construction staging areas. Excavators and bulldozers will be the principal equipment used.
4h. Please upload project drawings for the proposed project.
Click the upload button or drag and drop files here to attach decurrent
Carvers DD Drawings April 2018.pdf
File type rrust be pdf
5. Jurisdictional Determinations
15.07MB
5a. Have the wetlands or streams been delineated on the propertyor proposed impact areas?*
r Yes f No r Unknown
Comments:
Delineation by consultant in Sept 2017; Corps has not yet confirmed.
5b. If the Corps made a jurisdictional determination, what type of determination was made?
r Preliminary r Approved r Unknown C N/A
Corps AID Number:
Exarrple: SAM2017-99999
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known):
Agency/Consultant Company:
Other:
Gerald Pottern
Mogensen Mitigation Inc
5d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
A preliminary map of potential jurisdictional waters is attached, based on MMI's Sept 2017 delineation. This map is being submitted
concurrently to USACE as part of a JD Request package.
5d1. Jurisdictional determination upload
Click the upload button or drag and drop files here to attach docurrent
JD -PCN Figs Wetland PJD Map.pdf 336.18KB
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?*

C Yes C No C Unknown
7. Future Project Plans
7a. Is this a phased project?*
r 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.
No
D. Proposed Impacts Inventory
1. Impacts Summary
1a. Where are the impacts associated with your project? (check all that apply):
17 Wetlands ❑ Streams -tributaries r- Buffers
m Open Waters ❑ 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*
W-1 Cofferdam & new P Bottomland Hardwood Area D in PJD Yes Both 0.052
spillway Permanent () or Forest map (404, 10) or DAR (401, (acres)
Nap label (e.g. Finad Crossing 1 - Culvert, Temporary (T) other)
dewatering, etc)
2g. Total Temporary Wetland Impact
0.000
2g. Total Permanent Wetland Impact
0.052
2g. Total Wetland Impact
0.052
2h. Comments:
Wetland D (impact area W-1) will be cleared and graded during Stage 1 for the temporary cofferdam, and will be
converted to open water and/or stream channel during Stage 2 after the cofferdam is removed.
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*
0-1 Remove old 2° drain
T
Area Ain PJD map
gates
Ferrranent (F) or
(if applicable)
Nbp label (e.g. Road Crossing 1)
Temporary (T)
0-2 Cofferdam & new
T
Area Ain PJD map
spillway
Permanent (P) or
(if applicable)
Nbp label (e.g. Road Crossing 1)
Temporary (T)
4d. Activity type* 4e. Waterbody type *4f. Impact
area
Fill Pond 0.05
(acres)
Fill Pond 0.34
(acres)

0-3 New spillway
T
Area Ain PJD map Excavation Pond
0.06
Nap label (e.g. Finad Grossing 1)
Fbrnanent (F) or
(if applicable)
(acres)
Tenporary (T)
0-4 New spillway,
P
Area B in PJD map Fill Pond
0.11
embankment
Ferrranent(P)or
(if applicable)
(acres)
Nap label (e.g. Fbad Crossing 1)
Ter porary (T)
0-5 Cofferdam & new
T
Area B in PJD map Fill Pond
0.14
spillway
Permanent (P) or
(if applicable)
(acres)
Nap label (e.g. Road Grossing 1)
Tenporary (T)
4g. Total temporary open water Impacts:
0.59
4g. Total permanent open water impacts:
0.11
4g. Total open water impacts:
0.70
4h. Comments:
Area A (drained pond bed) is partially vegetated and meets criteria for a freshwater marsh wetland. We are
treating impacts in this area as 'open waters" because it was a pond (non -vegetated) prior to dam failure in
October 2016, and will be restored to pond condition upon project completion.
Area B (e)dsting breach and mill tailrace area) is below the dam but is treated as "open waters" associated with the
dam tailwaters, rather than as "stream". The stream (Area F) begins approx 120 ft downstream of the mill where
the tailrace area narrows forming a distinct channel.
Area C (man-made bypass channel, open waters), Area F (stream), and Area E (forested wetland downstream)
are beyond the construction impact area and will not be affected. Area C will remain a "dead-end" backwater
channel off Jump and Run Creek, as it is now.
E. Impact Justification and Mitigation
1. Avoidance and Minimization
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:*
The new spillway will be installed at the existing breach location, which is presumably near the original pre -
impoundment stream channel, and the spillway outlet will transition into the existing Jump and Run Creek channel
just downstream of the mill tailrace area. The forested wetland fringe along the southwest edge of the breach is
damaged (many fallen trees) and cannot be avoided due to the steep existing topography through the breach,
which requires grading to stabilize it. Jump and Run Creek and its adjacent floodplain wetlands downstream of the
mill tailrace have been avoided. The old primary spillway beside the grist mill will be filled in to protect the historic
mill structure.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:*
Equipment access will be provided from upland access roads on both sides of the dam, so that equipment will not
need to cross the stream below the dam. Flow will be bypassed around the construction areas (first through the
low level gates, then through the new spillway) to avoid excessive soil erosion and turbidity downstream. Silt
fencing will be provided around all disturbed areas as appropriate. Proposed fill and grading in the pond bed and
tailrace areas is the minimum required to erect the cofferdams needed for flow bypass and dewatering.
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:

