SW6190602_Supplemental Info Upload_20190903

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 9/3/2019 2:42:17 PM (Supplemental Submittal)
Submit by McCoy, Suzanne 9/4/2019 8:52:42 AM (Supplemental Info Submittal)
• The task was assigned to McCoy, Suzanne 9/3/2019 2:42 PM

Submittal Dated: 9/3/2019
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.
Existing Project Information:
Rease supply the perrrit nunber for this project.
D# * FL-rrrit Narrber
SW6190602
Exarrples: SWxxxxxxx, NOC;axxxx, or NCSxxxxxx
Facility Name:* Edgerton Industrial Park Storm Pond
County: Harnett
Name: Scott Brown, PE
Who is submitting the information?
Email Address:* [e-mail]
Please upload all files that need to be submited.
Qick the upload button or drag and drop files here to attach document
signed Supplement form.pdf
229.78KB
signed Deed Restriction.pdf
98.85KB
Edgerton Industrial Park revisions.pdf
4.78MB
1479-SW101 application.pdf
193.88KB
Only pdf files are accepted.
Describe the attachments:
updated forms and plan revisions as requested
* V By checking the box and signing box below, I certify that:
o I have given true, accurate, and complete information on this form;
• I agree that submission of this Supplemental Information form is a "transaction" subject to Chapter 66, Article 40 of the
NC General Statutes (the "Uniform Electronic Transactions Act)
o 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');
o I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written
signature; AND
o I intend to electronically sign and submit the Supplemental Information form."
Full Name:* Scott Brown

Signature:
Date Submitted: 9/3/2019

Initial Review
Updated ID#: IWORfANT: FEVIBAERSHOLLDVERIFY and revise here if necessary.
SW6190602
Who needs a V Central Office
copy?* r- Regional Office
Central Office Reviewer:*
Jim Farkas - eads\jjfarkas
Select Reviewing Office*
Fayetteville Regional Office — 910-433-3300
Select RO Reviewer:*
[e-mail]