SW3200202_Supplemental Info Review_2/18/2020

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 2/18/2020 10:49:40 AM (Supplemental Submittal)
Submit by Strickland, Shane 2/19/2020 10:21:07 AM (Supplemental Info Submittal)
• The task was assigned to Strickland, Shane 2/18/2020 10:50 AM

Submittal Dated: 2/18/2020
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# * Fbrnit Nurrber
SW3200202
Exarrples: SWxxxxxxx, NC Gxxxxxx, or NCSxxxxxx
Facility Name:* SCM A
County: Union
Name: Stuart Woodard
Vft is subrritting the inforrretion?
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 for Parcel 07120005A and 07120005E.pdf 189.01 KB
O&M Signed and Notarized.pdf 281.94KB
SSW-SWU-1 01 -Application - Signed and
645.12 KB
Notarized.pdf
SuppEZ - Signed and Sealed.pdf 87.83KB
VK Heritage LLC - Incumbency (M Kissel T Manning)
563.88KB
12.11.18.pdf
2020-01-21 - Phases 11-14 - Scans -Signed.pdf 166.31 MB
SIA- KLP19000.pdf 28.77MB
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 claimed as confidential: the narre and address of any perrrit applicant or
pernittee, pernit applications, perrrits, effluent data, information required by WCM application forms provided by
the Director inclusive of all forrrs and attachments [Ref. 40 CFR 122.7(b) and (c)].
Describe the attachments:
* 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:* Stuart Woodard
Signature:
Date Submitted: 2/18/2020

Initial Review
Updated ID#: WFORfANT. REV1RAERSH0LLDVMFY and revise here if necessary.
SW3200202
Who needs a W Central Office
copy?* r Regional Office
Central Office Reviewer:*
Jim Farkas - eads\jjfarkas
Select Reviewing Office*
Mooresville Regional Office — 704-663-1699
Select RO Reviewer:*
[e-mail]