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Home My WebLink AboutNCC220789_FRO Submitted_20220217DocuSign Envelope ID DAFBAEEA 8486-4375 B77C-1 FDFA74EC5E9 Land -Disturbing Permit Application Please complete both pages of this form and return to For Office Use Physical Address Mailing Address 80 East St PO Box 548 Pittsboro NC 27312 Pittsboro NC 27312 Phone (919) 545 8268 Please see PERMITTING FLOW CHART to determine which permit and plan requirements apply to your project and then check one of the boxes below ❑✓ Land Disturbing Permit The following items are required to obtain this permit completed application plans and fees Land Disturbing Permit applications must include all parcels/lots on one application with the total amount of disturbance in acres for all parcel/lots All clearing and disturbance must be included when calculating disturbed area Fee Requirements Permit Fee $250/disturbed acre Plan Review Fee $250/disturbed acre Fees are rounded up to the next whole acre Example 1 acre or less is $500 101 2 acres is $1 000 and 2 01 3 is $l 500 Plan Requirements Design Plan submit (1) copy of an erosion control plan completed & sealed by a professional land surveyor professional engineer or registered landscape architect This plan must meet the criteria of the Chatham County Erosion Control Plan Review Checklist and include all applicable construction details These can be found on the Chatham County Watershed Protection websrte on the Erosion Control webpage This plan must satisfy all local state and federal minimum plan requirements General Plan submit (1) copy of site plan along with the Chatham County Residential General Plan Site plan is not required to be completed by a design professional The Residential General Plan can be found on the Chatham County Watershed Protection website on the Residential Construction webpage Indicate lot drainage pattern(s) on sheet 1 of the Residential General Plan 0✓ Residential Lot Permit The following items are required to obtain this permit completed application (if required see note 4 on PERMITTING FLOW CHART) site plan and fee Fee Requirements Plan Requirements $100 flat fee Site Plan showing property boundaries The site plan required by the Environmental Health or Central Permitting Departments is sufficient ALL CHECKS MADE PAYABLE TO CHATHAM COUNTY Page 1 of 3 DocuSign Envelope ID DAFBAEEA 8486-4375 B77C 1 FDFA74EC5E9 Land -Disturbing Permit Application **The mailing and street address of the principal place of business for the person/entity financially responsible and the land owner(s) must be provided A P O box is NOT acceptable as an address **If the financially responsible person/party is different from the current land owner_ an agreement signed by both parties must be provided allowing the financially responsible party person to conduct the land disturbing activity on the property PROJECT NAME Colvard Farms Lot 148 DATE 1/19/2022 ADDRESS OF PROJECT 278 Crimson Oak Drive Durham NC 27713 LATITUDE/LONGITUDE OF PROPERTY AT SITE ENTRANCE 35 86400106432316 78 95354105391237 PARCEL #(S) 94998 TOTAL DISTURBED ACRES or SQUARE FEET 0 4 PURPOSE OF ACTIVITY New construction single family residence FEE AMOUNT SUBMITTED $500 "LANDOWNER(S) OF RECORD (attach page to list additional owners) Please provide a complete list of partners managing members and registered agents if the responsible entity or land owner is a group of individuals corporate organization or entity Name John and Amanda Goodman Phone 910 528 6357 Address 120 Council Gap Ct E Mail MnhmaqjWgfnai1 cop br Cary NC 27513 Signature 9EM2724F2A4GB—5ADAB1BF4CSE4EB **FINANCIALLY RESPONSIBLE PARTY (applicable only if different from propertyowner) Name Hearthstone Luxury Homes Phone 919 900 7090 Address 1004 Manor Glen Way E Mail s des com Raleigh NC 27615 SignatureXff ISP U' 0075F6G3UM52 NORTH CAROLINA AGENT (applicable only if owner or financially responsible party does not reside in North Carolina) Name Phone Address E Mail ENGINEER/SURVEYOR Company Name RCS Address 1917 Evans Road Cary NC 27513 Contact Person Dean Rhoads Phone 919 378 9316 E Mail dean@rls nc com Signature EROSION CONTROL Person to contact should erosion & sediment control issues arise during land disturbing activity Contact Person Bruce O Connell Company Name Hearthstone Luxury Homes Phone 919 740 2132 E Mail sheenan@arhomes com Page 2 of 3 DocuSign Envelope ID DAFBAEEA 8486-4375 B77C 1 FDFA74EC5E9 Sod Erosion and Sedimentation Control Financial Responsibility/Ownership Form PLEASE READ THE FOLLOWING INFORMATION 1) This section must be signed in the presence of a Notary 2) All Land Disturbing permits are valid for up to (2) years from the date of issuance If circumstances warrant the permit may be extended for (2) years per the conditions of the Chatham County Soil Erosion and Sedimentation Control Ordinance Upon written notice the Land Disturbing permit may be revoked for failure to comply with the Ordinance If the permit is revoked all other permits and approvals are withheld until the property is once again in compliance with Chatham County regulations Also upon written notice a civil penalty (fine) can be instigated against the property owner and/or additional financially responsible party (if any) for violations of the Chatham County Soil Erosion and Sedimentation Control Ordinance This penalty is up to $5000 00 per violation per day and is assessed daily for every day the property is in violation Interfering with or hampering an inspection can result in a civil penalty without written notice 3) The information provided on this form is true and correct to the best of my knowledge and belief and was provided by me while under oath 4) This form must be signed by the property owner if an individual if owned by a company or corporation this form must be signed by an officer director partner attorney in fact or other person with authority to execute instruments for the corporation and accompanied by a complete list of all partners managing members and registered agents of the company orcorporation OWNER OF PROPERTY Name and Title John and Amanda Goodman Company (if applicable) Signature led ADDITIONAL FINANCIALLY RESPONSIBLE PARTY (if any) Name and Title Jeff Logsdon President / Owner Company Hearthstone Luxury Homes Signature NORTH CAROL114A AGENT (if any) Name and Title 1 Company Signature I ri,n Jn a Notary Public of �v��-�. County in the state of I��„ �((�� (�. do hereby certify that personally appeared before me this day and under oath acknowledged reading the information above and acknowledged that the above form was executed by him or her I C� -41-k- Witnes my hand and official seal this the i day of ' 2(a hIII \`�� Li® Itttary Public v i4-IC- il(A S (AQ-) �-,� Notary Public 2 Wake My commission expires S c = C(oi61�tL) My, omixixp rrr C Ai iu\0 Page 3 of 3