SW4240501_Supplemental Info Review_20241121

Action History (UTC-05:00)Eastern Time(US&Canada)
Submit by Anonymous User 11/21/2024 12:08:44 PM (Supplemental Submittal)
Accept by Jacob Beeker 11/21/2024 1:59:14 PM(Supplemental Info Submittal)
• The task was assigned to DEMLR Post-Construction Team 11/21/2024 12:08:46 PM
• Jacob Beeker assigned the task to Jacob Beeker 11/21/2024 1:58:51 PM

=DEQ •
Submittal from 11/21/2024
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* SW4240501
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* Reserve at Old Hollow
Owner/Operator* YP Walkertown, LLC
County: Forsyth
Submitter Name:* Hugh Creed Associates, Inc., P.A.
Who is submitting this information?
E-mail Address:* [e-mail]
Phone Number* 3362759826
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* Property Deed
File Upload Click the upload button,or drag and drop files to attach
000-DB 3788 PG 1168.pdf 607.14KB
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
Deed Res Cov_signed.pdf 2.82MB
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_75M in uteTopo_20240304_202656787000_TM... 54.8M B
Only PDF files are accepted.
File Type* Application Form
File Upload Click the upload button,or drag and drop files to attach
Reserve at Old Hollow_Application.pdf 8.35MB
Only PDF files are accepted.
File Type* O&M Agreement/Plan
File Upload Click the upload button,or drag and drop files to attach
OM EZ.pdf 36.12KB
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
YP Walkertown LLC Annual Report.pdf 11.52KB
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:
We do not have scanned copy of O&M EZ form, blank form uploaded with correct information.
* By checking the box and signing box below, I certify that:
o 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');
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:* Dalton Ward
Signature:
011lW ve�lLtll'
Date Submitted: 11/21/2024

Initial Review
Verify Permit No.* IMPORTANT:REVIEWER SHOULD VERIFY and revise here if necessary.
SW4240501
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* 11/21/2024