SW6220802_Supplemental Info Review_20220816

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 8/16/2022 4:55:01 PM (Supplemental Submittal)
Submit by Tran, Kieu M 8/17/2022 7:48:05 AM (Supplemental Info Submittal)
• The task was assigned to Tran, Kieu M 8/16/2022 4:55 PM

Submittal from 8/16/2022
Permit Information:
Please provide specific permit details below.
What Type of Permit?
Choose one:
*
NPDES Industrial or MS4 Permit
• State Stormwater (Post -Construction) Permit
Other
Permit Number*
SW6220802
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* Champs Convenience Store
Owner/Operator*
Jay Ambe Shakti LLC
County:
Harnett
Submitter Name: *
Johnny Glenn Tew
Who is submitting this information?
E-mail Address:*
[e-mail]
Phone Number*
910-897-3257 Ext. 105
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
Champs #1 signed 6-10-2022.pdf 4.05MB
Only PDF files are accepted.
File Type*
Plansheet - Existing Conditions/Survey
File Upload
Click the upload button, or drag and drop files to attach
Champs #2 signed 6-10-2022.pdf 2.23MB
.........
Only PDF files are accepted.
......... .........
File Type*
Plansheet - Proposed Conditions/Site Plan

File Upload
Click the upload button, or drag and drop files to attach
Champs #3 signed 6-10-2022.pdf
3.09MB
Only PDF files are accepted.
File Type*
Plansheet - Grading/Drainage Plan
File Upload
Click the upload button, or drag and drop files to attach
Champs #4 signed 6-10-2022.pdf
4.76MB
Only PDF files are accepted.
File Type*
Plansheet - Other
File Upload
Click the upload button, or drag and drop files to attach
Champs #5 signed 6-10-2022.pdf
3.98MB
Only PDF files are accepted.
File Type*
Plansheet - Other
File Upload
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Champs #6 signed 6-10-2022.pdf
3.12MB
.................................................
Only PDF files are accepted.
File Type*
Plansheet - Other
File Upload
Click the upload button, or drag and drop files to attach
Champs #7 signed 6-10-2022.pdf
2.53MB
.....................................................................................................................................
Only PDF files are accepted.
File Type*
Plansheet - Other
File Upload
Click the upload button, or drag and drop files to attach
Champs #8 signed 6-10-2022.pdf
3.29MB
Only PDF files are accepted.
File Type*
Plansheet - Other
File Upload
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Champs #9 signed 6-10-2022.pdf
2.15MB
.........
Only PDF files are accepted.
......... ......... .........
File Type*
Plansheet - Misc. Detail
File Upload
Click the upload button, or drag and drop files to attach
Champs #10 signed 6-10-2022.pdf
4.09MB
Only PDF files are accepted.
File Type*
Plansheet - Notes
File Upload
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Champs #11 signed 6-10-2022.pdf
4.36MB
Only PDF files are accepted.
File Type*
Plansheet - Misc. Detail
File Upload
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Champs #12 signed 6-10-2022.pdf
2.1 MB
Only PDF files are accepted.
File Type*
Plansheet - SCM Detail

File Upload
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Champs #13 signed 6-10-2022.pdf
4.25MB
Only PDF files are accepted.
File Type*
Plansheet - Misc. Detail
File Upload
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Champs #14 signed 6-10-2022.pdf
3.61 MB
Only PDF files are accepted.
File Type*
Plansheet - Landscape/Planting Plan
File Upload
Click the upload button, or drag and drop files to attach
Champs #15 signed 6-10-2022.pdf
3.76MB
..........................................................................
Only PDF files are accepted.
File Type*
Plansheet - Landscape/Planting Plan
File Upload
Click the upload button, or drag and drop files to attach
Champs #16 signed 6-10-2022.pdf
2.99MB
Only PDF files are accepted.
File Type*
Application Form
File Upload
Click the upload button, or drag and drop files to attach
Champs Stormwater App.-signed.pdf
295.69KB
Only PDF files are accepted.
File Type*
Supplement-EZ Form
File Upload
Click the upload button, or drag and drop files to attach
Champs EZ Supplement - Sealed 7-27-22.pdf
156.38KB
Only PDF files are accepted.
File Type*
O&M Agreement/Plan
File Upload
Click the upload button, or drag and drop files to attach
Champs -O&M signed.pdf
132.09KB
Only PDF files are accepted.
File Type*
Design Calculations
File Upload
Click the upload button, or drag and drop files to attach
Champs ( Stormwater Statement - Sealed 6-13-
1.48MB
2022).pdf
Only PDF files are accepted.
File Type*
Soils/Geotechnical Report
File Upload
Click the upload button, or drag and drop files to attach
Champs SHWT & Infiltration Rate Report.pdf
55.43KB
Only PDF files are accepted.
.........................................................
File Type*
Property Deed
File Upload
Click the upload button, or drag and drop files to attach
Champs Deed.pdf
72.58KB
Only PDF files are accepted.

File Type* Signing Official Title & Position Information
File Upload Click the upload button, or drag and drop files to attach
Champs Sec.State.pdf 20.52KB
Only PDF files are accepted.
File Type* Response To Comments
File Upload Click the upload button, or drag and drop files to attach
Champs - UIC Notification Form- signed.pdf 97.54KB
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:
* By checking the box and signing box below, I certify that:
• 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 Genera[ 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:* Johnny Glenn Tew
Signature:
Date Submitted: 08/16/2022

Initial Review
Verify Permit No.* IMPORTANT. REVIEWER SHOULD VERIFY and revise here if necessary.
SW6220802
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
Added Info for CO
Staff Reviewer?
Review Date* 08/17/2022