SW4200901_Supplemental Info Review_20200914

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 9/14/2020 4:11:22 PM (Supplemental Submittal)
Submit by Gwinn, Matt 9/17/2020 2:46:32 PM (Supplemental Info Submittal)
• The task was assigned to Gwinn, Matt 9/14/2020 4:12 PM

Submittal Dated: 9/14/2020
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 Drolect.
D# * Perait N irrber
SW4200901
Examples: SWxxxxxxx, NC Gxxxxxx, or NCSxxxxxx
Facility Name:* Project optic
County: Rockingham
Name: Jacob Moore
Vft is subrritting the inforrration?
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
NRCS Soils Report.pdf
956.09KB
Sealed - SuppEZ-2018-Version-2.1.1-2-.pdf
73.05KB
Signed O&M.pdf
301.66KB
Signed Permit.pdf
614.47KB
Project Optic Calc Book 08.31.20.pdf
3.12MB
Project Optic FINAL Geotech.pdf
10.65MB
Project Optic Approved TRC Set - 8-31-20.pdf
43.49MB
Project Optic Stormwater Narrative.pdf
97.8KB
USGS Map.pdf
1.09MB
DB 1552 PG 1553.pdf
582.82KB
Project Optic Permission Letter 1.pdf
434.8KB
Project Optic Permission Letter 2.pdf
292.27KB
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 pernit applicant or
perrrittee, perrrit applications, permits, effluent data, inforrretion required by MODES application forrrs provided by
the Director inclusive of all forms and attachments [Ref. 40 CFR 122.7(b) and (c)].

Describe the attachments:
Please find the attached PDF versions of the documents submitted.
* 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');
o 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:* Jacob Samuel Moore
Signature:
Date Submitted: 09/14/2020

Initial Review
Updated ID#: WFORfANT. REV1RAERSH0LLDVMFY and revise here if necessary.
SW4200901
Who needs a W Central Office
copy?* r Regional Office
Central Office Reviewer:*
Corey Anen - eads\scanen
Review Date * 09/17/2020