SWA000066_Supplemental Info Review_1/27/2020

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 1/27/2020 3:53:43 PM (Supplemental Submittal)
Submit by Strickland, Shane 1/28/2020 10:05:02 AM (Supplemental Info Submittal)
• The task was assigned to Strickland, Shane 1/27/2020 3:53 PM

Submittal Dated: 1/27/2020
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 Nurrber
SW6200105
Examples: SWxxxxxxx, NC Gxxxxxx, or NCSxxxxxx
Facility Name:* Candlevvood Suite Hotel - Hardy Hall and
Moon Hall Fort Bragg
County: Cumberland
Name: Derek Baalbergen
Mo is subaitting the inforrration?
Email Address:* [e-mail]
Please upload all files that need to be submited.
aick the upload button or drag and drop files here to attach document
5147-18-014_Fort Bragg CWS - USGS Map.pdf
1.92MB
5147-18-014_Fort Bragg CWS Stormvvater
1.08MB
Exhibit.pdf
5147-19-014_2020-01-17_Fort Bragg - NC DEQ
93.91 KB
Transmittal.pdf
5147-19-014_Fort Bragg CWS - Sequence of
126.88K6
Construction. pdf
5147-19-014_Fort Bragg CWS—SSW Fast Track
214.05K6
ATC Form.pdf
Good Standing Certificate North Carolina.pdf
49.76KB
Holdings Officers.pdf
6.81 KB
Memorandum of Lease Supplements 2-6 -- Fort
774.76KB
Bragg (North Carolina).pdf
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 information cannot be claimed as confidential: the narre and address of any permit applicant or
perrrittee, perrrit applications, permits, effluent data, information required by MODES application forms provided by
the Director inclusive of all forms and attachments [Ref. 40 CFR 122.7(b) and (c)].
Describe the attachments:
SSW Fast Track ATC form
CWS Stormwater Exhibit
CWS USGS Map
Transmittal Form
CWS Sequence of Construction
Good Standing Certificate
Holding Officers
Lease Supplement
* 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:* Derek Baalbergen
Signature:
Date Submitted: 1/27/2020

Initial Review
Updated ID#: WFORfANT. REV1RAERSH0LLDVMFY and revise here if necessary.
SWA000066
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]