SW5200701_Supplemental Info Review_20200708

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 7/8/2020 3:52:16 PM (Supplemental Submittal)
Submit by Strickland, Shane 7/13/2020 10:14:02 PM (Supplemental Info Submittal)
• The task was assigned to Strickland, Shane 7/8/2020 3:52 PM

Submittal Dated: 7/8/2020
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# * Perrrit Nurrber
SW5200701
Examples: SWxxxxxxx, NC Gxxxxxx, or NCSxxxxxx
Facility Name:* Bojangles at Spring Hope
County: Nash
Name: Ethan Averette
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
Complete Set 7-1-20.pdf
7.17MB
Deed.pdf
154.26KB
Site Calculations.pdf
4.95MB
Stormwater Management Permit Application.pdf
4.08MB
Stormvvater Narrative.pdf
6.83KB
USGS Map.pdf
1.61 MB
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, inforrretion required by NODES application forms provided by
the Director inclusive of all forms and attachments [Ref. 40 CFR 122.7(b) and (c)].
Describe the attachments:
* 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:* Ethan Averette
Signature:
Date Submitted: 07/08/2020

Initial Review
Updated ID#: IWORfANT. RE\/1RAE 2SH0LLDVMFY and revise here if necessary.
SW5200701
Who needs a W Central Office
copy?* r Regional Office
Central Office Reviewer:*
Corey Anen - eads\scanen
Review Date * 07/13/2020