SW3140802_SIGNED SPF7-Permit-Minor-Mod-Form-GoldmineConvCtr 8-5-19_8/22/2019

DEMLR
USE ONLY
Date Received
Fee Paid
Permit
Number
Standard Permitting Program — No Fee for or Modification
Express Permitting Program— See Express Fee Schedule
Only complete applicatiars 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 detennined by locating
the project on the interactive online map at: http://deg.nagov/contact/regionat-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 . 0002 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).
x •A !"'t19il
1. State Stormwater Permit Number: SW3140802 MOD
2, Current Permit Holder's Company Name/Organization: UNION COUNTY GOVERNMENT
3. Signing Official's Narne: MICHELLE LANCASTER
4. Signing Official's Title: ASSISTANT COUNTY MANAGER
5. Mailing Address: 500 NORTH MAIN STREET, SUITE 4900
City: MONROE State: NC ZIP: 28112
6. Street Address (if different):: SAME AS ABOVE
City:
ZIP:
7. Phone: [phone] Email: michelle.lancasterno,unioncountync.gov
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):
Permitted Major Mod is being revised to decrease footprint of project site
Length of drive was shortened: access road extension to tie to existing paved drive was removed'
Asphalt paving was replaced with gravel' storm drain structures and pipes were removed
I �'i11�31U1Yr��e'1�'.7s�111 .. trite
Please rnar(< "Y" to confirm the items are included with Phis 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.
N/A 4. If applicable, the appropriate Express review fee.
Stormwater Permit Form 7: Mina- Modification Page 1 of 2 July 14, 2017

1. The Design Professional who is authorized to provide information on the Applicant's behalf:
Design Professionals Name: NATHAN T. BIVINS, PE
Consulting Firm: CIVIL & ENVIRONMENTAL CONSULTANTS INC.
Mailing Address: 3701 ARCO CORPORATE DRIVE, SUITE 400
City: CHARLOTTE State: NC Zip: 28273
Phone: [phone] Fax: [phone]
Email:: nbivins iiicecinc.com
2. [OPTIONAL] If you would like to designate another person to answer questions about the project:
Name & Title:
Organization:
Mailing AddrE
Entail: :
I� a! 2 �t E ar L( �I" , ,the current pennittee, 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
Signature:
I, yo�] rc �riC2 ,a Notary Public for the State of�/orJ-G, CQtd�)rca.- ,
County of M o ad t N l y ro do hereby certify that kfdq�&e `a k Ca qkr
personally appeared before n ei this the �'N`_ day of , f v , 2017,_and
acknowledge the due execution of the forgoing instrument. Witness m hand and official seal,
(Notary Seal)
�TAt�
�BUC
Notary Signature I`— 1
My commission a ffebO11MjMtRn FRRIr ltrtq""'i: '�i)'�$—
Stonnwater Permit Fonn 7: Minor Modification Page 2 of 2 Oct 6, 2017