SW6200904_Application Form_20220214

11 DEMLR USE ONLY
Date Received I Fee Paid I 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. httA:I/dea.nc.govlcontadlrepiaaal-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: SW6200904
2. Current Permit Holder's Company Name/Organization: Timberland Ranch, LLC
3. Signing Official's Name: D. Ralph Huff III
4. Signing Official's Title: —Member/Manager
5. Mailing Address: 2919 Breezewood Avenue Suite 100
City: Fayetteville State: NC ZIP: 28303
6. Street Address (if different):
City: State: ZIP:
7. Phone: [phone] Email: drhuff �hufffamilyoffice.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):
The overall ro'ect area will be reduced from 524.7ac to 524.24ac. The Project Percent of Impervious
Area has decreased from 4,43% to 4.42%, There is no increase in net built -upon area within the
romect and n❑ increase in the overall size of the Stormwater control measures that have been approved
for the promect.
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 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 a.nd a signed agreement to provide the final recorded document.
N 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:Matt Lowder, PE
Consulting Firm: Bowman North Carolina. Ltd.
Mailing Address:4.004 Barrett Drive, Suite 101
City:Raleiph State:NC Zip:27609
Phone: [phone] Fax:
Email:mlowderCcDbowman.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, D. Ralph Huff J11 , the current permittee, certify that I have authorized the minor
mod ificai listed,'n S ion A and,sh wn in the attached revised plan sheets. I further attest that this information is
accurate d co ` a th best of, 10
kn
U - .l� �21
Signature: Date. I
I, 1 1-le a Notary Public for the State of /c-' C
County of ,yc� ,fr C do hereby certify that 0 - kL 4Z 1,X
personally appeared before me this the J� day of fUUyC 0 2 / , and
acknowledge the due execution of the forgoing instrument. Witness my hand and official seal,
(Notary Seal)
NOTAI?r C
❑ MY
Q COMMISSION EXPIRES �
l(VIG12M
Notary Signature
O PUBUG �G
My commission expires /(J //a Zt! Z f'�•,,�;COUN..;`•````
Stormwater Perniit Form 7 Minor Modification Page 2 of 2 Oct 6, 2017