Proposed DaVita Dialysis Center - 11/8/2017 11:30:00 AM

WW "Arpplemental Information Upload Fon
Staff Review:
Updated ID#:
Updated Version:
Who needs a copy?*
SW5171101
u
V Central Office
r Regional Office
Select Reviewing Office*
Raleigh Regional Office — 919-791-4200
Central Office Reviewer:
Rick Riddle - eads\rlriddle1
Select RO Reviewer:*
[e-mail]
SUBMITTED PROJECT INFORMATION
Existing Project Information:
ID# SW5171101
Version: 1
Facility Name: Proposed DaVita Dialysis Center
County: Franklin
Name: Eric Blocher
Vft is submitting the infornation?
Email Address: [e-mail]
Water Resources
ENVIRONMENTAL QUALITY
Describe the attachments:
Attached are the permit forms with signature sheets, plans, stormwater narrative, operations and maintenance forms,
supplement sheets, and deeds.
Please upload all files that need to be submitted.

Business Registration Division.pdf
75.45KB
DB1754PG803. pdf
141.55KB
NCR162042 - Stormwater Narrative Revised. pdf
11.66MB
NCR172042 - Davita Bunn.pdf
10.88MB
NCR172042 - Drainage Areas. pdf
8.59MB
Operations and Maintenance Agreement.pdf
25.72KB
Permit Form.pdf
562.72KB
RetrieveCached PDF. pdf
163.6KB
Signature Sheets.pdf
2.03MB
Supplement Sheets.pdf
200.08KB
Only pdf files are accepted.
rJ By checking the box and signing box below, I 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: Eric Robert Blocher
Signature: