Full Gospel Tabernacle Church - 2/25/2019 12:07:20 PM

Submittal Dated: 2/25/2019
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
SW6190202
Examples: SWxxxxxxx, NO&xxxxx, or NOSxxxxxx
Facility Name:* Full Gospel Tabernacle Church
County: Harnett
Name: Austin Jackson
Who is submitting the information?
Email Address:* [e-mail]
Please upload all files that need to be submited.
Oick the upload button or drag and drop files here to attach document
190102 - LETTER OF TRANSMITTAL.pdf
84.75KB
18080144-01 _O&M. pdf
85.06KB
18080144-01_Pond Calculations.pdf
136.95KB
18080144-01_Stormwater Narrative - 190102.pdf
191.61 KB
18080144-01_Supplmental EZ Form.pdf
232.51 KB
Check Scan.pdf
22.1 KB
Full Gospel Tabernacle Church - Full Set
12.47MB
(signed).pdf
Signed SWUApplication.pdf
3.85MB
USGS 7.5-minute image map for Erwin, North
11.88MB
Carolina.pdf
Only pdf files are accepted.
Describe the attachments:

1) Letter of transmittal stating what is included in this submittal package.
2) Signed O&M form for wet detention pond.
3) Pond calculations for wet detention pond.
4) Stormwater narrative describing the intended use of the wet detention pond to treat runoff.
5) Signed Supplemental EZ form.
6) Signed check.
7) Signed plans.
8) Signed SWU application.
9) USGS Quad map.
* V By checking the box and signing box below, I certify that:
o I have given true, accurate, and complete information on this form;
o 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:* James Austin Jackson
Signature:
At > 4--
Date Submitted: 2/25/2019

Initial Review
Updated ID#: IWORfANT: FEVIBAERSHOLLDVERIFY and revise here if necessary.
SW6190202
Who needs a V Central Office
copy?* rJ Regional Office
Central Office Reviewer:
Corey Anen - eads\scanen
Select Reviewing Office*
Fayetteville Regional Office — 910-433-3300
Select RO Reviewer:*
[e-mail]