SW6240701_Supplemental Info Review_20240716

Action History (UTC-05:00)Eastern Time(US&Canada)
Submit by Anonymous User 7/16/2024 12:20:28 PM (Supplemental Submittal)
Accept by bethany.georgoulias 7/18/2024 7:30:27 AM (Supplemental Info Submittal)
• The task was assigned to DEMLR Post-Construction Team 7/16/2024 12:20:29 PM
• bethany.georgoulias reassigned the task to bethany.georgoulias 7/17/2024 3:57:44 PM

=DEQ •
Submittal from 7/16/2024
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* SW6240701
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* McDonald's @ Hoke Landing
Owner/Operator* McDonald's USA LLC
County: Hoke
Submitter Name:* Brian Soltz
Who is submitting this information?
E-mail Address:* [e-mail]
Phone Number* 9198486121
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
1 a-Stormwater Management Permit Application
3.14MB
Form.pdf
Only PDF files are accepted.
File Type* Deed Restriction/Protective Covenant Form
File Upload Click the upload button,or drag and drop files to attach
2-Deed Restrictions&Protective Covenants.pdf 181.04KB
Only PDF files are accepted.

File Type* Lease Agreement
File Upload Click the upload button,or drag and drop files to attach
1 b-Certificate of Lease.pdf 407.11 KB
Only PDF files are accepted.
File Type* Plansheet-Other
File Upload Click the upload button,or drag and drop files to attach
32-1742 Raeford—NC-Civil Plans.pdf 32.79MB
Only PDF files are accepted.
File Type* Property Deed
File Upload Click the upload button,or drag and drop files to attach
10-Current Deed DB 1282 PG 560.pdf 152.19KB
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
11 b-SECRETARY'S CERT-McDonald's USA LLC
207.52KB
(January 2023).pdf
11a-NC Secretary of State Info.pdf 63.92KB
Only PDF files are accepted.
File Type* Stormwater Narrative
File Upload Click the upload button,or drag and drop files to attach
6-Narrative.pdf 180.27KB
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-
924.15KB
SEALED.pdf
Only PDF files are accepted.
File Type* Supplement Form-Offsite
File Upload Click the upload button,or drag and drop files to attach
3-Notarized Supplement Form(Off-Site System).pdf 740.33KB
Only PDF files are accepted.
File Type* USGS Topographic Site Map
File Upload Click the upload button,or drag and drop files to attach
7-USGS Map.pdf 10.52MB
Only PDF files are accepted.
File Type* Soils/Geotechnical Report
File Upload Click the upload button,or drag and drop files to attach
Soil_Map.pdf 613.99KB
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:
Per email dated 7-12-24 from Lawyer, Mike [e-mail] this project has been determined to be
administratively complete post-construction stormwater permit application for the subject project on 7-2-24. Please
accept these attachments of all items as previously submitted in hard copy format.
* 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');
• I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written
signature;AND
• I intend to electronically sign and submit the Supplemental Information Upload form.
Full Name:* Brian Soltz
Signature: /�
4 t4m,C5W/:.7
Date Submitted: 07/16/2024

Initial Review
Verify Permit No.* IMPORTANT:REVIEWER SHOULD VERIFY and revise here if necessary.
SW6240701
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* 07/18/2024