Raleigh Regional Office - 3/6/2019 3:28:38 PM

Submittal Dated: 3/6/2019
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# * Permit Namber
SW7190209
Examples: SWxxxxxxx, NOC;axxxx, or NCSxxxxxx
Facility Name:* Raleigh Regional Office
County: Pitt
Name: Bill Hamilton
Who is subrritting the information?
Email Address:* [e-mail]
Please upload all files that need to be submited.
tick the upload button or drag and drop files here to attach document
17-158 Farmville Public Library - Plan Set.pdf 8.03MB
17-158 Farmville Public Library - STMWM
19.14MB
Narrative.pdf
17-158 DEED.pdf 483.19KB
72175082 Complete Farmville Library Geotech
7.93MB
Report.pdf
2019-02-07 Signed Application.pdf 557.97KB
Only pdf files are accepted.
Describe the attachments:
Farmville Public Library Plan Set, Stormwater Management Narrative & Calculations, Deed, Geotechnical Report,
Application Form
* 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:* Bill Hamilton
Signature:
Date Submitted: 3/6/2019

Initial Review
Updated ID#: IWORfANT: FEVIBAERSHOLLDVERIFY and revise here if necessary.
SW7190209
Who needs a d Central Office
copy?* F Regional Office
Central Office Reviewer:
Select Reviewing Office*
Washington Regional Office — 252-946-6481
Select RO Reviewer:*
[e-mail]