SW3220302_Minor Modification Form_20230223

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: htto.//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: SW3220302
2. Current Permit Holder's Company Name/Organization: PSA Denver, LLC
3. Signing Official's Name: Julian Wilson
4. Signing Official's Title: Manager
5. Mailing Address: 3850 Fernandina Rd.
City: Columbia State: SC ZIP: 29201
6. Street Address (if different):
City: State: ZIP:
7. Phone: [phone] Email: iulian.wilson(a�iiech.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):
Back portion of site shown as future phase instead of aettina built now. BUA allocations were chanaed to
show more BUA as future instead of proposed. No changes to storm or bmp calculations.
Pipe material of proposed storm drainage was changed to HDPE instead of RCP on plans.
Calculation book was updated to reflect material change. Mannings changed from 0.013 to 0.012.
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.
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:Jay Henson
Consulting Firm: HensonFolev
Mailing Address:121 Gilead Rd.
City: Huntersville State:NC Zip:28078
Phone: [phone] Fax: ( )
Email:: jayCc)_hensonfoley.com
2. [OPTIONAL] If you would like to designate another person to answer questions about the project
Name & Title:Kennedv Wilson
Organization: HensonFolev
Mailing Address:121 Gilead Rd.
City:Huntersville State:NC Zip:28078
Phone: [phone] Fax: ( )
Email: :ken nedy(a)hensonfolev.com
D. CERTIFICATION OF PERMITTEE
I, Julian Wilson , 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 complete
to the best of my
Signature:
December 6, 2022
I, John Pincelli , a Notary Public for the State of South Carolina
County of Lexington do hereby certify that Julian Wilson
personally appeared before me this the 6th day of December 20 22 , and
acknowledge the due execution of the forgoing instrument. Witness my hand and official seal,
Stormwater Permit Form 7: Minor Modification Page 2 of 2 Oct 6, 2017