SWA000102_Supplemental Info Review_20210504

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 5/4/2021 4:15:20 PM (Supplemental Submittal)
Submit by McCoy, Suzanne 5/5/2021 7:52:13 AM (Supplemental Info Submittal)
• The task was assigned to McCoy, Suzanne 5/4/2021 4:15 PM

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 urolect.
D# * Perrrit N irrber
SWA000102
Examples: Sftxxxxxx, NC Gxxxxxx, or NCSxxxxxx
Facility Name:* Hopewell Gardens
County: Forsyth
Name: Brent Sievers
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
USGS Map-Hopevvell.pdf
3.14MB
Construction Sequence.pdf
474.39KB
DB3527 PG2251_latest Deed.pdf
176.11KB
Hopewell Drainage Plan.pdf
1.32MB
North Carolina Secretary of State Results.pdf
70.73KB
SSW Fast Track ATC Form —Owner signed.pdf
520.91 KB
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, permits, effluent data, information required by MODES application forms provided by
the Director inclusive of all forms and attachments [Ref. 40 CFR 122.7(b) and (c)].
Describe the attachments:
* 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:* Brentley C. Sievers
Signature:
Date Submitted: 05/04/2021

Initial Review
Updated ID#: WFORfANT. REV1RAERSH0LLDVMFY and revise here if necessary.
SWA000102
Who needs a W Central Office
copy?* r Regional Office
Central Office Reviewer:*
Corey Anen - eads\scanen
Review Date * 05/05/2021