SW4231001_Supplemental Info Review_20240417

Action History (UTC-05:00)Eastern Time(US&Canada)
Submit by Anonymous User 4/17/2024 11:24:36 AM(Supplemental Submittal)
Accept by Kaitlin Peck 4/17/2024 2:06:02 PM(Supplemental Info Submittal)
• The task was assigned to DEMLR Post-Construction Team 4/17/2024 11:24:39 AM
• The task was assigned to Kaitlin Peck by round robin distribution 4/17/2024 11:24:39 AM

=DEQ •
Submittal from 4/17/2024
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* SW4231001
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* Word of Life
Owner/Operator* Bruce Henry,Sr.
County: Forsyth
Submitter Name:* Steve Causey
Who is submitting this information?
E-mail Address:* [e-mail]
Phone Number* 3367652377
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* Plansheet-Proposed Conditions/Site Plan
File Upload Click the upload button,or drag and drop files to attach
SWM 2.pdf 619.09KB
Only PDF files are accepted.
File Type* Plansheet-Misc. Detail
File Upload Click the upload button,or drag and drop files to attach
SWM 5.pdf 731.5KB
Only PDF files are accepted.
File Type* Supplement-EZ Form

File Upload Click the upload button,or drag and drop files to attach
SUPP EZ REVISED DRAINAGE AREA PAGE.pdf 82.24KB
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:
Hard copies will be sent to the address given on the email that provided comments.
* 0 By checking the box and signing box below, I certify that:
cl I have given true,accurate,and complete information on this form;
d 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');
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:* Steve Causey
Signature:
Date Submitted: 04/17/2024

Initial Review
Verify Permit No.* IMPORTANT:REVIEWER SHOULD VERIFY and revise here if necessary.
SW4231001
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* 04/17/2024