SW6210904_Application Form_20230803

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: http://deq.nc.qov/contact/reqional-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: SW6210904
2. Current Permit Holder's Company Name/Organization: Greenfield Serenity, LLC
3. Signing Official's Name: Yang Song
4. Signing Official's Title: Manager
5. Mailing Address: 8601 Six Forks Road, Suite 270
City: Raleigh State: NC ZIP: 27615
6. Street Address (if different): :
City: State: ZIP:
7. Phone: [phone] Email: ysonq(a�greenfieldcommunities.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):
Due to easement changes during construction 2 lots are being removed (143 and 169) MAIS 5,060 SF.
Lot 170 increased MAIS by 506 SF, Lot 295 increased MAIS by 900 SF, Lot 298 decreased MAIS by
350, and Lot 299 decreased MAIS by 350 SF. The net reduction is 4,354 SF
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).
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 Name: Brandon Miller, PE
Consulting Firm: WithersRavenel
Mailing Address: 137 S Wilmington Street, Suite 200
City: Raleigh State: NC Zip:27601
Phone: (919) 469-3340 Fax: (
Email: bmiller(a�withersravenel.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 r I, AW67 S-O W Er , 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: J 3 //6722 2
I, 1,ARISf L la . OS-reek)) , a Notary Public for the State of N of iti Cero.ou kR
County of (A3P11. , do hereby certify that i G &01
personally appeared before me this the I(o il day of MM2LH , 20 a3 , and
acknowledge the due execution of the forgoing instrument. Witness my hand and official seal,
KRISTLE H. OSTEEN
(Notary Seal) NOTARY PUBLIC
WAKE COUNTY, N.C.
Notary Signature404-0:11_, r
My commission expires cSuu& I'1 20E3
Stormwater Permit Form 7: Minor Modification Page 2 of 2 Oct 6, 2017