SW3161201_Supplemental Info Review_3/2/2020

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 3/2/2020 11:17:59 AM (Supplemental Submittal)
Submit by Strickland, Shane 3/2/2020 11:57:55 AM (Supplemental Info Submittal)
• The task was assigned to Strickland, Shane 3/2/2020 11:18 AM

Submittal Dated: 3/2/2020
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 urolect.
D# * Perait Nurrber
SW3161201
Examples: SWxxxxxxx, NC Gxxxxxx, or NCSxxxxxx
Facility Name:* THE CONSERVANCY AT WAXHAW PARK PH
2
County: Union
Name: RICHARD L MODLIN
ftio is subrritting 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
1 - NCDEMLR Transmittal.pdf
80.96KB
2 - SW Permit Mod Application signed.pdf
929.19KB
3 - O&M Agreement signed.pdf
824.81 KB
4 - Supplemental-EZ-2018-Version-2.pdf
152.5KB
5 - SWM Calculations REV02-13-20.pdf
1.82MB
6 - Rev SW Permit Plans.pdf
6.24MB
7 - Attachments .pdf
1.7MB
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, pernit applications, permits, effluent data, inforrretion required by NR7ES application forrrs provided by
the Director inclusive of all forms and attachments [Ref. 40 CFR 122.7(b) and (c)].
Describe the attachments:

Copy of permit modification documents for SW3161201:
Transmittal
Application Form signed
O&M Agreement signed
Supplement-EZ form
SW Calculations sealed
SW Plans sealed
USGS map
Deed and parcel map
Corporation documentation
* 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
o I intend to electronically sign and submit the Supplemental Information form."
Full Name:* RICHARD L MODLIN
Signature:
KATAWL. it rt
Date Submitted: 3/2/2020

Initial Review
Updated ID#: IWORfANT. RE\/1RAE 2SH0LLDVMFY and revise here if necessary.
SW3161201
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]