NCG020969_Supplemental Info Review_20211012

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 10/12/2021 1:51:59 PM (Supplemental Submittal)
Submit by McCoy, Suzanne 10/12/2021 1:55:53 PM (Supplemental Info Submittal)
• The task was assigned to McCoy, Suzanne 10/12/2021 1:52 PM

Submittal from 10/12/2021
Permit Information:
Rease provide specific permit details below.
........ ......... ......... .........
What Type of Choose one:
Permit?* F NPDES Industrial or MS4 Permit
r State Stormwater (Post -Construction) Permit
f Other
Permit Number* NCG020969
Begins with "SW', "NOG', or "NOS'
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)
Facility Name * Polk Island Pit
For WD S pernits
Owner/Operator* Battleboro East Properties, LLC
County: Nash
Submitter Name:* Bartlett Engineering & Surveying, PC
VUio is submitting this information?
E-mail Address:*
Phone Number*
[e-mail]
252-399-0704
Additional E-mail for [e-mail]
Submittal (Optional)
Confirmation:
NPDES Permit Information Uploads
Choose file type and upload attachrrent (Reviewer nay rermve unnecessary subnittals)
File Type* Modification Request
File Upload Click the upload button, or drag and drop files to attach
Polk Island Mining Modification Sealed.pdf
Only RDFfiles are accepted.
Uploads contain F NO
2.05MB
Confidential r YES
Information * NOTE The following information cannot be claimed as confidential: the narre and address of any permit applicant or
perrrittee, permt applications, pernits, effluent data, information required by NR7ES application forms provided by
the Director inclusive of all forms and attachrrents [Ref. 40 CFR 122.7(b) and (c)].
Notes about the attachments:

As requested per 10/12/2021 email from Suzanne McCoy.
* 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:* Steve Oliverio
Signature:
Date Submitted: 10/12/2021

Initial Review
Verify Permit No.* I1\410RfANT. RE\/lRAE 2SHOLLDVMFY and revise here if necessary.
NCG020969
Who needs a
Reviewer selections will only be required for offices checked here.
copy? *
r% Central Office Staff
r Regional Office Stormwater Contact
State Stormwater RO Staff
r No Copy Needed
Central Office Reviewer:*
Notifies OD Staff with 5rail
Suzanne McCoy
Any Comments or
Added Info for CO
Staff Reviewer?
Review Date * 10/12/2021