HomeMy WebLinkAboutNCC230108_FRO Submitted_20230113JCN
Durham City/County (Office Use Only)
Sedimentation and Erosion ControI
[� FINANCIAL RESPONSIBILITYIOWNERSHIP FORM
WITH LANDOWNER CONSENT FORM
No person may initiate any land -disturbing activity covered by the Durham City -County Unified Development Ordinance before a
Land Disturbing Permit is issued by the Sedimentation and Erosion Control Office. Issuance of a Land Disturbing Permit does not
relieve the permittee of the obligation to obtain any other licenses, permits and approvals as may be required by Federal, State,
County or Municipal governments. This office must be notified in writing of any change to the information on this form.
PLEASE TYPE OR PRINT
1. Project name: Olive Branch Waterline Extension
2. Road location of land -disturbing activity: Olive Branch Road
Tax Map - Block - Parcel: 194192 PIN: 0860-03-84-5286
3. Square footage of land to be disturbed or uncovered: 133,880 S.F. 3.07 AC.
4. List below the landowner of record. Each landowner must complete Item S.
(If there are multiple owners, please list on a separate page):
Pulte Home Comoanv. LLC
Name
1225 Crescent Green Drive. Suite 250
Address
City State Zip
919-816-1146 nIa chris.raughievnc.pultegroup.com
Telephone Fax Email
5. List the person or entity financially responsible for this land -disturbing activity: The financially responsible party shall
be (1) the developer or other person who has or holds themselves as having financial or operational control over the land -
disturbing activity and/or (2) the land owner or person in possession or control of the land when they have directly or
indirectly allowed the land -disturbing activity or have benefited from it and (3) the named party on the Land Disturbing
Permit.
Pulte Home Comoanv. LLC
Name
1225 Crescent Green Drive, Suite 250
_
Street Address
Cary, NC
27518
City State
Zip
919-816-1146 nla
chris.rauohley@i)uiteoroup.com
Telephone Fax
Email
The Sedimentation and Pollution Control Act (Act) and the Durham City -County Unified Development Ordinance
(Ordinance) includes, but is not limited to, the following legal obligations of the financially responsible party:
E Maintain a set of approved sedimentation and erosion control plans, if required, on site.
■ Display permit on site.
■ Understand and implement any required plan, including the construction sequence and details.
■ Inspect, maintain and repair sedimentation and erosion control measures, especially after rainfall events.
■ Provided adequate ground cover or otherwise stabilize all areas that have not been actively graded within 21 calendar
days.
201 E. Main St, 51 Floor, Durham, N.C. 27701 • (919) 560-0735 • Fax (919) 560-0740
www.co.durham.nc.us/cerPg
■ Plan and conduct all land -disturbing activity so as to prevent off -site sedimentation.
6. For business applicants, list below the North Carolina registered agent for the financially responsible entity:
Chris Raughley
Name
1225 Crescent Green Drive, Suite 250
Street Address
Cary North Carolina 27518
City State Zip
919-816-1161 chris.raughley@pulte.com
Telephone Fax Email
7. The above information is true and correct to the best of my knowledge and belief and was provided by me while under oath. I
understand that the person or entity listed on Line 5 above will be: (1) the owner of the Land Disturbing Permit when issued;
(2) responsible for ensuring compliance with the Act and Ordinance; and, (3) will be the only person or entity with standing to
appeal any action taken or decision made by the Sedimentation and Erosion Control Office.
1 —1$ " Z'z Chris Raughley
Date Type or Print Name
eA1_pl lat o ti VP Land Development
Telephone Fax Tile or Autj ity
G" V t S . r A, %A- A Lt l.� A C@ Ire a k- . eD,nn ` L1 n._ riv
Email t - Signature
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Business Applicant Provide co orate resolution on signatory authority)
I, /1nOk-1 SK Sjv-A ` 4&n L_ a Notary Public of the County of W of _
State of i\/ (/ , hereby certify that
personally came before me this day and acknowledged that he is Veve i-i
of _L" V &V4)&ypMCAd& and acknowledged, on behalf of v►I
"C, the due execution of the foregoing instrument.
Witness my hand and official seal, this Qj day of_J 01ML&C wVl 20y'L
Notary Puj]se
My commission expires ! 6� Vd-. j _, 20']i ,•° V\SA S/j'/^''�.,•
Individual Applicant
a Notary Public of the Coup i `A0811 G
State of , hereby certify that
personally appeared before me this date and under oath acknowledged that the above form was executed by them.
Witness my hand and official seal, this day of
Notary Public
My commission expires 20.
LAND DISTURBING PERMITS ARE NON -TRANSFERABLE
20
Provide a Notarized Item 8 for each landowner listed in Item 4.
8. Land Owner Consent. As a landowner, I provide my consent for land -disturbing activities to occur on the property listed in
Item 2 by the person or entity listed in Item 5.
I _ % 6 — -7 -L Chris Raughley
Date Type or Print Name
k 0� S %ka 11 to VP Land Development _
Telephone Fax Title or Aut�ity
C:.'b►r+y. PP,,, kt
Aj
Email Signature V
Business Landowner (Provide corporate resolution on signatory authority)
I, IVI4A i SO jrylX f a n N- , a Notary Public of the County of o/at
State of IV hereby certify that ✓i
personally came before me this day and acknowledged that he is � U,
of► 'Ae!j Pezyi aV and acknowledged, on behalf of ?o,24C {�'��✓Y�-E �Y1'i loGt.L,,�
L L L , the due execution of the foregoing instrument.
Witness my hand and official seal, this i f day of
20 2 Z
Notary Publ,}e`
My commission expires 74 20 2lL
+
Individual Landowner = ;
I a Notary Public of the County of
State of hereby certify thatk�COV�.�`'�
personally appeared before me this date and under oath acknowledged that the above form was executed by them.
Witness my hand and official seal, this
My commission expires
20
day of
Notary Public
5E-03 Rev.07106