SW5190701_Form (Application)_20201217

DEMLR USE ONLY
Date Received Fee Paid Permit Number
I01IRIM "'I"'IIf;;;:IIR Ilf�llf;;;:IIRIMIII"'1"""'lII'°IIIIN IIf°°' IIRIM "
M111NOIR MODIFICA noIN
Standard Permitting Program — No Fee for Minor Modification
Express Permitting Program — See IF plr IF Schedull
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: afitp.// g q: g�✓/gc�fat qt/f g o at -offices,
This form is to only to be used by the current permittee to notify the Division of a minor
modification. Pursuant to .e I5 ...N.CAC 021 1, 1002a 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„ GIENIBRAII,,,.IINFORIMATII N
1. State Stormwater Permit Number: SW5190701
2. Current Permit Holder's Company Name/Organization: After School, LLC
3. Signing Official's Name: Richard Angino
4. Signing Official's Title: Owner
5. Mailing Address: 463'/ Carolina Circle
City: Winston Salem State: NC ZIP: 27104
6. Street Address (if different):
City: State: ZIP:
7. Phone: [phone] Email: team thirdwavehousing.com
8. Describe the minor modifications that you are requesting, including any revised BUA allocations (attach
additional pages or supporting tables similar to Section 1 V.10 of the original application, if needed):
The original proposed stormwater system was for 2 underground storage (UGS) in two locations. The
modification to the plans includes combining the UGS systems to 1 system at one of the original locations.
These UGS systems were required to meet local quantity requirements and the drainage area, location or
design relative to the state approved Filterra has not been modified. It should noted that upon reviewing
the sizing calculations, The Filterra Reviewers opted to provide an alternate size Filterra than the one we
had originally specified based on their review of our design and impervious surface ratio. See attached
Emails for documentation of this.
IE„ SUIBIMITTAII,,,.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 F:'ermit I::arm 7: IMinor (Modification F:'age 1 of 2 wJUly 14, 2017

C. CONTACT INFORMATION
The Design Professional who is authorized to provide information on the Applicant's behalf:
Design Professional's Name: Chad Abbott
Consulting Firm: C3 Design & Engineering, PLLC
Mailing Address: PO Box 361
City: Creedmoor State: NC Zip: 27522
Phone: [phone] Fax:
Email: :-chad(a-)c3designeng.com
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, Richard Angino , the curr ent-permittee, certify that I have authorized the minor
modifications listed in Section A n in t ached revised plan sheets. I further attest that this information is
ledge.
accurate and complete to the k���
Signature: �55 —Date:
- .- ­ - 10
1, k)OW (� h)-frto, , a Notary Public for the State of A10OX &Mk�w
County of Vv"(i 144% do hereby certify that X 'CAcW Aj5,�
personally appearbd before me this the 164' day of lVokt."bet, 20 , and
acknowledge the due execution of the forgoing instrument. Witness my hand and official seal,
Forsyth County, North Carolina]
(Notary Seal) Notary Public
Wilson D, Warren
MY Commission Expires 1113/2023
J
Notary Signature W*1 A,--
My commission expires
Fcat n 7 Minot [Vlachhc;ahon Page 2 of 2 0(.,,t 6, 2017