SW6211203_Supplemental Info Review_20211227 (2)

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 12/27/2021 2:47:12 PM (Supplemental Submittal)
Submit by Georgoulias, Bethany A 12/29/2021 12:09:10 PM (Supplemental Info Submittal)
• Georgoulias, Bethany A reassigned the task to Georgoulias, Bethany A 12/28/2021 3:36 PM
• The task was assigned to McCoy, Suzanne 12/27/2021 2:47 PM

Submittal from 12/27/2021
Permit Information:
Please provide specific hermit details below.
What Type of Permit?
Choose one:
*
NPDES Industrial or MS4 Permit
• State Stormwater (Post -Construction) Permit
Other
Permit Number*
SW6211203
Begins with "SW", "NCG", or "NCS'
What DEQ Office is
Reviewer: Please correct if misidentified, close this review form, and reassign task to the appropriate contact.
the Primary Contact?
• Central Office
*
Washington Regional Office (Attn: Carl Dunn)
Wilmington Regional Office (Attn: Christine Hall)
Project Name* McCain Gas Station
Owner/Operator*
211 Shopping Center, LLC
County:
Hoke
Submitter Name: *
Lee Humphrey
Who is submitting this information?
E-mail Address:*
[e-mail]
Phone Number*
910-684-8646
Additional E-mail for (Optional)
Submittal
Confirmation:
State Stormwater (Post -Construction) Information Uploads
Choose file type and upload attachment (Reviewer may remove unnecessary submittals)
File Type* Plansheet - Cover Sheet
File Upload Click the upload button, or drag and drop files to attach
McCain Gas Station Cover - Revised.pdf 1.86MB
Only PDF files are accepted.
File Type* Plansheet - Grading/Drainage Plan
File Upload Click the upload button, or drag and drop files to attach
McCain Gas Station - C3 Grading.pdf 3.46MB
Only PDF files are accepted.

Uploads contain NO
Confidential YES
Information* NOTE: The following information cannot be claimed as confidential: the name and address of any permit applicant
or permittee, permit applications, permits, effluent data, information required by NPDES application forms provided
by the Director inclusive of all forms and attachments [Ref. 40 CFR 122.7(b) and (c)].
Notes about the attachments:
We found an error on the cover sheet and are submitting the revision. The grading plan is now included.
* 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
• I intend to electronically sign and submit the Supplemental Information Upload form.
Full Name:* Lee Humphrey
Signature:
Date Submitted: 12/27/2021

Initial Review
Verify Permit No.* IMPORTANT. REVIEWER SHOULD VERIFY and revise here if necessary.
SW6211203
Who needs a Copy?* Reviewer selections will only be required for offices checked here.
Central Office Staff
Regional Office Stormwater Contact
State Stormwater RO Staff
No Copy Needed
Central Office Reviewer:*
Notifies CO Staff with Email
Jim Farkas
Any Comments or Uploads correctly identified as State Post -construction files.
Added Info for CO
Staff Reviewer?
Review Date* 12/29/2021