SW5190101_Supplemental Upload Form_1/14/2019

Submittal Dated: 1/14/2019
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
SW5190101
Exarrples: SWxxxxxxx, NOCaaxxxx, or NCSxxxxxx
Facility Name:* Nash 97 Solar 2, LLC
County: Nash
Name: Kimberly Brooks
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
Nash 97 NCDEQ Stormwater Submittal Packet-1- 36.81
acket1-
36.81 MB
10-19. pdf
Only pdf files are accepted.
Describe the attachments:
Attached is a scanned copy of what was submitted for the Nash 97 Solar 2 post construction stormwater application
including the stormwater fees, signed application, supporting documents, and an electronic copy of the plan set.
* 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:* Kimberly Brooks

Signature:
Date Submitted: 1/14/2019

Initial Review
Updated ID#: IWORfANT: FEVIBAERSHOLLDVERIFY and revise here if necessary.
SW5190101
Who needs a d Central Office
copy?* F Regional Office
Central Office Reviewer:
Rick Riddle - eads\rlriddle1
Select Reviewing Office*
Raleigh Regional Office — 919-791-4200
Select RO Reviewer:*
[e-mail]