SW1191202_Supplemental Info Review_1/10/2020

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 1/10/2020 9:57:07 AM (Supplemental Submittal)
Submit by Strickland, Shane 1/10/2020 10:14:45 AM (Supplemental Info Submittal)
• The task was assigned to Strickland, Shane 1/10/2020 9:58 AM

Submittal Dated: 1/10/2020
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# * Perait N irrber
SW1191202
Examples: SWxxxxxxx, NC Gxxxxxx, or NCSxxxxxx
Facility Name:* Circle K Mills River (Jeff ress Rd)
County: Henderson
Name: Bridgette Ganter
Vft is subrritting the inforrration?
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
Deed.pdf
347.49KB
Mills River Circle K Drainage Report.pdf
3.11 MB
NC_ Skyland_20190816_TM geo.pdf
91.77MB
North Carolina Secretary of State - Circle K Stores
157.05KB
Inc.pdf
O&M signed.pdf
795.92KB
Report of Subsurface Exploration - Circle K Store -
1.1M6
Jeff ress Road - Mills River, NC.pdf
Stormvvater Management Narrative.pdf
45.26KB
Supplement Form_signed.pdf
204.04KB
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 inforrretion cannot be clairred as confidential: the narre and address of any pernit applicant or
perrrittee, perrrit applications, permits, effluent data, inforrretion required by NODES application forrrs provided by
the Director inclusive of all forms and attachments [Ref. 40 CFR 122.7(b) and (c)].
Describe the attachments:
Deed, Drainage Calculations, Map, LLC Documentation, O&M Agreement, Geotech Report, Narrative, Supplement
Form

* W 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:* Bridgette Ganter
Signature:
Date Submitted: 1/10/2020

Initial Review
Updated ID#: IWORfANT. RE\/1RAE 2SH0LLDVMFY and revise here if necessary.
SW1191202
Who needs a V Central Office
copy?* r Regional Office
Central Office Reviewer:*
Corey Anen - eads\scanen
Select Reviewing Office*
Asheville Regional Office — 828-296-4500
Select RO Reviewer:*
[e-mail]