This project involves repair of an existing historic dam structure, with USACE application submitted less than two years after the dam failure.
Permanent impacts to wetlands are 0.052 acre, and the remaining impacts affect only open waters and recently created marsh (0.59 acre
temporary + 0.11 acre permanent impacts). The pond area and pool below the spillway after construction will be similar in area to current
conditions. No compensatory mitigation is required.
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?
r Yes G No
For a list of options to meet the diffuse flow requirements, click here.
If no, explain why:
The Little River watershed (HUC # 03030004) in the Cape Fear River basin has no riparian buffer requirements
2. Stormwater Management Plan
2a. Is this a NCDOT project subject to compliance with NCDOT's Individual NPDES permit NCS000250?*
r Yes t: No
2b. Does this project meet the requirements for low density projects as defined in 15A NCAC 02H .1003(2)?*
r Yes
r 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?*
r Yes r 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 Policy Act (NEPA/SEPA)?*
r Yes r No
Comments:*
Project is state -funded and does not meet the cost or impact area thresholds that trigger SEPA compliance.
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)? *
r Yes r No
2b. Is this an after -the -fact permit application?*
r Yes F 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.
The project will repair an existing lake within a state park; it is not likely to induce additional urban development.
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project?
r Yes r 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?*
r Yes r No r Unknown
5e. Is this a DOT project located within Division's 1-8?*
r 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)?*
r 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.?
r Yes r No
5j. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?

MMI consulted NC -NHP Data Explorer and the US-FWS list of protected species by counties. Seven endangered or
threatened species subject to Endangered Species Act Section 7 Consultation are reported from Cumberland
and/or Harnett Counties. For five of these species (Cape Fear Shiner, St. Francis's Satyr, Pondberry, Michawes
Sumac, and American Chaffseed) NC -NHP has no record of them on the Manchester USGS Quadrangle, and MMI
determined that no suitable habitat exists in or adjacent to the project construction areas. Consequently, the
project is not likely to affect these species. The remaining two species, Rough -leaf Loosestrife and Red -cockaded
Woodpecker, are both known to occur within a mile of the project area.
Rough -leaf Loosestrife occurs in wet sandy to peaty soils along pocosin edges, forest edges, and seeps with an
open canopy maintained by periodic fires or mowing. The currently known population nearest to the project site is
in a powerline corridor subject to periodic mowing. MMI inspected the project area and access corridors and
determined than no suitable habitat exists for this plant. Other plant species indicative of Rough -leaf Loosestrife
habitat were not present. Consequently, the project is not likely to affect Rough -leaf Loosestrife.
Red -cockaded Woodpeckers live in small family groups in large tracts of relatively mature pine -dominated forests
with sparse understory, or younger pine forests with scattered clusters of old trees. Nesting (cavity) trees must be
60 years or older, and are most often longleaf pines. Each group maintains several active cavities in old living
pines, and forages among pines generally within a half -mile of the cavity tree cluster. A Red -cockaded
Woodpeckers group within one mile west of the project area is reported as "current". It is possible that birds from
this group may forage along the western edge of Long Valley Farm lake, but none was seen during the two field
visits in September 2017 and park staff have not heard any reports of Red -cockaded Woodpecker sightings in the
park. A few large loblolly pines on the downstream side of the dam will need to be removed, but these are not
cavity trees (based on MMI inspection) and they are surrounded by predominantly hardwood forest with
understory trees and vines. These pines are unlikely to be used frequently by foraging Red -cockaded
Woodpeckers, and the project is not likely to affect these birds.
The NC -NHP auto -generated report of element occurrences in and near the project area is attached.
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as an Essential Fish Habitat?*
r Yes r No
6b. What data sources did you use to determine whether your site would impact an Essential Fish Habitat?*
NOAA-NMFS does not have any Essential Fish Habitat mapped in or near Carvers Creek State Park.
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)?*
C Yes r No
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?*
State park staff are coordinating directly with SHPO to minimize impacts to historic resources, including the dam
and mill structures and the Rockefeller house. Construction will occur adjacent to the Pavilion and Mill, and special
precautions will be taken to protect these structures. The old primary spillway adjacent to the Mill will be partially
filled in, which will help protect the mill's foundation from erosion. Contact Justin Williamson for further information.
7c. Historic or Prehistoric Information Upload
Click the upload button or drag and drop files here to attach document
File rrust 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 repaired dam will not change flood elevations upstream or downstream (relative to the pre -breach condition)
and is designed to safely pass the 100 -year storm. The dam is classified as low -hazard by NC Dam Safety.
8c. What source(s) did you use to make the floodplain determination?*
FEMA Flood Insurance Rate Map (FIRM) Panel # 3720050300K (Jan 2007). The Zone AE base flood (100 -yr)
elevation mapped is 156 ft below the dam and 162 ft above the dam (NAVD-88).
Miscellaneous
Miscellaneous attachments not previously requested.
Click the upload button or drag and drop files here to attach docurrent
NHP project_report_14399.pdf 2.76MB
File rrust be FDF or IME
Signature
PF 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:*
Gerald Pottern
Signature
Date Submitted:
9/19/2018
Initial Review
Is this project a public transportation project?*(?)
r Yes r No
Change only rf needed.
Has this project met the requirements for acceptance in to the review process?*
r Yes
r No
BIMS # Assigned *
20161199
Version#*
2
Reviewing Office
Fayetteville Regional Office - [phone]
Select Project Reviewer*
Chad Turlington:eads\ccturlington
Is a payment required for this project?*

r No payment required
r Fee received
r Fee needed - send electronic notification
What amout is owed?
E $240.00
O $570.00