SW6190802_Supplemental Info Review_1/5/2020

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 1/5/2020 7:29:09 PM (Supplemental Submittal)
Submit by Strickland, Shane 1/6/2020 10:34:37 AM (Supplemental Info Submittal)
• The task was assigned to Strickland, Shane 1/5/2020 7:29 PM

Submittal Dated: 1/5/2020
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
SW6190802
Exarrples: SWxxxxxxx, NC Gxxxxxx, or NCSxxxxxx
Facility Name:* Four Sierra Ranch
County: Cumberland
Name: Jeffrey Nobles
Vft is subrritting the infornetion?
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
2020-01-05 Revised Sheet C04.pdf 320.39KB
2020-01-05 Storm Calcs and Misc Docs.pdf 5.97MB
2020-01-05 Supplement Form.pdf 614.16KB
2020-01-05 SWU-101.pdf 380.37KB
Four Sierra Ranch USGS Quad-2.pdf 309.59KB
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 infornetion cannot be claimed as confidential: the nave and address of any perrrit applicant or
perrrittee, perrrit applications, perrrits, effluent data, information required by NRJES application forms provided by
the Director inclusive of all forrrs and attachments [Ref. 40 CFR 122.7(b) and (c)].
Describe the attachments:
Revised SWU-101 per comments
Revised Supplement per comments
USGS Quad sheet
Revised Calculations
Revised sheet C04
Deed Restriction form is pending. Ovvner is out of state, attempting signatures.
* V 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:* Jeffrey A Nobles
Signature:
Date Submitted: 1/5/2020

Initial Review
Updated ID#: IWORfANT. RE\/1RAE 2SH0LLDVMFY and revise here if necessary.
SW6190802
Who needs a W Central Office
copy?* r Regional Office
Central Office Reviewer:*
Corey Anen - eads\scanen
Select Reviewing Office*
Fayetteville Regional Office — 910-433-3300
Select RO Reviewer:*
[e-mail]