SW6100804_Minor Modification Application_20220520

DEMLR USE ONLY
Date Received
Fee Paid
Permit Number
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STORMWATER PERMITTING FORM 7: �y
MINOR MODIFICATION R51- E Vy i :zl V
Standard Permitting Program — No Fee for Minor Modification
Express Permitting Program — See Express Fee Schedule OEQ.FAYETTEVILL.E REGIONAL OFFICE
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.pov/contact/repional-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: SW6100804
2. Current Permit Holder's Company Name/Organization: VP Spout Springs, LLC
3. Signing Official's Name: Martin D Koon
4. Signing Official's Title: Manager/Member
5. Mailing Address: PO Box 843
City: Wilkesboro State: NC ZIP: 28697
6. Street Address (if different): : 126 Executive Drive, Suite 200
City: Wilkesboro State: NC ZIP: 28697
7. Phone: [phone] Email: martykoon(aD-vpdevelopment.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):
A portion of the original residential built -upon area will become commercial built -upon area.
The percentage of residential -built upon area is being reduced due to more accurate data related to
home footprints and driveway sizes. The built -upon areas for Food Lion and Outparcel No. 2 have been
updated to reflect as -built conditions.
B. SUBMITTAL REQUIREMENTS
Please mark "Y" to confirm the items are included with this form. Please mark "Y' 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).
Y 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 Namejarrod E. Hilliard, PE, CFM
Consulting Firm: Hilliard Engineering, PLLC
Mailing Address:PO Box 249
City:Sanford
Phone: [phone]
Email::iilliard(cDhilliardengineerinci.com
State: NC Zip:27331
Fax: ( 1
[OPTIONAL] If you would like to designate another person to answer questions about the project:
Name & Title:
Organization:
Mailing Address:
City:
State:
Phone: ( ) Fax:
Email:
D. CERTIFICATION OF PERMITTEE
Zip:
I, Martin D Koon , 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 compI of
my knowledge.
Signature: 11J�
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I, �}1Grr, S c>L�,4r a Notary Public for the State of Iva U'a.
M&r4-\P 7> Ka a r—
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;s my hand and official seal,
My commission expires �J ' DO - C� aaS
Stormwater Permit Form 7: Minor Modification Page 2 of 2 Oct 6, 2017