SW5190901_Supplemental Info Review_9/27/2019

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 9/27/2019 9:22:27 AM (Supplemental Submittal)
Submit by Strickland, Shane 9/27/2019 9:56:27 AM (Supplemental Info Submittal)
• The task was assigned to Strickland, Shane 9/27/2019 9:22 AM

Submittal Dated: 9/27/2019
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
SW5190901
Exarrples: SWxxxxxxx, NOC;axxxx, or NCSxxxxxx
Facility Name:* Deliveracne Church
County: Chatham
Name: Zachary Gardner
Who is subrritting 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
1 - $505 Fee Check.pdf 59.18KB
2 - NCDEQ SW Permit App. - Signed.pdf 644KB
3 - NCDEQ Stream Determination - Deliverance
3.03MB
Chruch.pdf
4 - 4637 Deliverance Church Wet
1.35MB
Report_04.05.19.pdf
5 - USACOE JD - Deliverance Church.pdf 5.39MB
6 - Deed.pdf 173.46KB
7 - 2019-08-29 Stormwater Report.pdf 8.25MB
8 - LOA NCDEQ Erosion Control - Deliverance.pdf 58.94KB
9 - 2019-09-17 Civil Plans - Deliverance.pdf 14.95MB
2019-09-24 - NCDEQ Transmittal - Signed.pdf 56.88KB
Only pdf files are accepted.
Please alert us to any confidential information contained in the uploaded documents.
Uploads contain r NO
Confidential r YES
Information * NOTE The following information cannot be clairred as confidential: the narre and address of any permit applicant or
perrrittee, perrrit applications, permits, effluent data, information required by M:M application forms provided by
the Director inclusive of all forrrs and attachments [Ref. 40 CFR 122.7(b) and (c)].

Describe the attachments:
Complete Stormwater Permit submittal for Deliverance Church - Siler City, NC
* 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)
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');
• 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 Gardner
Signature:
Date Submitted: 9/27/2019

Initial Review
Updated ID#: IWORfANT: FEVIBAERSHOLLDVERIFY and revise here if necessary.
SW5190901
Who needs a d Central Office
copy?* F Regional Office
Central Office Reviewer:*
Corey Anen - eads\scanen
Select Reviewing Office*
Raleigh Regional Office — 919-791-4200
Select RO Reviewer:*
[e-mail]