SWA000053_Supplemental Info Review_20190508

Submittal Dated: 5/8/2019
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
SWA000053
Examples: SWxxxxxxx, NO&xxxxx, or NOSxxxxxx
Facility Name:* Baucom's Nursery Phase 3
County: Cabarrus
Name: Concord Engineering & Surveying
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
180414.300 NC Sec of State Form.pdf
60.85KB
180414.300 NCDEQ Stormwater Fast Track Permit
1.14MB
Application.pdf
180414.300 Property Deed.pdf
346.22KB
180414.300 Stormwater Calculations. pdf
12.08MB
180414.300 Transmittal - NCDEQ.pdf
140.89KB
180414.300 USGS Quad Map.pdf
6.99MB
180414.300 Baucom's Nursery.pdf
26.79MB
Only pdf files are accepted.
Describe the attachments:
* W By checking the box and signing box below, I certify that:
o 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:* Skarlet Perez
Signature:
t >k
Date Submitted: 5/8/2019

Initial Review
Updated ID#: IWORfANT: FEVIBAERSHOLLDVERIFY and revise here if necessary.
SWA000053
Who needs a V Central Office
copy?* F Regional Office
Central Office Reviewer:*
Corey Anen - eads\scanen
Select Reviewing Office*
Mooresville Regional Office — 704-663-1699
Select RO Reviewer:*
[e-mail]