SW4231001_Supplemental Info Review_20231023

Action History (UTC-05:00)Eastern Time(US&Canada)
Submit by Anonymous User 10/23/2023 8:20:51 AM (Supplemental Submittal)
Accept by Kaitlin Peck 10/23/2023 8:27:58 AM (Supplemental Info Submittal)
• The task was assigned to Kaitlin Peck 10/23/2023 8:20:52 AM

DEQ •
Submittal from 10/23/2023
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 S. 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* Application Form
File Upload Click the upload button,or drag and drop files to attach
stormwater permit app_SIGNED_WordOfLife.pdf 1.59MB
Only PDF files are accepted.
File Type* O&M Agreement/Plan
File Upload Click the upload button,or drag and drop files to attach
O&M Agree&Bioretention_SIGNED_WordOfLife.pdf 546.69KB
Only PDF files are accepted.
File Type* Property Deed

File Upload Click the upload button,or drag and drop files to attach
Deed_Bk3448 Pg681_WordOf Life.pdf 157.78KB
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 and Forms_SIGNED_WordOfLife.pdf 513.66KB
Only PDF files are accepted.
File Type* Stormwater Narrative
File Upload Click the upload button,or drag and drop files to attach
stormwater narrative&calculations_WordOf Life.pdf 3.51 MB
Only PDF files are accepted.
File Type* USGS Topographic Site Map
File Upload Click the upload button,or drag and drop files to attach
USGS Topo location Map_WordOfLife.pdf 6.26MB
Only PDF files are accepted.
File Type* Plansheet-Existing Conditions/Survey
File Upload Click the upload button,or drag and drop files to attach
SWM 1.pdf 217.79KB
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
SWM 2.pdf 629.53KB
Only PDF files are accepted.
File Type* Plansheet-Grading/Drainage Plan
File Upload Click the upload button,or drag and drop files to attach
SWM 3.pdf 559.11KB
Only PDF files are accepted.
File Type* Plansheet-Proposed Drainage Area
File Upload Click the upload button,or drag and drop files to attach
SWM 4.pdf 638.53KB
Only PDF files are accepted.
File Type* Plansheet-SCM Detail
File Upload Click the upload button,or drag and drop files to attach
SWM 5.pdf 588.2KB
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:
o 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)
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:* Nicole Michel Ellis
Signature:
Piet f ffG�
Date Submitted: 10/23/2023

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* 10/23/2023