SW3240203_Supplemental Info Review_20240222

Action History (UTC-05:00)Eastern Time(US&Canada)
Submit by Anonymous User 2/22/2024 6:28:09 PM (Supplemental Submittal)
Accept by Kaitlin Peck 2/23/2024 4:06:45 PM (Supplemental Info Submittal)
• The task was assigned to Kaitlin Peck 2/22/2024 6:28:10 PM

=DEQ •
Submittal from 2/22/2024
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* SW3240203
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* Union County Shrine Club
Owner/Operator* Union Shrine Properties, LLC
County: Union
Submitter Name:* Jesse Wilson
Who is submitting this information?
E-mail Address:* [e-mail]
Phone Number* 3367369267
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
2-12-24-SSW-SWU-1 01-Application-DEM LR-SPU
186.54K6
Oct 2013-UNION.pdf
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 Agreement-Signed.pdf 309.42KB
Only PDF files are accepted.

File Type* Supplement-EZ Form
File Upload Click the upload button,or drag and drop files to attach
Su pp EZ-2020-Version-2.1.3-20201203-D ELM R-SW-
293.04K6
WEG.pdf
Only PDF files are accepted.
File Type* Design Calculations
File Upload Click the upload button,or drag and drop files to attach
2-12-24-SW Project Narrative w Design Calcs&
1.7MB
Attachments.pdf
Only PDF files are accepted.
File Type* Plansheet-Cover Sheet
File Upload Click the upload button,or drag and drop files to attach
CAD Survey File-PCSM-WEG COVER(1 R).pdf 341.38KB
Only PDF files are accepted.
File Type* Plansheet-Existing Conditions/Survey
File Upload Click the upload button,or drag and drop files to attach
CAD Survey File-PCSM-WEG 1 -EXISTING COND
409.87K6
(1 R).pdf
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
CAD Survey File-PCSM-WEG 3-FINAL GRADES
978.34K6
(1 R).pdf
Only PDF files are accepted.
File Type* Plansheet-Grading/Drainage Plan
File Upload Click the upload button,or drag and drop files to attach
CAD Survey File-PCSM-WEG 2-G&EC PLAN
1.09M6
(1 R).pdf
Only PDF files are accepted.
File Type* Plansheet-Proposed Drainage Area
File Upload Click the upload button,or drag and drop files to attach
CAD Survey File-PCSM-WEG 1 OF 1 -DAs(1 R).pdf 953.11 KB
Only PDF files are accepted.
File Type* Property Deed
File Upload Click the upload button,or drag and drop files to attach
Deed-DB08739PG0014.pdf 241.82KB
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 Map-Pageland-SC(1 R).pdf 2.57MB
Only PDF files are accepted.
File Type* Recorded Document
File Upload Click the upload button,or drag and drop files to attach
Articles of Incorporation-Union Shrine.pdf 192.09KB
Only PDF files are accepted.
File Type* Plansheet-Other
File Upload Click the upload button,or drag and drop files to attach
CAD Survey File-PCSM-WEG 4-EC DET(1 R).pdf 1.65MB
Only PDF files are accepted.
File Type* Response To Comments
File Upload Click the upload button,or drag and drop files to attach
Gmail-Union County Shrine Club; Monroe, Union
317.13K6
County-WEG.pdf
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:
Plansheet-Other is the Erosion Control Detail Sheet
* 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
d I intend to electronically sign and submit the Supplemental Information Upload form.
Full Name:* Jesse W.Wilson
Signature:
/G�lG IV. lU(,L�O/G
Date Submitted: 02/22/2024

Initial Review
Verify Permit No.* IMPORTANT:REVIEWER SHOULD VERIFY and revise here if necessary.
SW3240203
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* 02/23/2024