Jo Ellen Ammons Fieldhouse - 5/4/2018 1:19:47 PM

PMW"`-WW "A
upplemental Information Upload Fon
Staff Review:
Updated ID#: SW1180402
Updated Version: 1
Who needs a copy?* 17 Central
Office
r Regional
Office
Select Reviewing Office*
Asheville Regional Office — 828-296-4500
Central Office Reviewer:
Annette Lucas - eads\amlucas1
Select RO Reviewer:*
[e-mail]
SUBMITTED PROJECT INFORMATION
Existing Project Information:
ID# SW1180402
Version: 1
Facility Name: Jo Ellen Ammons Fieldhouse
County: Madison
Name: Zachary Roman
Who is subnitting the inforrration?
Email Address: [e-mail]
Water Resources
ENVIRONMENTAL QUALITY
Describe the attachments:
Attached are PDFs of the drawings and stormwater design report for the project. If NCDEQ requires the first page of
the digital design report to be sealed please contact me and we can insert a signed copy into that PDF.
Thanks!
Please upload all files that need to be submitted
16.00164 Stormwater Management Permit
8.2MB
Application.pdf
16.00164 MHU Fieldhouse Stormwater Management
10.13MB
Permit Set. pdf
Only pdr files are accepted

fJ By
checking
the
box
and
signing
box
below,
certify
that:
• 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')
• 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
o I intend to electronically sign and submit the Supplemental Information form.
Full Name: Zachary Roman
Signature:
Date Submitted: