SW4200702_Supplemental Info Review_20201208

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 12/8/2020 1:15:28 PM (Supplemental Submittal)
Submit by McCoy, Suzanne 12/9/2020 10:36:37 AM (Supplemental Info Submittal)
• The task was assigned to McCoy, Suzanne 12/8/2020 1:15 PM

Submittal Dated: 12/8/2020
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
SW4200702
Examples: SWxxxxxxx, NC Gxxxxxx, or NCSxxxxxx
Facility Name:* Lewisville Community Center
County: Forsyth
Name: Adam Carroll
Vft is subrritting the inforr ation?
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
Lewisville CC Stormwater Narrative.pdf 95.39KB
Recombination Deed for Community Center.pdf 172.13KB
Lewisville CC Stormwater Calculations 09.08.20.pdf 4.03MB
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 infornation cannot be claimed as confidential: the nave and address of any perrrit applicant or
perrrittee, perrrit applications, perrrits, effluent data, information required by WCM application forms provided by
the Director inclusive of all forrrs and attachments [Ref. 40 CFR 122.7(b) and (c)].
Describe the attachments:
Items requested by Jim Farkas for permit approval:
- Stormwater narrative
- Recombination Plat
- Stormwater Calculations
* 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:* Joseph A Carroll
Signature:
Date Submitted: 12/08/2020

Initial Review
Updated ID#: WFORfANT. REV1RAERSH0LLDVMFY and revise here if necessary.
SW4200702
Who needs a W Central Office
copy?* r Regional Office
Central Office Reviewer:*
Jim Farkas - eads\jjfarkas
Review Date * 12/09/2020