SW5231002_Supplemental Info Review_20231019

Action History (UTC-05:00)Eastern Time(US&Canada)
Submit by Anonymous User 10/19/2023 10:01:29 AM (Supplemental Submittal)
Accept by Kaitlin Peck 10/19/2023 10:06:59 AM (Supplemental Info Submittal)
• The task was assigned to Kaitlin Peck 10/19/2023 10:01:31 AM

DEQ •
Submittal from 10/19/2023
Permit Information:
Please provide specific permit details below.
................................................................................................................................................................................................................................................................................................................................................................................................
What Type of Permit? Choose one:
* NPDES Industrial or MS4 Permit
State Stormwater(Post-Construction)Permit
Other
Permit Number* SW5231002
Begins with"SW","NCG",or"NCS"
What DEQ Office is Reviewer:Please correct if misidentified,close this review form,and reassign task to the appropriate contact.
the Primary Contact? Central Office
*
Washington Regional Office(Attn: Carl Dunn)
Wilmington Regional Office(Attn:Christine Hall)
..............................................................................................................................................................................................................................................................................................................................................................................................
Project Name* Chatham Vet Services New Bldg
Owner/Operator* JKSCOTT, LLC
County: Chatham
Submitter Name:* BREC, PA-Justin Church
Who is submitting this information?
E-mail Address:* [e-mail]
Phone Number* 336-844-4088
Additional E-mail for [e-mail]
Submittal (Optional)
Confirmation:
State Stormwater (Post-Construction) Information Uploads
Choose file type and upload attachment(Reviewer may remove unnecessary submittals)
File Type* Plansheet-SCM Detail
File Upload Click the upload button,or drag and drop files to attach
CHATHAM_VET_plans.pdf 10.71 MB
Only PDF files are accepted.
File Type* USGS Topographic Site Map
File Upload Click the upload button,or drag and drop files to attach
CROPPED_USGS.pdf 7.07MB
Only PDF files are accepted.
File Type* Property Deed

File Upload Click the upload button,or drag and drop files to attach
DB_1976_107.pdf 122.04KB
Only PDF files are accepted.
File Type* Application Form
File Upload Click the upload button,or drag and drop files to attach
NCDENR_STORMWATER_PERMIT_10032023.pdf 374.91KB
Only PDF files are accepted.
File Type* Signing Official Title&Position Information
File Upload Click the upload button,or drag and drop files to attach
NCSOS_REPORT.pdf 47.56KB
Only PDF files are accepted.
File Type* O&M Agreement/Plan
File Upload Click the upload button,or drag and drop files to attach
SIGNED_O&M.pdf 121.12KB
Only PDF files are accepted.
File Type* Supplement-EZ Form
File Upload Click the upload button,or drag and drop files to attach
SIGNED_SUPPLEMENTAL_FORM.pdf 368.5KB
Only PDF files are accepted.
File Type* Design Calculations
File Upload Click the upload button,or drag and drop files to attach
STORMWATER_CALCS_CHATHAM_VET.pdf 3.44MB
Only PDF files are accepted.
Is this project funded No
with ARPA grant Yes
funds?*
Uploads contain NO
Confidential YES
Information* NOTE:The following information cannot be claimed as confidential:the name and address of any permit applicant
or permittee,permit applications,permits,effluent data,information required by NPDES application forms provided
by the Director inclusive of all forms and attachments[Ref.40 CFR 122.7(b)and(c)].
Notes about the attachments:
* By checking the box and signing box below, I certify that:
o I have given true,accurate,and complete information on this form;
o 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)
o 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
o I intend to electronically sign and submit the Supplemental Information Upload form.

Full Name:* Justin Church
Signature:
OzAir;r C�
Date Submitted: 10/19/2023

Initial Review
Verify Permit No.* IMPORTANT:REVIEWER SHOULD VERIFY and revise here if necessary.
SW5231002
Who needs a Copy?* Reviewer selections will only be required for offices checked here.
Central Office Staff
Regional Office Stormwater Contact
State Stormwater RO Staff
No Copy Needed
Central Office Reviewer:*
Notifies CO Staff with Email
Jim Farkas
Any Comments or
Added Info for CO
Staff Reviewer?
Review Date* 10/19/2023