SW6220101_Application Form (Minor Mod)_20230831

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.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: SW6220101
2. Current Permit Holder's Company Name/Organization: Caviness Land Development, Inc
3. Signing Official's Name: Watson Caviness
4. Signing Official's Title: President
5. Mailing Address: 1041 B Robeson Street
City: Fayetteville State: NC ZIP: 28305
6. Street Address (if different): :
City: State: ZIP:
7. Phone: [phone] Email: [e-mail]
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 BUA per lot remains unchanged. The storm pond location was modified to reduce the construction
cost of the project. The total lot count dropped from 71 to 67. The updated O&M agreement as well as
the updated supplement and storm calculations are attached.
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).
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.
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: C. Scott Brown, PE
Consulting Firm: 4D Site Solutions, Inc
Mailing Address: 409 Chicago Drive, Suite 112
City: Fayetteville State:NC Zip:28306
Phone: (910) 426-6777 Fax: (
Email: :[e-mail]
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, Watson Caviness , 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:
I, , a Notary Public for the State of
County of , do hereby certify that
personally appeared before me this the day of , 20 , and
acknowledge the due execution of the forgoing instrument. Witness my hand and official seal,
(Notary Seal)
Notary Signature
My commission expires
Stormwater Permit Form 7: Minor Modification Page 2 of 2 Oct 6, 2017