SW4240101_Supplemental Info Review_20240528

Action History (UTC-05:00)Eastern Time(US&Canada)
Submit by Anonymous User 5/28/2024 3:31:14 PM (Supplemental Submittal)
Accept by bethany.georgoulias 5/31/2024 1:37:06 PM (Supplemental Info Submittal)
• The task was assigned to DEMLR Post-Construction Team 5/28/2024 3:31:15 PM
• The task was assigned to bethany.georgoulias by round robin distribution 5/28/2024 3:31:15 PM

=DEQ •
Submittal from 5/28/2024
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* SW4240101
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* Lakeside Phase One
Owner/Operator* IRS Parker Homes
County: Forsyth
Submitter Name:* Norris Z. Clayton
Who is submitting this information?
E-mail Address:* [e-mail]
Phone Number* 336-275-9826
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
SSW-SWU-1 0 1-Application-DEMLR-SPU Oct 2013
77.2KB
REVISED SHEET 3.pdf
Only PDF files are accepted.
File Type* Supplement-EZ Form
File Upload Click the upload button,or drag and drop files to attach
SuppEZ-2020-Lakeside-Ph1.pdf 1.2MB
Only PDF files are accepted.

File Type* Plansheet-Existing Conditions/Survey
File Upload Click the upload button,or drag and drop files to attach
SITE19 DEQ PCS-EX.pdf 1.11MB
Only PDF files are accepted.
File Type* Plansheet-Grading/Drainage Plan
File Upload Click the upload button,or drag and drop files to attach
SITE19 DEQ PCS-PROP(1).pdf 1.63MB
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
SITE19 DEQ PCS-OVERAL(1).pdf 2.59MB
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:
d 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');
d 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:* Norris Z. Clayton
Signature:
Date Submitted: 05/28/2024

Initial Review
Verify Permit No.* IMPORTANT:REVIEWER SHOULD VERIFY and revise here if necessary.
SW4240101
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 This one is still assigned to Kaitlin Peck in BIMS.
Added Info for CO
Staff Reviewer?
Review Date* 05/31/2024