NCC233138_FRO Submitted_20231020

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Soil Erosion and Sedimentation Control
CHATHAM COUNTY N O permit Application
R "1' H C. A R O L [ N i\
Please complete both pages of this form and return to:
Physical Address Mailing Address For Office Use:
80 East St. PO Box 548
Pittsboro, NC 27312 Pittsboro,NC 27312
Phone: [phone]
Please check one of the boxes below for the permit that you wish to apply for:
❑✓ Land-Disturbing Permit:This permit is required for the following activities: (1)all new commercial,land
clearing/development,and non-residential projects greater than 20,000-ft2 and construction of all new residential dwellings
greater than 25,000-ft2 of uncovered or disturbed land
a. The following items are required to obtain this permit
i. Two copies of an erosion control plan which was completed and sealed by a professional land surveyor,professional
engineer,or registered landscape architect. This plan must meet the criteria provided on the Chatham County SESC
Plan Review Checklist and must include all disturbance and clearing for the project including driveways,yards,and
septic systems for residential projects.
ii. A permit fee of$250/acre of disturbance and a plan review fee for$250/acre of disturbance. These are rounded up
to the next whole acre. Example 1 acre or less is$500, 1.1-2 acres is$1,000,2.1-3 is$1,500.
❑ Multi-Lot Residential:This permit is required for all multiple lot construction in the same subdivision by the same builder that
cumulatively disturbs greater than 25,000-f0. All submittal requirements are the same as the Land-Disturbing Permit listed
above.
❑ Residential Lot Permit:This permit is required for all disturbance related to home building activities that do not exceed 25,000-
ft2 of disturbance. This disturbance must include driveways,yards,and septic system clearing. The following required submittals
must be submitted to Central Permitting when you apply for your Building Permit.
a. The following items are required to obtain this permit
i. A plot plan showing clearing boundaries and approximate location of the areas listed above must be included. This
plot plan is not required to be completed by a surveyor or engineer.
ii. A permit fee of$100 must be paid to Central Permitting when you apply for your building permit.
Should you have any questions regarding the above permits or required submittals please contact:
Land Development/Commercial Projects Residential/Multi-Lot Residential Projects
Morgan DeWit,PE Drew Blake
Senior Watershed Specialist Watershed Specialist
919-542-8268 919-545-8394
[e-mail] [e-mail]
Residential Lot Permits
Robyn Wharton
Watershed Specialist
919-545-8344
[e-mail]
Page 1 of 3

k- Soil Erosion and Sedimentation Control
CHATHAM COUNTY A R N Permit Application
CI 1- H C' O L I N A
PROJECT NAME: Fearrington Section X Area F-Currituck DATE:
LOCATION OF PROJECT: Millcroft west of Halifax
PARCEL#: 18998
TOTAL DISTURBED ACRES or SQUARE FEET: 0.99 acres
PURPOSE OF ACTIVITY: Single family residential subdivision
FEE AMOUNT SUBMITTED: $500.00
($250/acre plan review fee,$250/acre land disturbing permit fee)
LANDOWNER(S) OF RECORD (attach page to list additional owners)
Name: Fitch Creations, Inc. Phone: [phone]
Address: 2000 Fearrington Village Center Pittsboro, NC 27312 E-mail: [e-mail]
Signature: . -z,21
hi--,,e
FINANCIALLY RESPONSIBLE PARTY (applicable only if different from property owner)
Name: Fitch Creations, Inc. Phone: [phone]
Address: 2000 Fearrington Village Center Pittsboro,NC 27312 E-mail: [e-mail]
Signature: 4 Si Pi,—(2%152
NORTH CAROLINA AGENT(applicable only if owner or financially responsible party does not residein
North Carolina)
Name: Phone:
Address: E-Mail:
Signature:
ENGINEER/SURVEYOR EROSION CONTROL
Company Name: Diehl&Phillips, P.A. Person to contact should erosion &sediment
Address: 1500 Piney Plains Road Suite 200 control issues arise during land-disturbing activity:
Cary, NC 27518 Contact Person: Laura Morgan
Contact Person: Alan Keith, P.E. Company Name: Fitch Creations, Inc.
Phone: [phone] Phone: [phone]
E-mail: [e-mail] E-mail: [e-mail]
Page 2 of 3

CHATHAM COLINTY Soil Erosion and Sedimentation Control
N O 13"IF H CAROLINA
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(1)year 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 or corporation.
OWNER OF PROPERTY:
Name and Title: Greg Fitch, Vice President
Company (if applicab Fitch Creations, Inc.
Signature: ,
ADDITIONAL FINANCIALLY RESPONSIBLE PARTY (if any):
Name and Title:
Company:
Signature:
NORTH CAROLINA AGENT (if any):
Name and Title:
Company:
Signature:
**************************************)***�*************************
[. —Sal; 5f. // L //(i/�Ctn ,a Notary Public of C. 1 �'04--'1 County in the state
of No r4k Carol;r?O.. 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
Witness my hand and official seal,this the J5 day of A1A tA54' , 20
otary Public too
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My commission expires i/ o/ 20.2 7 (SEAL) T NOTARj' y
COMMISSION EXPIRES
C? 11/1/2027
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