SWA000100_Supplemental Info Review_20210407

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 4/7/2021 10:28:43 AM (Supplemental Submittal)
Submit by McCoy, Suzanne 4/7/2021 10:31:34 AM (Supplemental Info Submittal)
• The task was assigned to McCoy, Suzanne 4/7/2021 10:28 AM

Submittal Dated: 4/7/2021
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 urolect.
D# * Perrrit N irrber
SWA000100
Examples: SWxxxxxxx, NC Gxxxxxx, or NCSxxxxxx
Facility Name:* The Lake at Spicewood- Phase 1
County: Forsyth
Name: Paul Stimpson
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
Phase 1- Stormwater Fast Track Application.pdf 1 AMB
Phase 1- site plan.pdf 2.31MB
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, pernits, effluent data, infornation required by MODES application forr s provided by
the Director inclusive of all fours and attachments [Ref. 40 CFR 122.7(b) and (c)].
Describe the attachments:
Stormwater Fast Track Application- Phase 1
Site Plan- Phase 1
* Pr 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:* Paul Stimpson
Signature:
O�awil,L7C.r�W,�,Lfow
Date Submitted: 04/07/2021

Initial Review
Updated ID#: WFORfANT. REV1RAERSH0LLDVMFY and revise here if necessary.
SWA000100
Who needs a W Central Office
copy?* r Regional Office
Central Office Reviewer:*
Jim Farkas - eads\jjfarkas
Review Date * 04/07/2021