SWA000098_Supplemental Info Review_20210728 (2)

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 7/28/2021 2:59:03 PM (Supplemental Submittal)
Submit by McCoy, Suzanne 7/29/2021 8:17:24 AM (Supplemental Info Submittal)
• The task was assigned to McCoy, Suzanne 7/28/2021 2:59 PM

Submittal from 7/28/2021
Permit Information:
Rease provide specific permit details below.
........ ......... ......... .........
What Type of Choose one:
Permit?* r NPDES Industrial or MS4 Permit
r State Stormwater (Post -Construction) Permit
f Other
Permit Number* SWA000098
Begins with "SW', "NCG', or "NCS'
What DEQ Office is Reviewer: Rease correct if nisidentlfied, close this review forrn and reassign taskto the appropriate contact.
the Primary r Central Office
Contact?* r Washington Regional Office (Attn: Carl Dunn)
f Wilmington Regional Office (Attn: Christine Hall)
Project Name* Wesley Chapel VFD
Owner/Operator* Wesley Chapel Fire Department, Inc
County: Union
Submitter Name:* Brian Crutchfield
Vft is submitting this information?
E-mail Address:* [e-mail]
Phone Number* 7043761073
Additional E-mail for (Optional)
Submittal
Confirmation:
State Stormwater (Post -Construction) Information Uploads
Choose file type and upload attachrrent (Reviewer nay rerrove unnecessary submittals)
File Type* Application Form
File Upload Clickthe upload button, or drag and drop files to attach
Wesley Chapel VFD Sta. 44 - NCDEQ Stormwater
501.36KB
Fast Track ATC (Signed).pdf
Only PDF files are accepted.
Uploads contain r NO
Confidential r YES
Information * NOTE The following information cannot be claimed as confidential: the name and address of any permt applicant or
permittee, permit applications, permits, effluent data, information required by WDM application forms provided by
the Director inclusive of all forrrs and attachments [Ref. 40 CFR 122.7(b) and (c)].

Notes about the attachments:
Supplemental information requested by Jim Farkas
* P By checking the box and signing box below, I certify that:
o I have given true, accurate, and complete information on this form;
o 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');
o 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 Upload form.
Full Name:* Brian V. Crutchfield
Signature:
Date Submitted: 07/28/2021

Initial Review
Verify Permit No.* INRORfANT. RE\/lRAE 2SHOLLDVMFY and revise here if necessary.
SWA000098
Who needs a Reviewer selections will only be required for offices checked here.
copy? * rJ Central Office Staff
r Regional Office Stormwater Contact
State Stormwater RO Staff
r No Copy Needed
Central Office Reviewer:*
Notifies OD Staff with 5rail
Jim Farkas
Any Comments or
Added Info for CO
Staff Reviewer?
Review Date * 07/29/2021