Food Mart 6/11/2018 4:10:40 PM

Supplemental Information Upload Form
Please note: fields mark ed with a red asterisk * below are required. You will not be able to submit the form until all
mandatory questions are answered.
ID#*
Ve rsion:*
Facility Name :*
County:
Name :
Email Addre ss:*
Ple ase upload all file s that ne e d to be submite d.
De scribe the attachme nts:
*
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.”
Existing Project Information:
If it is an existing project, please supply the DWR#.
SW Permit Number
SW3180102
9 digits - example SWxxxxxxx
2
Food Mart
Catawba
Nick Fitzgerald
Who is submitting the information?
[e-mail]
Click the upload button or drag and drop files here to attach document
C5.0 DETAILS.pdf 1.1MB
Sand Filter Certification.pdf 108.58KB
Only pdf files are accepted.
Updated drawings and calculations certifying that the sand filter meets requirements of MDC 1.
By
checking
the
box
and
signing
box
below,
I
certify
that:
Full Name :*
Signature :*
Date Submitte d:
Nicholas Fitzgerald