SW3191202_Supplemental Info Review_1/2/2020

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 1/2/2020 10:05:03 AM (Supplemental Submittal)
Submit by Strickland, Shane 1/2/2020 1:08:35 PM (Supplemental Info Submittal)
• The task was assigned to Strickland, Shane 1/2/2020 10:05 AM

Submittal Dated: 1/2/2020
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 Drolect.
D# * Perrrit Number
SW3191202
Examples: SWxxxxxxx, NC Gxxxxxx, or NCSxxxxxx
Facility Name:* The Residence at Northgate
County: Iredell
Name: Hannah Breed
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
2019_11_26 Northgate Stormwater Report.pdf
10.24MB
2019_11_21 Northgate Site Documents.pdf
17.03MB
1 - NCDEQ Stormwater Permit Application.pdf
525.44KB
2 - NCDEQ O&M Agreement.pdf
319.07KB
3 - Northgate Supplemental Form.pdf
958.76KB
4 - USGS Map.pdf
8.55MB
5 - Residence_geotech_report_11.5.18.pdf
4.06MB
6 - Northgate Soil Map (Full Site).pdf
406.91 KB
7 - Northgate Deed.pdf
516.99KB
8 - Northgate Articles of Org.pdf
107.61 KB
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:

The attachments include the site development plan set, stormwater report, stormwater application, O&M agreement,
and stormwater supplemental form. It also includes copies of the USGS map, geotech report, soil map, deed, and
articles of organization.
* 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');
• I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written
signature; AND
• I intend to electronically sign and submit the Supplemental Information form."
Full Name:* Hannah Breed
Signature:
Date Submitted: 1/2/2020

Initial Review
Updated ID#: IWORfANT. RE\/1RAE 2SH0LLDVMFY and revise here if necessary.
SW3191202
Who needs a W Central Office
copy?* r Regional Office
Central Office Reviewer:*
Corey Anen - eads\scanen
Select Reviewing Office*
Mooresville Regional Office — 704-663-1699
Select RO Reviewer:*
[e-mail]