SW6240704_Supplemental Info Review_20240807

Action History (UTC-05:00)Eastern Time(US&Canada)
Submit by Anonymous User 8/7/2024 10:33:20 AM (Supplemental Submittal)
Accept by bethany.georgoulias 8/19/2024 2:44:25 PM (Supplemental Info Submittal)
• The task was assigned to DEMLR Post-Construction Team 8/7/2024 10:33:21 AM
• bethany.georgoulias assigned the task to bethany.georgoulias 8/19/2024 2:44:11 PM

=DEQ •
Submittal from 8/7/2024
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* SW6240704
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* Circle K-HSD Addition 2723997
Owner/Operator* Lennon Family Properties, LLC/Circle K Stores, Inc.
County: Cumberland
Submitter Name:* Mike Davidson
Who is submitting this information?
E-mail Address:* [e-mail]
Phone Number* 984-222-1610
Additional E-mail for (Optional)
Submittal
Confirmation:
State Stormwater (Post-Construction) Information Uploads
Choose file type and upload attachment(Reviewer may remove unnecessary submittals)
File Type* As-Built-Certification
File Upload Click the upload button,or drag and drop files to attach
PermitteeCert AsBuiltCert_20180209.pdf 474.37KB
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:* Mike Davidson
Signature: �yy o
Date Submitted: 08/07/2024

Initial Review
Verify Permit No.* IMPORTANT:REVIEWER SHOULD VERIFY and revise here if necessary.
SW6240704
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
Jacob Beeker
Any Comments or
Added Info for CO
Staff Reviewer?
Review Date* 08/19/2024