SW4231002_Supplemental Info Review_20231114

Action History (UTC-05:00)Eastern Time(US&Canada)
Submit by Anonymous User 11/14/2023 10:47:27 AM (Supplemental Submittal)
Accept by Kaitlin Peck 11/14/2023 12:43:01 PM(Supplemental Info Submittal)
• The task was assigned to Kaitlin Peck 11/14/2023 10:47:55 AM

=DEQ •
Submittal from 11/14/2023
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* SW4231002
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* Dollar Tree-Welcome, NC(Davidson)
Owner/Operator* Barnes Boykin
County: Davidson
Submitter Name:* Joshua Crumpler
Who is submitting this information?
E-mail Address:* [e-mail]
Phone Number* 9194131704
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* Application Form
File Upload Click the upload button,or drag and drop files to attach
Dollar Tree-Welcome-SSW-SWU-1 01-Application- 343.97KB
DEMLR-SPU Oct 2013.pdf
Only PDF files are accepted.
File Type* USGS Topographic Site Map
File Upload Click the upload button,or drag and drop files to attach
UGSG.pdf 211.57KB
Only PDF files are accepted.

File Type* O&M Agreement/Plan
File Upload Click the upload button,or drag and drop files to attach
0-M-EZ-20201215-2.1-Combined.pdf 601.32KB
Only PDF files are accepted.
File Type* Supplement-EZ Form
File Upload Click the upload button,or drag and drop files to attach
S u p p E Z-2020-Version-2.1.3-20201203-D E M L R-S W-
656.56K6
Combined.pdf
Only PDF files are accepted.
File Type* Stormwater Report
File Upload Click the upload button,or drag and drop files to attach
2023-10-16 Dollar Tree-Welcom Stormwater
1.99MB
Report.pdf
Only PDF files are accepted.
File Type* Development Agreement
File Upload Click the upload button,or drag and drop files to attach
Dollar Tree-Welcome-Contract Final Signed
474.79KB
Redacted.pdf
Only PDF files are accepted.
File Type* Lease Agreement
File Upload Click the upload button,or drag and drop files to attach
Dollar Tree-Welcome-Property Consent.pdf 227.88KB
Only PDF files are accepted.
File Type* Soils/Geotechnical Report
File Upload Click the upload button,or drag and drop files to attach
Crumpler Engineering-Dollar Tree 5744 Old US
Highway 52 Welcome NC BMP soils inspection 389.33KB
Davidson Co Final(2023).pdf
Only PDF files are accepted.
File Type* Stormwater Narrative
File Upload Click the upload button,or drag and drop files to attach
Dollar Tree Welcome SW Narrative.pdf 83.73KB
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
2023-10-16_Welcome_Sealed Site Plans.pdf 4.32MB
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:
* 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:* Joshua Crumpler
Signature:
.rP-Q/V.4 C�uArLs�-
Date Submitted: 11/14/2023

Initial Review
Verify Permit No.* IMPORTANT:REVIEWER SHOULD VERIFY and revise here if necessary.
SW4231002
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
Brianna Holland
Any Comments or
Added Info for CO
Staff Reviewer?
Review Date* 11/14/2023