SW5190702_Supplemental Info Review_7/12/2019

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 7/12/2019 11:26:00 AM (Supplemental Submittal)
Submit by Strickland, Shane 7/12/2019 11:58:21 AM (Supplemental Info Submittal)
• The task was assigned to Strickland, Shane 7/12/2019 11:26 AM

Submittal Dated: 7/12/2019
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
SW5190702
Exarrples: SWxxxxxxx, NOC;axxxx, or NCSxxxxxx
Facility Name:* Raleigh State Veterans' Home
County: Wake
Name: Will Mowery
Who is submitting the information?
Email Address:* [e-mail]
Please upload all files that need to be submited.
Click the upload button or drag and drop files here to attach document
plan set.pdf 35.54MB
NC Veterans Home Geotechnical Report 071618.pdf 580.91 KB
Property Deed.pdf 145.7KB
O&M.pdf 23.12KB
Raleigh Vet Home SIA.pdf 24.48MB
SSW-SWU-101-Application-DEMLR.pdf 356.21 KB
SCM Supplemental Form.pdf 327.5KB
Only pdf files are accepted.
Describe the attachments:
The attached documents are pdfs of everything that was submitted for this project including the plan set,
geotechnical report, property deed, O&M, stormwater calculations, SCM supplemental form, and the permit
application.
* W 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

o I intend to electronically sign and submit the Supplemental Information form."
Full Name:* Will Mowery
Signature:
�clGo�.j
Date Submitted: 7/12/2019

Initial Review
Updated ID#: IWORfANT: FEVIBAERSHOLLDVERIFY and revise here if necessary.
SW5190702
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]