Q Mart - 5/23/2018 6:06:27 PM

Water Resources
ENVIRONMENTAL QUALITY
Staff Review:
Updated ID#: SW6180503
Updated Version: 1
Who needs a copy?* 17 Central
Office
r Regional
Office
Select Reviewing Office*
Fayetteville Regional Office — 910-433-3300
Central Office Reviewer:
Rick Riddle - eads\rlriddle1
Select RO Reviewer:*
[e-mail]
SUBMITTED PROJECT INFORMATION
Existing Project Information:
I D# SW6180503
Version: 1
Facility Name: Q Mart
County: Hoke
Name: George Rose
Vft is subnit ing the informAion?
Email Address: [e-mail]
Describe the attachments:
Current deed, Stormwater managment plan and routing report that includes calculations and soils reports,
Bioretention supplement, Portion of USGS map Raeford, operation & maintenance agreement, stormwater
management application, complete set of site drawings
Please upload all files that need to be submitted.

DB 1229PG927. pdf
191.56KB
QMartsite51218.pdf
8.98MB
QMartswmgmtrouting51218.pdf
6.94MB
Supplement_Bioretention_Rev.9_Locked.pdf
151.48KB
Portion USGSRaeford. pdf
611.43KB
QMart.O&M.pdf
360.88KB
QMart.swmapplication.pdf
2.44MB
Only pdf files are accepted.
IF 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
• I intend to electronically sign and submit the Supplemental Information form.
Full Name
Signature:
Date Submitted:
George M. Rose