DaVita Spencer - 8/7/2017 2:11:57 PM

Action History (UTC -05:00) Eastern Time (US & Canada)
Submit by Anonymous User 8/7/2017 2:11:57 PM (Supplemental Submital)
Approve by Alexander, Laura 8/7/2017 2:26:15 PM (Supplemental Info Submittal)
• The task was assigned to Alexander, Laura 8/7/2017 2:11 PM

Water Resources
ENVIRONMENTAL QUALITY
Staff Review:
Updated ID#: SW3170801
Updated Version: 1
Reviewers Email Address:
[e-mail]
Submitted Information:
What type of project is this?
r Existing Project
F Pre -Application Information
Facility Name: DaVita Spencer
County: Rowan
Name: Matt Johnson
Vft is subrritting the inforrreticn?
Email Address: [e-mail]
Describe the
attachments:
Please upload all files that need to be submited.
17-025_C0.1 INDEXpdf
1.56MB
17-025_C1.0 EX COND. & DEMO.pdf
837.19KB
17-025_C1.1 SITE.pdf
782.91 KB
17-025_C1.2 LJTIL.pdf
1021.78KB
17-025_C1.3 GRAD.pdf
1.39MB
17-025_C1.4 EC.pdf
1.3MB
17-025_C1.5 DRAIN AREA.pdf
910.32KB
17-025_C2.1 POND.pdf
932.04KB
17-025_C2.2 SITE DETAILS.pdf
700.29KB
17-025_C2.3 UTILITY DETAILS.pdf
1.89MB
17-025_C2.4 EC DETAILS.pdf
1.8MB
E&SC Stormwater Calc Report.pdf
482.02KB
Copy of Supplement Wet Basin_Rev9_Locked.pdf
246.86KB
O&M EZ 071414_1.1.pdf
60.61 KB
Only pdf files are accepted.
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
• I intend to electronically sign and submit the Supplemental Information form.
Full Name: Matthew W. Johnson, P.E.
Signature: