SW1190801_Supplemental Info Review_12/13/2019

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 12/13/2019 1:53:17 PM (Supplemental Submittal)
Submit by Strickland, Shane 12/16/2019 1:40:41 PM (Supplemental Info Submittal)
• The task was assigned to Strickland, Shane 12/13/2019 1:53 PM

Submittal Dated: 12/13/2019
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 suDDly the Derrrit nunber for this urciect.
D# * Perrrit N irrber
SW 1190801
Examples: SWxxxxxxx, NC Gxxxxxx, or NCSxxxxxx
Facility Name:* Leicester Volunteer Fire Deaprtment
County: Buncombe
Name: Jacob Grieb
Vft is subrritting the information?
Email Address:* [e-mail]
Please upload all files that need to be submited.
Click the upload button or drag and drop files here to attach docurrent
Scanned Originals - Permit Agreements.pdf 5.12MB
3827 RESVISED SET 12-13-19.pdf 23.87MB
3827 Revised SW Report 12-13-19.pdf 9.46MB
65X 0079 (Leicester VFD) - Draft Report - Proposed
Leicester Vol. Fire Stn., Alexander Road, Leicester, 3.38MB
NC).pdf
Only pdf files are accepted.
Please alert us to any confidential information contained in the uploaded documents.
Uploads contain r NO
Confidential r YES
Information * NOTE The following information cannot be clairred as confidential: the narre and address of any perrrit applicant or
perrrittee, perrrit applications, permits, effluent data, information required by MODES application forms provided by
the Director inclusive of all forms and attachments [Ref. 40 CFR 122.7(b) and (c)].
Describe the attachments:
See attached revisions per comments. Hard copies to follow.
* V 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');
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:* Jacob Grieb
Signature:
Date Submitted: 12/13/2019

Initial Review
Updated ID#: IWORfANT. RE\/1RAE 2SH0LLDVMFY and revise here if necessary.
SW 1190801
Who needs a W Central Office
copy?* r Regional Office
Central Office Reviewer:*
Jim Farkas - eads\jjfarkas
Select Reviewing Office*
Asheville Regional Office — 828-296-4500
Select RO Reviewer:*
[e-mail]