SW6200204_Supplemental Info Upload_20200303

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 3/3/2020 7:09:06 AM (Supplemental Submittal)
Submit by Strickland, Shane 3/6/2020 9:38:22 AM (Supplemental Info Submittal)
• The task was assigned to Strickland, Shane 3/3/2020 7:09 AM

Submittal Dated: 3/3/2020
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 N irrber
SW6200204
Exarrples: SWxxxxxxx, NC Gxxxxxx, or NCSxxxxxx
Facility Name:* Midway Plaza
County: Hoke
Name: George M. Rose
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
Midway.stormwaterapp1.pdf
2.06MB
Midway.O&M. EZ. pg 1. pdf
476.61 KB
Midway. stormmg mtpla n. pdf
8.12MB
Midway. USGSlocation.pdf
677.57KB
MidwayPlazasite.21520.pdf
21.11 MB
DB1273PG209.pdf
316.05KB
Schultz.SOSinfo.pdf
210.74KB
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 claimed as confidential: the name and address of any perrrit applicant or
perrrittee, perrrit applications, permits, effluent data, information required by NRDM application forms provided by
the Director inclusive of all forrrs and attachments [Ref. 40 CFR 122.7(b) and (c)].
Describe the attachments:
Construction plans; stormwater management plan and routing report with calculations and soil reports; O&Mez;
USGS location map; stormwater application; recorded deed; SOS info
* 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');
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
• I intend to electronically sign and submit the Supplemental Information form."
Full Name:* George M. Rose
Signature:
�,O0f�e M f?os.0
Date Submitted: 3/3/2020

Initial Review
Updated ID#: IWORfANT. RE\/1RAE 2SH0LLDVMFY and revise here if necessary.
SW6200204
Who needs a W Central Office
copy?* r Regional Office
Central Office Reviewer:*
Jim Farkas - eads\jjfarkas
Select Reviewing Office*
Fayetteville Regional Office — 910-433-3300
Select RO Reviewer:*
[e-mail]