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HomeMy WebLinkAboutGrace One Church - 2/5/2019 2:47:59 PMSubmittal Dated: 2/5/2019 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 SW3180906 Exarrples: SWxxxxxxx, NOC;axxxx, or NCSxxxxxx Facility Name:* Grace One Church County: Union Name: Bob Spalding Who is submitting the information? Email Address:* bspalding@isaacsgrp.com Please upload all files that need to be submited. Qick the upload button or drag and drop files here to attach document 18098-Civilplans-1-30-19.pdf 9.03MB O&M-Signed.pdf 311.21 KB Only pdf files are accepted. Describe the attachments: Revised Civilplans (full Set) and Signed O&M Agreement * 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'); 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:* Robert K Spalding Jr Signature: Date Submitted: 2/5/2019 Initial Review Updated ID#: IWORfANT: FEVIBAERSHOLLDVERIFY and revise here if necessary. SW3180906 Who needs a V Central Office copy?* rJ Regional Office Central Office Reviewer: Corey Anen - eads\scanen Select Reviewing Office* Mooresville Regional Office — 704-663-1699 Select RO Reviewer:* rick.riddle@ncdenr.gov