SW5190501_Supplemental Info Upload_20190910

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 9/10/2019 4:30:40 PM (Supplemental Submittal)
Submit by McCoy, Suzanne 9/11/2019 8:14:56 AM (Supplemental Info Submittal)
• The task was assigned to McCoy, Suzanne 9/10/2019 4:30 PM

Submittal Dated: 9/10/2019
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
SW5190501
Exarrples: SWxxxxxxx, NOC;axxxx, or NCSxxxxxx
Facility Name:* Chatham Charter Recreational Field Exp
County: Chatham
Name: Christine Brown
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 docurrant
C-102 GRADING. pdf 859.56KB
C-105 SSW PERMIT MAP. pdf 487.95KB
Only pdf files are accepted.
Describe the attachments:
Please see attached PDF's revised per your e-mail on 9/10/19. 1 have revised sheet C-105 to reflect the latest Basin
Information sent to you recently. These should print at 24" x 36".
* V 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")
o 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:* Christine Brown

Signature:
Date Submitted: 9/10/2019

Initial Review
Updated ID#: IWORfANT: FEVIBAERSHOLLDVERIFY and revise here if necessary.
SW5190501
Who needs a d Central Office
copy?* r- Regional Office
Central Office Reviewer:*
Jim Farkas - eads\jjfarkas
Select Reviewing Office*
Raleigh Regional Office — 919-791-4200
Select RO Reviewer:*
[e-mail]