SW6220802_Supplemental Info Review_20230217

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 2/17/2023 10:18:46 AM (Supplemental Submittal)
Submit by bethany.georgoulias 2/27/2023 10:51:49 AM (Supplemental Info Submittal)
• The task was assigned to bethany.georgoulias 2/17/2023 10:18:55 AM

Submittal from 2/17/2023
Permit Information:
Please Drovide sDecific Dermit 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 Ankit K. Patel , Member 210 Weaver Forest Way Morrisville,
N.C. 27560
County: Harnett
Submitter Name:* Johnny Glenn Tew P.E. ECLS Global Inc. 19 North Mckinley Street Coats, N.C.
27521
Who is submitting this information?
E-mail Address:*
Phone Number*
Additional E-mail for
Submittal
Confirmation:
[e-mail]
910-897-3257 Ext. 105
(Optional)
State Stormwater (Post -Construction) Information Uploads
Choose file type and upload attachment (Reviewer may remove unnecessary submittals)
File Type* Plansheet - Other

File Upload Click the upload button, or drag and drop files to attach
Champs sh.#8 latest rev. 2-10-23 sealed plan.pdf
3.31 MB
Champs sh.3 latest rev. 11-10-22.pdf
3.11 MB
Champs sh.4 latest rev. 11-10-22.pdf
4.83MB
Champs sh.5 latest rev. 11-10-22.pdf
4.16MB
Champs sh.6 latest rev. 11-10-22.pdf
3.34MB
Champs sh.11 latest rev. 11-10-22.pdf
4.99MB
Champs sh.13 latest rev. 11-10-22.pdf
4.41MB
Only PDF files are accepted.
File Type* Response To Comments
File Upload Click the upload button, or drag and drop files to attach
Champs #3 Transmittal.pdf 41.85KB
#2 Champs summary letter.pdf 2.68MB
Only PDF files are accepted.
File Type* Supplement-EZ Form
File Upload Click the upload button, or drag and drop files to attach
Champs #3 Supplement- sealed 2-10-2023.pdf 161.24KB
Champs #2 Supplement -sealed.pdf 1.45MB
Only PDF files are accepted.
File Type* Application Form
File Upload Click the upload button, or drag and drop files to attach
Champs #3 Application signed 2-13-2023.pdf 301.44KB
#2 Champs App..pdf 295.69KB
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 #3 O & M signed 2-13-2023.pdf 56.74KB
Only PDF files are accepted.
File Type* Design Calculations
File Upload Click the upload button, or drag and drop files to attach
#3 Champs Swale Calcs - sealed 2-10-2023.pdf 408.43KB
Champs 2nd sub. pre-dev. sealed 11-10-22.pdf 1.87MB
Champs 2nd sub. post-dev.bypass sealed 11-10-
1.93M6
22.pdf
Champs 2nd sub. post-dev. thru storage sealed 11-
5.46M6
10-22. pdf
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:
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:* Johnny Glenn Tew
Signature:
(/OY OA x C�,-Irw Pit'11
Date Submitted: 02/17/2023

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* 02/27/2023