SW4200301_Supplemental Info Review_4/14/2020

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 4/14/2020 3:12:50 PM (Supplemental Submittal)
Submit by Strickland, Shane 4/15/2020 2:59:02 PM (Supplemental Info Submittal)
• The task was assigned to Strickland, Shane 4/14/2020 3:12 PM

Submittal Dated: 4/14/2020
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# * Perrrit N irrber
SW4200301
Examples: SWxxxxxxx, NC Gxxxxxx, or NCSxxxxxx
Facility Name:* Haw Village
County: Alamance
Name: Lauren Granger
Vft is subrritting the information?
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
2020.04.08. Haw Village Subdivision Plan.pdf 10.85MB
Haw Village Permit App.pdf 5.98MB
Response Letter.pdf 76.78KB
Supp EZ.pdf 211.83KB
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 clairred as confidential: the narre and address of any perrrit applicant or
perrrittee, perrrit applications, permits, effluent data, information required by MODES application forms provided by
the Director inclusive of all fours and attachments [Ref. 40 CFR 122.7(b) and (c)].
Describe the attachments:
Response letter, revised application, revised Supplement EZ and revised plans
* 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:* Lauren Granger
Signature:
Date Submitted: 4/14/2020

Initial Review
Updated ID#: WFORfANT. REV1RAERSH0LLDVMFY and revise here if necessary.
SW4200301
Who needs a W Central Office
copy?* r Regional Office
Central Office Reviewer:*
Corey Anen - eads\scanen
Select Reviewing Office*
Winston-Salem Regional Office — 336-776-
9800
Select RO Reviewer:*
[e-mail]