SWA000198_Supplemental Info Review_20230419

Action History (UTC-05:00)Eastern Time(US&Canada)
Submit by Anonymous User 4/19/2023 11:08:58 PM (Supplemental Submittal)
Submit by bethany.georgoulias 4/24/2023 7:10:18 AM (Supplemental Info Submittal)
• The task was assigned to bethany.georgoulias 4/19/2023 11:08:59 PM

=DEQ •
Submittal from 4/19/2023
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* SWA000198
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* Rehobeth Flex Space
Owner/Operator* Rehobeth Business Park LLC
County: Union
Submitter Name:* Richard L. Modlin
Who is submitting this information?
E-mail Address:* [e-mail]
Phone Number* 980.322.4191
Additional E-mail for [e-mail]
Submittal (Optional)
Confirmation:
State Stormwater (Post-Construction) Information Uploads
Choose file type and upload attachment(Reviewer may remove unnecessary submittals)
File Type* Application Form
File Upload Click the upload button,or drag and drop files to attach
1 SSW Fast Track ATC Form_20180210 FINAL.PDF 310.49KB
Only PDF files are accepted.
File Type* USGS Topographic Site Map
File Upload Click the upload button,or drag and drop files to attach
2 USGS Maps.pdf 2.66MB
Only PDF files are accepted.
File Type* Construction Sequence

File Upload Click the upload button,or drag and drop files to attach
3 Construction Sequence.pdf 127.13KB
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
4 Rehobeth Flex Space 032123-SP-1 NCDEQ SITE
704.08K6
PLAN.pdf
Only PDF files are accepted.
File Type* Property Deed
File Upload Click the upload button,or drag and drop files to attach
5208 Rehobeth Road Recorded Deed-20221011.pdf 148.82KB
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
6 NC Secretary of State Documentation.pdf 598.88KB
Only PDF files are accepted.
Is this project funded No
with ARPA grant Yes
funds? This question was added 3/19/2023 and will not be answered on submissions prior to that date.Reviewer may
update if known.
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:
* 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:* Richard L. Modlin
Signature:
Date Submitted: 04/19/2023

Initial Review
Verify Permit No.* IMPORTANT:REVIEWER SHOULD VERIFY and revise here if necessary.
SWA000198
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* 04/24/2023