SW3210402_Supplemental Info Review_20210426

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 4/26/2021 1:22:24 PM (Supplemental Submittal)
Submit by McCoy, Suzanne 4/27/2021 8:28:12 AM (Supplemental Info Submittal)
• The task was assigned to McCoy, Suzanne 4/26/2021 1:23 PM

Submittal Dated: 4/26/2021
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# * Perait Nurrber
SW3210402
Samples: SWxxxxxxx, NC Gxxxxxx, or NCSxxxxxx
Facility Name:* Cuthbertson Tovnhomes
County: Union
Name: Marc Van Dine
Vft is subrritting the inforrretion?
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
O&M EZ Form.pdf 274.02KB
Recorded Deed - 6.045 Acres.pdf 209.5KB
Recorded Deed 38.315 Acres B7931 P0484.pdf 332.23KB
SuppEZ-2018-Version-2.1.1 (1).pdf 163.54KB
SSW-SWU-1 01 -Application- DEML R-SPU Oct
343.25K6
2013.pdf
SSW-DeedRestric-HDResid-2015061 1 -DEMLR-
159.83KB
SW.pdf
2021-04-14 - Cuthbertson Townhomes - UCPW - 1st
23.98MB
Submittal.pdf
2021-04-14 - Cuthbertson Townhomes - 1st
68.59MB
Submittal.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 inforrretion cannot be clairred as confidential: the narre and address of any pernit applicant or
perrrittee, perrrit applications, permits, effluent data, inforrretion required by NR7ES application forrrs provided by
the Director inclusive of all forms and attachments [Ref. 40 CFR 122.7(b) and (c)].

Describe the attachments:
UCPW Water/Sewer Plans
CD Set
Recorded Deed(s)
High Density Deed Restriction Form
Supp EZ
O&M Agreement
SW Application
* 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')
o 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:* Marc Van Dine
Signature:
qiG cyan Oct:
Date Submitted: 04/26/2021

Initial Review
Updated ID#: IWORfANT. RE\/1RAE 2SH0LLDVMFY and revise here if necessary.
SW3210402
Who needs a W Central Office
copy?* r Regional Office
Central Office Reviewer:*
Corey Anen - eads\scanen
Review Date * 04/27/2021