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HomeMy WebLinkAboutSW5100602_Application Form_20230526DEMLR 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: http://deq.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: SW5100602 2. Current Permit Holder's Company Name/Organization: 3. Signing Official's Name: 4. Signing Official's Title: 5. Mailing Address: City: Cary Israel Flores ABB Inc. Health, Safety and Environment Manager 305 Gregson Drive State: NC ZIP: 27511 6. Street Address (if different): City: �� vV State: NC _ ZIP: 2 sd 7. Phone: ( 252 ) 366-4122 Email: israel.flores1@us.abb.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): In the previous application from 2018 we allocated 41,688 sf to "Future use" impervious area (see Stormwater Application, page 3). We will use 31,925 sf of that area in the proposed parking lot expansion. 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. NIA 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: J. Michael Stocks Consulting Firm: Stocks Engineering Mailing Address: P.o Box 1108 City: Nashville State: NC Zip: 27856 Phone: ( 252 ) 459 - 8196 Fax: Email:: mstocks@stocksengineering.com 2. [OPTIONAL] If you would like to designate another person to answer questions about the project: Name & Title: Kevin Varnell Organization: Stocks Engineering Mailing Address: P.o Box 1108 City: Nashville Phone: ( 252 Email:: kvarnell@stocksengineering.com State:_ 459 - 819E NC ax: Zip: 27856 D. CERTIFICATION OF PERMITTEE I, 17';fCl M � , SQ 11LC5 , 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 knowledge. Signature: Date: ()S/25/?(3 - I, X . V-v-4 . v, V ow w -VI , a Notary Public for the State of 4,41, County of do hereby certify that s� c_l Pt personally appeared before me this the Z day of aj,, 20 23, and acknowledge the due execution of the forgoing instrument. Witness my qand and official seal, J. KEVIN VARNELL (Notary &NOtary Public North Carolina Edgecombe County LI Notary Signature 4&�Z) My commission expires ?j/I S Z& Stormwater Permit Form 7: Minor Modification Page 2 of 2 Oct 6, 2017