SW6201004_Supplemental Info Review_20201008

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 10/8/2020 9:25:18 AM (Supplemental Submittal)
Submit by McCoy, Suzanne 10/8/2020 10:30:12 AM (Supplemental Info Submittal)
• The task was assigned to McCoy, Suzanne 10/8/2020 9:25 AM

Submittal Dated: 10/8/2020
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
SW6201004
Examples: SWxxxxxxx, NC Gxxxxxx, or NCSxxxxxx
Facility Name:* Blackhawk Landing
County: Hoke
Name: Lee Humphrey
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
Blackhawk Landing 9.24.2020.pdf 8.56MB
Deed Restrictions. pdf 738.16KB
O&M Agreement.pdf 1.18MB
Stormwater report.pdf 4.58MB
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 perrrit applicant or
perrrittee, perrrit applications, permits, effluent data, infornation required by NR7ES application forms provided by
the Director inclusive of all forms and attachments [Ref. 40 CFR 122.7(b) and (c)].
Describe the attachments:
Please find the project files requested for the proposed Blackhawk Landing Project.
* 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:* Lee Humphrey
Signature:
Date Submitted: 10/08/2020

Initial Review
Updated ID#: IWORfANT. RE\/1RAE 2SH0LLDVMFY and revise here if necessary.
SW6201004
Who needs a W Central Office
copy?* r Regional Office
Central Office Reviewer:*
Jim Farkas - eads\jjfarkas
Review Date * 10/08/2020