SW6240802_Supplemental Info Review_20240905

Action History (UTC-05:00)Eastern Time(US&Canada)
Submit by Anonymous User 9/5/2024 4:19:35 PM(Supplemental Submittal)
Accept by bethany.georgoulias 9/11/2024 8:29:48 AM(Supplemental Info Submittal)
• The task was assigned to DEMLR Post-Construction Team 9/5/2024 4:19:36 PM
• bethany.georgoulias reassigned the task to bethany.georgoulias 9/11/2024 8:24:41 AM

=DEQ •
Submittal from 9/5/2024
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* SW6240802
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* Broadway Crossing
Owner/Operator* Raccoon Path Holdings, LLC.
County: Harnett
Submitter Name:* Ryan Wadsworth
Who is submitting this information?
E-mail Address:* [e-mail]
Phone Number* 9198664516
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
SSW-SWU-1 0 1-Application-DEMLR-SPU Oct 2013-
696.37KB
Signed.pdf
Only PDF files are accepted.
File Type* Stormwater Report
File Upload Click the upload button,or drag and drop files to attach
20240725 Broadway Crossing Stormwater
25.8M6
Report.pdf
Only PDF files are accepted.

File Type* Property Deed
File Upload Click the upload button,or drag and drop files to attach
DEED 1.pdf 406.73KB
DEED 2.pdf 406.73KB
DEED 3.pdf 406.73KB
DEED 4.pdf 406.73KB
DEED 5.pdf 406.73KB
DEED 6.pdf 406.73KB
DEED 7.pdf 406.73KB
DEED 8.pdf 406.73KB
DEED 9.pdf 406.73KB
DEED 10.pdf 406.73KB
DEED 11.pdf 406.73KB
Only PDF files are accepted.
File Type* USGS Topographic Site Map
File Upload Click the upload button,or drag and drop files to attach
NC_Broadway_20220817_TM_geo.pdf 45.8M B
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--3-1 -Signed.pdf 188.92KB
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
SSW-DeedRestric-LDResid-20150611-DEMLR-SW-
102.05KB
Signed.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-Version-2.1.3-20201203-DEMLR-SW-
254.08KB
Signed.pdf
Only PDF files are accepted.
File Type* Soils/Geotechnical Report
File Upload Click the upload button,or drag and drop files to attach
UI_Contour-Soils.pdf 4.62MB
UI_Soils.pdf 2.98MB
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
NCSOS.pdf 60.74KB
Only PDF files are accepted.

File Type* Plansheet-Cover Sheet
File Upload Click the upload button,or drag and drop files to attach
Coversheet.pdf 1.43MB
Only PDF files are accepted.
File Type* Plansheet-Notes
File Upload Click the upload button,or drag and drop files to attach
notes.pdf 3.73M B
Only PDF files are accepted.
File Type* Plansheet-Existing Conditions/Survey
File Upload Click the upload button,or drag and drop files to attach
Existing conditions.pdf 4.28MB
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
Proposed Site plan.pdf 14.69MB
Only PDF files are accepted.
File Type* Plansheet-Grading/Drainage Plan
File Upload Click the upload button,or drag and drop files to attach
Grading Plan.pdf 8.14MB
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;
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)
cl 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:* John Ryan Wadsworth

Signature:
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Date Submitted: 09/05/2024

Initial Review
Verify Permit No.* IMPORTANT:REVIEWER SHOULD VERIFY and revise here if necessary.
SW6240802
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
Jacob Beeker
Any Comments or
Added Info for CO
Staff Reviewer?
Review Date* 09/11/2024