1215 Long Ferry Road - 5/24/2019 3:29:13 PM

Submittal Dated: 5/24/2019
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
SW3190502
Exarrples: SWxxxxxxx, NOC;axxxx, or NCSxxxxxx
Facility Name:* 1215 Long Ferry Road
County: Rowan
Name: Blake Day
Who is submitting 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
Project Kodiak - SHWT Report.pdf
432.99KB
Project Kodiak - Deed - 1326-23 WD.pdf
381.35KB
Project Kodiak - Deed - 1326-24 WD.pdf
1011.39KB
Project Kodiak - O&M Manual EZ - Slgned.pdf
198.94KB
Project Kodiak - Stormwater Application_Signed.pdf
579.89KB
Project Kodiak - Stormwater Report - 2019-0508.pdf
5.38MB
Project Kodiak - SuppEZ_2018_Signed.pdf
196.8KB
Project Kodiak - Construction Plans - 2019
65.49MB
0508_Signed.pdf
Only pdf files are accepted.
Describe the attachments:
* 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

o I intend to electronically sign and submit the Supplemental Information form."
Full Name:* Robert Blake Day
Signature:
Date Submitted: 5/24/2019

Initial Review
Updated ID#: IWORfANT: FEVIBAERSHOLLDVERIFY and revise here if necessary.
SW3190502
Who needs a d 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]