SW3220701_Application Form_20240408

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: SW3220701
2. Current Permit Holder's Company Name/Organization: Tri Pointe Homes Holdings, Inc.
3. Signing Official's Name: Margaret Puckett
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4. Signing Official's Title: Vice President of Land
5. Mailing Address: 6325 Ardrey Kell Road, Suite 125
City: Charlotte State: NC ZIP: 28212
6. Street Address (if different): :
City: State: ZIP:
7. Phone: [phone] Email: Margaret.pucketttripointehomes.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):
Reduction of 2 lots and sidewalks, on street parking impervious has been included in the roadway BUA.
BUA allocations have been revised with no change to overall BUA contributing to the previously permitted
SCM's. BUA calculations are attached as an additional page for clarification of revised allocations,
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:Mason Greeson, PE
Consulting Firm: Civil and Environmental Consultants, Inc.
Mailing Address:3701 Arco Corporate Drive, Suite 400
City:Charlotte State:NC Zip:28273
Phone: (704) 900-4755 Fax: ( )
Email: :mgreeson(cr�.cecinc.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
I, Margaret Puckett , 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: v��� V l/ l/ ruvu---e\-- Date: 3 I I I
I, Affl J4wo\U V 11is , a Notary Public for the State of �o($ aCk('dkt A
County of (abG«US , do hereby certify that cat e-(<�}�1'
personally appeared before me this the [ S {' day of�ho� , 20 24 , and
acknowledge the due execution of the forgoing instrument. Witness my hand and official seal,
(Notary Seal)
Amanda Seward-Chavis
NOTARY PUBLIC
�1 ,, Cabarrus County
Notary Signature0S �—�/ ., f My Commiss Commission Carolina
slJanuary 8,2028
My commission expires 0 VOCg12 o7
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Stormwater Permit Form 7: Minor Modification Page 2 of 2 Oct 6, 2017