NCG050450_Supplemental Info Review (ROS Request)_20240308

Action History (UTC-05:00)Eastern Time(US&Canada)
Submit by Anonymous User 3/8/2024 11:55:27 AM(Supplemental Submittal)
Accept by bethany.georgoulias 3/11/2024 2:45:52 PM(Supplemental Info Submittal)
• The task was assigned to Kaitlin Peck 3/8/2024 11:55:28 AM
• Kaitlin Peck reassigned the task to bethany.georgoulias 3/8/2024 1:32:18 PM

pEQNC Stormwater - Supplemental Information Upload
Submittal from 3/8/2024
Permit Information:
Please provide specific permit details below.
...................................................................................................................................................................................................................................................................................................................................................................................................
What Type of Permit? Choose one:
* 0 NPDES Industrial or MS4 Permit
0 State Stormwater(Post-Construction)Permit
Other
Permit Number* NCG050450
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)
.................................................................................................................................................................................................................................................................................................................................................................................................
Facility Name* Southern Pipe
For NPDES permits
Owner/Operator* Bryan Mitchell
County: Stanly
Submitter Name:* Mike Cato
Who is submitting this information?
E-mail Address:* [e-mail]
Phone Number* 9193095665
Additional E-mail for [e-mail]
Submittal (Optional)
Confirmation:
NPDES Permit Information Uploads
Choose file type and upload attachment(Reviewer may remove unnecessary submittals)
......................................................................................................................................................................................................................................
File Type* Representative Outfall Status Initial Request
File Upload Click the upload button,or drag and drop files to attach
SP-One outfall request-Combined File.pdf 1 AMB
Only PDF files are accepted.
..........................................................................................................
Is this project funded QQ No
with ARPA grant Q 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:
REPRESENTATIVE OUTFALL STATUS(ROS)
REQUEST FORM.Original package mailed to Mooresville Regional Office.
* 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:* Mike Cato
Signature: y�
Date Submitted: 03/08/2024

Initial Review
Verify Permit No.* IMPORTANT:REVIEWER SHOULD VERIFY and revise here if necessary.
NCG050450
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
Brittany Cook
Identify Regional Office:*
Mooresville Regional Office—704-663-1699
Any Comments or ROS Initial Request. Please be sure to enter the SW Representative Outfall Status
Added Info for CO Requested event in BIMS(received 3/8/2024)and eventually the ROS Approved or
Staff Reviewer? Denied event. If approved,the CO will need to enter a monitoring suspension and
ROS info in BIMS,so be sure to copy us on the correspondence/import into
Laserfiche.Thanks!
Select RO Stormwater Contact(s):
[e-mail]
Kicks off e-mail notification
Review Date* 03/11/2024