SW3161003 Minor Mod application

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: htta://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: SW3161003
2. Current Permit Holder's Company Name/Organization: SUNBELT HOLDINGS SE I LLC
3. Signing Official's Name: RANDY ALLEN
4. Signing Official's Title: MANAGING DIRECTOR
5. Mailing Address: 3129 SPRINGBANK LANE
City: CHARLOTTE State: NC ZIP: 28226
6. Street Address (if different):
City: State: ZIP:
7. Phone: [phone] Email: GRAHAM cOSUNBELTLANDMGMT.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):
REMOVED CURB AND GUTTER AND SIDEWALK FROM ROAD CROSS-SECTION
REDUCED ROAD PAVEMENT WIDTH FROM 26' TO 18'
REDUCED OVERALL ROAD LENGTH FROM 2,285.90 LF TO 2,278.27
REDUCED IMPERVIOUS AREA FROM 15% (271.357 SF) TO 10.71%0_(193,754 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).
X 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 recordegdd document.
NIA 4. If applicable, the appropriate Express review fee.
DENR-LAND QUA.!.i'',
STORIVIVATER FEPW'
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: WESTON BOLES
Consulting Firm: WK DICKSON
Mailing Address:616 COLONNADE DRIVE
City: CHARLOTTE
State: NC
Phone: [phone] Fax:
Email: :WBOLES-,c,�WKDICKSON.COM
Zip:28205
2. [OPTIONAL] If you would like to designate another person to answer questions about the project:
Name & Title:
Organization:
Mailing Address:
City:
Phone:
Email:
State:
Fax:
Zip:
D. CERTIFICATION OF PERMITTEE
I, Randy n lien , 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:�G/ Date:
I, ; 4,7 ri 4AVI a Notary Public for the State of4L
County of k do hereby certify that
personally appeared before me this the _ day of 20—Li, and
acknowledge the due execution of the forgoing instrument. Witness my hand and official seal,
X0r&YmnWW
(Notary Seal) Vnion county
N,rifi cdwt6,
Notary Signat re
My commission expires
Stormwater Permit Form 7: Minor Modification Page 2 of 2 Oct 6, 2017