Mountain Park Elementary School - 3/18/2019 4:34:30 PM

Submittal Dated: 3/18/2019
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
SW4190301
Exarrples: SWxxxxxxx, NOC;axxxx, or NCSxxxxxx
Facility Name:* Mountain Park Elementary School
County: Surry
Name: Eddie MacEldowney
Who is submitting the information?
Email Address:* [e-mail]
Please upload all files that need to be submited.
Oick the upload button or drag and drop files here to attach document
MtPark- Stormwater Management Permit_Signed.pdf
2.58MB
MTNPARK_D.B. 131 PG20.pdf
171.8KB
NC_Elkin_North_20160624_TM_geo.pdf
25.32MB
CO.1-INDEXpdf
1.29MB
C1.1-EXIST CONDITIONS.pdf
1.02MB
C1.2-DEMOLITION.pdf
1.07MB
C2.1-OVERALL SITE.pdf
944.24KB
C3.1-GRADING DRAINAGE.pdf
1.09MB
C4.1-UTILITY.pdf
976.88KB
C4.2-WASTEWATER SYSTEM.pdf
555.55KB
C4.3-WELL HOUSE.pdf
785.25KB
C5.1-EROSION CONTROL.pdf
1.05MB
C6.1-DETAILS. pdf
965.57KB
C6.2-DETAILS. pdf
897.97KB
C6.3- EROSION DETAILS.pdf
1.34MB
Only pdf files are accepted.
Describe the attachments:

Stormwater Permit Application
Deed
USGS Quad Map
Plan Set
* V By checking the box and signing box below, I certify that:
o I have given true, accurate, and complete information on this form;
o 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');
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:* Edward Thomas MacEldowney, Jr.
Signature:
c�ak+ral ��rr�Y.�o�r,My. rJ�.
Date Submitted: 3/18/2019

Initial Review
Updated ID#: IWORfANT: FEVIBAERSHOLLDVERIFY and revise here if necessary.
SW4190301
Who needs a V Central Office
copy?* F Regional Office
Central Office Reviewer:
Corey Anen - eads\scanen
Select Reviewing Office*
Winston-Salem Regional Office — 336-776-
9800
Select RO Reviewer:*
[e-mail]