SW5190703_Form_(Minor_Mod)_20200408

DEMLR USE ONLY
Date Received Fee Paid Permit Number
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: ottp./Meq. 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: SW5190703
2. Current Permit Holder's Company Name/Organization: North Carolina Central University
3. Signing Official's Name: Zack Abegunrin.
4. Signing Official's Title: Associate Vice Chancellor of Facilities Management
5. Mailing Address: 1801 Fayetteville Street
City: Durham State: NC ZIP: 27707
6. Street Address (if different):
City: State: ZIP:
7. Phone: [phone] Email: zabegunrinaNCCU.EDU
8. Describe the minor modifications that you are requesting, including any revised BUA allocations (attach
additional pages or supporting tables similar to Section I V.10 of the original application, if needed):
The grading was redesigned and a portion of retaining wall west of the sand filter is removed from
the current design. As a result less off -site area is now draining to the sand filter and less
off -site impervious is to be treated. Also, a lot wasn't acquired for the protect as originally planned and the
drainage area from the lot is now considered off -site, that was previously considered on -site. A proposed
sidewalk was removed due to a design change since the original permit. As a result, the proposed sand
filter size is smaller.
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.

C. CONTACT INFORMATION
1. The Design Professional who is authorized to provide information on the Applicant's behalf:
Design Professional's Name: Patrick L Covil
Consulting Firm: Dewberry Engineers Inc
Mailing Address:2601 Wycliff Road, Suite 410
City: Raleigh State:NC
Phone: [phone] Fax:
Email:: pcovil(o)dewberry.com
Zip:27607
[OPTIONAL] If you would like to designate another person to answer questions about the project:
Name & Title:
Organization:
Mailing Address.
City: State: Zip:
Phone: 1 ) Fax: ( )
Email:
D. CERTIFICATION OF PERMITTEE
I,Y the current permittee, certify that I have authorized the minor modifications listed
in Section A and shWWn in Phe attached revised plan sheets. I further attest that this information is accurate and
complete to Ahe best of
Signature:
Date:'
I, ��/moot a Notary Public fo�rlt�he State of 001 CarOU nU
County of �( y[� N do hereby certify thatIA & E0um kiN1
personally appeared before me this the �Jr day of A 2020, and
acknowledge the due execution of the forgoing instrument. Witness my hand and official seal,
HEATHER J GREGORY
SeAotary Public - North Carolina
Johnston County
Notary Signature ae�flr /7 /1
My commission expires 'g6