SWA000221_Supplemental Info Review_20230907

Action History (UTC-05:00)Eastern Time(US&Canada)
Submit by Anonymous User 9/7/2023 1:01:46 PM(Supplemental Submittal)
Accept by Kaitlin Peck 9/8/2023 8:55:26 AM (Supplemental Info Submittal)
• The task was assigned to Kaitlin Peck 9/7/2023 1:01:47 PM

=DEQ •
Submittal from 9/7/2023
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* SWA000221
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* Brookside Christian Academy
Owner/Operator* Brookside Christian Academy
County: Harnett
Submitter Name:* Fleet Temple
Who is submitting this information?
E-mail Address:* [e-mail]
Phone Number* 9106582446
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
Revised S2 Stormwater Application.pdf 67.4KB
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 44.82KB
Only PDF files are accepted.

Is this project funded No
with ARPA grant Yes
funds?*
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:
Revised S2 of Stormwater Application
LLC information from SOS webpage
* 0 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');
cl 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:* Peter Temple
Signature:
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Date Submitted: 09/07/2023

Initial Review
Verify Permit No.* IMPORTANT:REVIEWER SHOULD VERIFY and revise here if necessary.
SWA000221
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* 09/08/2023