SWA000200_Supplemental Info Review_20230420

Action History (UTC-05:00)Eastern Time(US&Canada)
Submit by Anonymous User 4/20/2023 4:47:20 PM (Supplemental Submittal)
Submit by bethany.georgoulias 4/24/2023 7:14:34 AM (Supplemental Info Submittal)
• The task was assigned to bethany.georgoulias 4/20/2023 4:47:21 PM

=DEQ •
Submittal from 4/20/2023
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* SWA000200
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* Stapleton Subdivision Phase I and II
Owner/Operator* Clayton Properties Group, LLC
County: Forsyth
Submitter Name:* Jeremy L McCall
Who is submitting this information?
E-mail Address:* [e-mail]
Phone Number* 3336-294-9394
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
SSW Fast Track ATC Form-Signed.pdf 3.26MB
Only PDF files are accepted.
File Type* Deed Restriction/Protective Covenant Form
File Upload Click the upload button,or drag and drop files to attach
SSW-DeedRestric-LDCommer-2015061 1-DEMLR-
15.79KB
SW.pdf
Only PDF files are accepted.

File Type* Property Deed
File Upload Click the upload button,or drag and drop files to attach
PB3605-PG2757.pdf 252.73KB
PB3605-PG2762.pdf 185.5KB
PB3605-PG2902.pdf 151.27KB
Only PDF files are accepted.
File Type* Stormwater Report
File Upload Click the upload button,or drag and drop files to attach
20-058-STM NARRATIVE 2023-03-10.pdf 162.73KB
Only PDF files are accepted.
File Type* USGS Topographic Site Map
File Upload Click the upload button,or drag and drop files to attach
USGS TOPO MAP.pdf 52.34MB
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
North Carolina Secretary of State Search Results.pdf 75.68KB
Only PDF files are accepted.
File Type* Plansheet-Other
File Upload Click the upload button,or drag and drop files to attach
20-058 Stapleton PHI Stormwater 2023-03-01.pdf 7.78MB
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:
* 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:* Jeremy Lee McCall

Signature:
ln~f,eewltalw
Date Submitted: 04/20/2023

Initial Review
Verify Permit No.* IMPORTANT:REVIEWER SHOULD VERIFY and revise here if necessary.
SWA000200
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