SW3190803_Supplemental Info Review_8/22/2019

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 8/22/2019 5:01:10 PM (Supplemental Submittal)
Submit by McCoy, Suzanne 8/23/2019 8:05:55 AM (Supplemental Info Submittal)
• The task was assigned to McCoy, Suzanne 8/22/2019 5:01 PM

Submittal Dated: 8/22/2019
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
SW3190803
Exarrples: SWxxxxxxx, NOC;axxxx, or NCSxxxxxx
Facility Name:* Salem Leasing Corporation
County: Iredell
Name: Gerald V Grant
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
2569-1893.pdf
628.59KB
C3-3-1.pdf
1.59MB
Calculations.pdf
466.05KB
JGA_JamesMoore-SalemLeasingCorp-080219.pdf
117.07KB
NC —Statesville West_220DelrayStreet-112718.pdf
3.18MB
O&M-Agreement.pdf
119.22KB
SCL-CheckNu tuber-14699. PDF
272.69KB
SOS-SalemLeasingCorporation. pdf
28.4KB
SSW-NOI-SWG03-20100217-DWQ-SPU.pdf
137.33KB
SSW-SWU-101-Application-DEMLR-SPU Oct
238.39KB
2013.pdf
Stormwater-narrative description 120418.pdf
70.93KB
Only pdf files are accepted.
Describe the attachments:

1) Stormwater management permit application form.
2) O&M agreement.
3) Narrative description of the project.
4) Check number 15291 for the $505.00 application fee.
5) State stormwater notice of intent.
6) USGS map.
7) Calculations.
8) Plans.
9) Deed Book 2569, Page 1893.
10) Salem Leasing Corporation Secretary of State annual report.
11) Cover letter.
* V By checking the box and signing box below, I certify that:
• 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)
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');
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:* Gerald V Grant
Signature:
Date Submitted: 8/22/2019

Initial Review
Updated ID#: IWORfANT: FEVIBAERSHOLLDVERIFY and revise here if necessary.
SW3190803
Who needs a d Central Office
copy?* r- Regional Office
Central Office Reviewer:*
Jim Farkas - eads\jjfarkas
Select Reviewing Office*
Mooresville Regional Office — 704-663-1699
Select RO Reviewer:*
[e-mail]