New Wingate Elevated Tank - 1/25/2019 12:39:52 PM

Submittal Dated: 1/25/2019
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
SW3181202
Examples: SWxxxxxxx, NO&xxxxx, or NOSxxxxxx
Facility Name:* New Wingate Elevated Tank
County: Union
Name: W.K. Dickson
Who is submitting 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
Stormwater Permit Signed and Combined Revised
19.71 MB
Jan 2019.pdf
Only pdf files are accepted.
Describe the attachments:
Permit and all supporting documents.
* 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');
o 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:* Colleen Brophy
Signature:

Date Submitted: 1/25/2019

Initial Review
Updated ID#: IWORfANT: FEVIBAERSHOLLDVERIFY and revise here if necessary.
SW3181202
Who needs a V Central Office
copy?* rJ Regional Office
Central Office Reviewer:
Corey Anen - eads\scanen
Select Reviewing Office*
Mooresville Regional Office — 704-663-1699
Select RO Reviewer:*
[e-mail]