SW4200902_Supplemental Info Review_20210412

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 4/12/2021 9:37:11 AM (Supplemental Submittal)
Submit by McCoy, Suzanne 4/12/2021 3:34:37 PM (Supplemental Info Submittal)
• The task was assigned to McCoy, Suzanne 4/12/2021 9:38 AM

Submittal Dated: 4/12/2021
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 N irrber
SW4200902
Exarrples: SWxxxxxxx, NC Gxxxxxx, or NCSxxxxxx
Facility Name:* Miller's Reserve
County: Forsyth
Name: Lee Bryant
Vft is subrritting the inforr ation?
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
Miller's Reserve Phase 2-4 Construction Drawings 3-
50.38M6
22-21.pdf
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, pernits, effluent data, infornation required by MODES application forr s provided by
the Director inclusive of all fours and attachments [Ref. 40 CFR 122.7(b) and (c)].
Describe the attachments:
Permit has already been issued for this project no modification have been made. As requested I've uploaded the full
construction set for Phase 2-4 of this project.
* Pr 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:* Lee Bryant
Signature:
w oar
Date Submitted: 04/12/2021

Initial Review
Updated ID#: WFORfANT. REV1RAERSH0LLDVMFY and revise here if necessary.
SW4200902
Who needs a W Central Office
copy?* r Regional Office
Central Office Reviewer:*
Corey Anen - eads\scanen
Review Date * 04/12/2021