SW3140802_Minor Mod_20190806

T.
DEMLR USE ONLY
Date Received Fee Paid Permit Number
STORMWATER PERMITTING FORM 7:
MINOR MODIFICATION
Standard Permitting Program — No Fee for Minor Modification r-,,���'
Express Permitting Program — See Express Fee Schedule,
06 "n
Only complete applications packages will be accepted and reviewed. This fotm and the t8y mltl"401Y UTY
original signatures) must be sent to the appropriate DEMLR Regional Office, which can be dete
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: SW3140802 MOD
2. Current Permit Holder's Company Name/Organization: UNION COUNTY GOVERNMENT
3. Signing Official's Name: MICHELLE LANCASTER
4. Signing Official's I itle: ASSIS [AN I COUN I Y MANAGER
5. Mailing Address: 500 NORTH MAIN STREET, SUITE #900
City: MONROE State: NC ZIP: 28112
6. Street Address (if different): : SAME AS ABOVE
City:
State: ZIP:
7. Phone: [phone] Email: michelle.lancaster(a�unioncountync.gov
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):
Permitted Maior Mod is being revised to decrease footprint of project site.
Length of drive was shortened; access road extension to tie to existing paved drive was removed;
Asphalt paving was replaced with gravel; storm drain structures and pipes were removed
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 dpplicdble, Ilie dppropridle 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: NATHAN T. BIVINS, PE
Consulting Firm: CIVIL & ENVIRONMENTAL CONSULTANTS, INC.
Mailing Address: 3701 ARCO CORPORATE DRIVE, SUITE 400
City: CHARLOTTE State: NC Zip: 28273
Phone: [phone] Fax: [phone]
Email:: nbivins(cD_cecinc.corn
2. [OP I IONAL] It you would like to designate another person to answer questions about the project:
Name & Title:
Organization: s______
Mailing Address:
City: State: ZIP:
Phone:
ax:
Email:
.V,- _
A U 103 0 ) d0i-
D. CERTIFICATION OF PERMITTEE
f , DENR-LAND QUALITY
Lam► I, V V1NSIC' , the current permittee, certify that I have aT 0ATqfRPL4W1lrf1*jJications 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 knowledg . G%
Signature: Date:
I, J oc1 i Q Pr r c e --.,a Notary Public for the State of 1ti/a r4-1., 00"O KaL,
County of Moe d e ( r —,do hereby certify that hl � &k,e((e /,q k 0-& S kr
personally appeared before e this the /8-4"*- day of , 20_/'J , and
acknowledge the due execution of the forgoing Instrument. Witness mJ hand and official seal,
(Notary Seal)
NOTARY
PUBM
Notary Signature
My commission expire..
MY
Stormwater Permit Form 7: Minor Modification Page 2 of 2 Oct 6, 2017