SWA000229_Supplemental Info Review_20231228

Action History (UTC-05:00)Eastern Time(US&Canada)
Submit by Anonymous User 12/28/2023 9:35:53 AM (Supplemental Submittal)
Accept by Kaitlin Peck 12/28/2023 1:38:56 PM (Supplemental Info Submittal)
• The task was assigned to Kaitlin Peck 12/28/2023 9:35:54 AM

DEQ •
Submittal from 12/28/2023
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* SWA000229
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* EMPOWERED TO SUCCEED
Owner/Operator* EMPOWERED TO SUCCEED MINISTRIES
County: Harnett
Submitter Name:* John Stephen Janowski
Who is submitting this information?
E-mail Address:* [e-mail]
Phone Number* 2527143002
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* Application Form
File Upload Click the upload button,or drag and drop files to attach
Pg 3 and 4 SSW Fast Track ATC Form_20180210
210.6KB
Empowered 12-27-23.pdf
Only PDF files are accepted.
File Type* Construction Sequence
File Upload Click the upload button,or drag and drop files to attach
Construction Sequences.pdf 145.62KB
Only PDF files are accepted.

File Type* Property Deed
File Upload Click the upload button,or drag and drop files to attach
DB3683-260.pdf 188.85KB
Only PDF files are accepted.
File Type* Response To Comments
File Upload Click the upload button,or drag and drop files to attach
Response to eMail-Steve Janowski-Outlook.pdf 774.88KB
Only PDF files are accepted.
File Type* USGS Topographic Site Map
File Upload Click the upload button,or drag and drop files to attach
USGS Map.pdf 740.36KB
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
North Carolina Secretary of State Search Results.pdf 55.1 KB
Only PDF files are accepted.
File Type* Response To Comments
File Upload Click the upload button,or drag and drop files to attach
Transmittal-NCDEQ Submittal Stormwater 10-30-
159.44KB
23.pdf
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:* John Stephen Janowski

Signature:
cam'
Date Submitted: 12/28/2023

Initial Review
Verify Permit No.* IMPORTANT:REVIEWER SHOULD VERIFY and revise here if necessary.
SWA000229
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* 12/28/2023