Stormwater Permit-Minor Modification_signed_1-18-18.pdf

STORMWATER PERMITTING FORM 7:
MINOR MODIFICATION
Standard Permitting Program — No Fee for Minor Modification
Express Permitting Program — See Express Fee Schedule
Only complete applications packages will be accepted and reviewed. This form and the required items (with
original signatures) must be sent to the appropriate DEMLR Regional Office, which can be determined by locating
the project on the interactive online map at: http://deg.nc.gov/contact/regional-offices.
This form is to only to be used by the current permittee to notify the Division of a minor
modification. Pursuant to Rule 15A NCAC 02H. 1002, a minor modification is a change to the project that:
1) does not increase the net built -upon area; and/or
2) does not change the size or design of the SCM(s).
A. GENERAL INFORMATION
1. State Stormwater Permit Number: SW3171001
2, Current Permit Holder's Company Name/Organization: Union Electric Membership Corp
3, Signing Official's Name: Davd A. Gross
4. Signing Official's Title: VP Engineering and Operations
5, Mailing Address: Post Office Box 127
City: Monroe State: NC ZIP: 28100-0127
6. Street Address (if different): : 1525 North Rocky River Road
City: Monroe State: NC ZIP: 28100-0127
7. Phone: [phone] Email: David. Gross a un ion-power,com
8. Describe the minor modifications that you are requesting, including any revised BUA allocations (attach
additional pages or supporting tables similar to Section IV.10 of the original application, if needed):
Impervious area has been reduced from 2.15 to 2.07 acres due to shift in the entry drive, requested by
Cabarrus_County Planning, from the western property line. Culvert #6 was relocated with the drive and an
additional
DEMLR USE ONLY
Date Received
Fee Paid
Permit Number
#7,
was placed
under
the
entry
drive.
Due
STORMWATER PERMITTING FORM 7:
MINOR MODIFICATION
Standard Permitting Program — No Fee for Minor Modification
Express Permitting Program — See Express Fee Schedule
Only complete applications packages will be accepted and reviewed. This form and the required items (with
original signatures) must be sent to the appropriate DEMLR Regional Office, which can be determined by locating
the project on the interactive online map at: http://deg.nc.gov/contact/regional-offices.
This form is to only to be used by the current permittee to notify the Division of a minor
modification. Pursuant to Rule 15A NCAC 02H. 1002, a minor modification is a change to the project that:
1) does not increase the net built -upon area; and/or
2) does not change the size or design of the SCM(s).
A. GENERAL INFORMATION
1. State Stormwater Permit Number: SW3171001
2, Current Permit Holder's Company Name/Organization: Union Electric Membership Corp
3, Signing Official's Name: Davd A. Gross
4. Signing Official's Title: VP Engineering and Operations
5, Mailing Address: Post Office Box 127
City: Monroe State: NC ZIP: 28100-0127
6. Street Address (if different): : 1525 North Rocky River Road
City: Monroe State: NC ZIP: 28100-0127
7. Phone: [phone] Email: David. Gross a un ion-power,com
8. Describe the minor modifications that you are requesting, including any revised BUA allocations (attach
additional pages or supporting tables similar to Section IV.10 of the original application, if needed):
Impervious area has been reduced from 2.15 to 2.07 acres due to shift in the entry drive, requested by
Cabarrus_County Planning, from the western property line. Culvert #6 was relocated with the drive and an
additional
culvert,
#7,
was placed
under
the
entry
drive.
Due
to
the
shift
in
the
driveway
entry,
slight
modifications
were implemented
to the
deeded Swale
easement
and vegetated
swale
along
drive.
B. SUBMITTAL REQUIREMENTS
Please mark "Y" to confirm the items are included with this form. Please mark `X" if previously provided. If not
applicable or not available, please mark N/A.:
Y 1. Two hard copies (with original signatures) and one electronic copy of this completed form.
Y 2. Two hard copies and one electronic copy of the revised plan sheets (must be a revision of the
originally approved plan sheets).
N/A 3. If there is reallocation of lot BUA, a copy of the revised recorded deed restrictions and protective
covenants OR the proposed recorded deed restrictions and protective covenants documenting
the changes and a signed agreement to provide the final recorded document.
N/A 4. If applicable, the appropriate Express review fee.
Stormwater Permit Form 7: Minor Modification Page 1 of 2 July 14, 2017

C. CONTACT INFORMATION
1. The Design Professional who is authorized to provide information on the Applicant's behalf:
Design Professional's Name:Averett M. Tinsley
Consulting Firm: UC Synergetic
Mailing Address:123 N. White Street
City:Fort Mill
Phone: [phone]
Email: :ATINSLEY(a,)UCSENG.COM
State:SC Zip:29715
2. [OPTIONAL] If you would like to designate another person to answer questions about the project:
Name &Title:
Organization:
Mailing Address:
City:
State: Zip:
Phone: ( ) Fax:
Email: :
D. CERTIFICATION OF PERMITTEE
I, C� r7:;r, r,).<C�
,the current permittee, certify that I have authorized the minor modifications listed
in Section A and shown in the attached revised plan sheets. I further attest that this information is accurate and
complete to the best of my knowledae.
Signature:
Notary. signature
ary Public forth"e "State
certify that .1�`tv i l�
daY of SAT1WJft U , 201
Hent. Witness my hand and official seal,
My commission expires
Stormwater Permit Form 7: Minor Modification Page 2 of 2 Oct 6, 2017