SW3201201_Supplemental Info Review_20210504

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 5/4/2021 11:37:41 AM (Supplemental Submittal)
Submit by McCoy, Suzanne 5/5/2021 7:51:37 AM (Supplemental Info Submittal)
• The task was assigned to McCoy, Suzanne 5/4/2021 11:37 AM

Submittal Dated: 5/4/2021
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 Drciect.
D# * Perrrit Nurrber
SW3201201
Examples: SWxxxxxxx, NC Gxxxxxx, or NCSxxxxxx
Facility Name:* Union County Sheriff's Office
County: Union
Name: Alexander Rhode
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
9314-SuppEZ REV 3.pdf 841.39KB
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 claimed as confidential: the narre and address of any perrrit applicant or
pernittee, perrrit applications, perrrits, effluent data, information required by WCM application forms provided by
the Director inclusive of all forrrs and attachments [Ref. 40 CFR 122.7(b) and (c)].
Describe the attachments:
Attached is a revised SuppEZ form with minor issues resolved per email sent by Jim Farkas. Vegetated setback
provided, BUA values revised to capture entire site BUA as advised, and minor revision to note in Line 43 for
clarification.
* 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:* Alexander Rhode
Signature:
Date Submitted: 05/04/2021

Initial Review
Updated ID#: IWORfANT. RE\/1RAE 2SH0LLDVMFY and revise here if necessary.
SW3201201
Who needs a W Central Office
copy?* r Regional Office
Central Office Reviewer:*
Jim Farkas - eads\jjfarkas
Review Date * 05/05/2021