NCC241109_FRO Submitted_20240411

°Q�NTr Gaston County
R ' .` Gaston Natural Resources Department
a `+ i p 1303 Dallas-Cherryville Hwy. Dallas, N.C. 28034 Telephone: [phone]
,,;tl Soil Erosion & Sedimentation Control
4. f Financial Responsibility/Ownership
No person may initiate any land-disturbing activity on one (1) or more acres of property in all portions of
Gaston County, except for that property within the city limits of the incorporated municipalities of Gaston
County who have not adopted the Gaston County Soil Erosion & Sedimentation Control Ordinance,
before this form and an acceptable Soil Erosion & Sedimentation Control Plan have been completed and
approved by the Gaston County Natural Resources Department's staff.
(Please type or print and, if question is not applicable, place N/A in blank)
EARL A:
1. Project Name Dollar General-Dallas Store#30459
2. Location of land-disturbing activity
City Dallas Highway/Street 429 Old NC 277 Loop Road-Dallas,NC
Latitude 35.328742 Longitude -81.229225
3. Approximate date land-disturbing activity will commence April 2024
4. Purpose of development (residential, commercial, industrial, etc.) Commercial
5. Total acreage disturbed or uncovered (including off-site borrow and waste areas) 1.so acres
6. Amount of fee enclosed $800
7. Soil Erosion & Sedimentation Plan Filed? Yes �— Enclosed{ _ No
8. Landowner(s)of Record (Use blank page to list additional owners)
Teramore Development,LLC
Name Name
PO Box 6460
Mailing Address Mailing Address
Thomasville GA 31753
City State Zip City State Zip
229-516-4289
Telephone Number Telephone Number
9. Indicate Deed Book and Page where deed(s)or instrument(s) are recorded
Deed Book 5464 Page 405
Deed Book Page
10. Tax Map No. _ Block Lot No.
Page 1

PART B:
1. Person(s)or firm(s)who are financially responsible for this land-disturbing activity. NOTE: if FRP is not the
Landowner of Record Part A:8., include with this form the landowners signed and notarized written consent for the
applicant to submit a draft erosion and sedimentation control plan and to conduct the anticipated land disturbing
activity.
Teramore Development,LLC Joe Strickland
Name Contact Name for Inspection Reports
214 Klumac Road-Suite 101 [e-mail]
Street and Mailing Address Email Address
Salisbury NC 28144 704-224-7364
State Zip Telephone Number
704-224-7364
Telephone Number Fax Number
2. If the Financially Responsible Party is not a resident of North Carolina, give the name and street
address of a North Carolina agent.
Joe Strickland
Name
214 Klumac Road-Suite 101 [e-mail]
Street and Mailing Address Email Address
Salisbury NC 28144 704-224-7364
City State Zip Telephone Number
3. If the Financially Responsible Party is a Partnership or other person engaging in business under
an assumed name, attach a copy of the certificate of assumed name. If the Financially
Responsible Party is a corporation, give the name and street address of the Registered Agent.
N/A
Name
Street and Mailing Address Email Address
City State Zip Telephone Number
4. The above information is true and correct to the best of my knowledge and belief and was
provided by me under oath. (This form must be signed by the financially responsible person if an
individual or his attorney-in-fact, or, if not an individual, by an officer, director, partner, or
registered agent with authority to execute instruments for the financially responsible person). I
agree to provide corrected information should there be any change in the information provided
herein. fr
Joe Stricklandi/_ --- __ Registered Agent
Type or Fyint Name \ Title or Authority
__ � - --� March 4, 2024
iSignature Date
I, � L A LJ14 , a Notary Public of the County of A t.t"'4-A/ ,State of North
Carolinay,ihereby c rti hat .D—U S';�`,['c k iVZ appeared personally before me this day
and being dulyswor acknowledged that th `e above form was executed by him.
Witness my hand no,t riall seal, this ` ' / day of /74.4--i- , 2 0z-4 .
✓ `= G' J U.VE, Z Z U 27
Nota SEAL My Commission Expires
DANIEL R.ALMAZAN
NOTARY PUBLIC
Rowan County Page 2
North Carolina
My Commission Expires June 28,2027

Erosion and Sedimentation Control Permit Submittal Checklist
Document Submittal Requirements
FRO has created a Citizens Self Service (CSS)
Completed, Signed, and Notarized FRO n Portal Account and the account has been
Form (to be signed by person financially verified
I V I responsible for the project and no item
should be left blank, mark N/A if needed) [7 Copy of most current Deed for the site
roil Landownerof Record Authorization LetterEll Name and contact information of NC Registered
v I (if the FRO is not the landowner of record) Agent, if applicable
Copy of Certificate of Assumed Name, if � Complete set of Erosion Control Plans and
applicable I� I Calculations (utilize remaining checklists to
ensure complete submittal)
Plans-Location Information and General Site Features
V Project Location l? l Roads, Streets
✓ North Arrow I4-] Scale
Adjoining lakes, streams, or other major
ri drainage ways Property lines
✓ Legend V Existing Contours
V Proposed Contours V Limit and acreage of disturbed area
FijiI�' I
Planned and existing building(s) location V Planned and existing road(s) location and
and elevations elevations
Lot and/or building numbers V Land use of surrounding areas
Rock outcrops Seeps or springs
Wetland limits V Easements
Streams, lakes, ponds, drainageways,
dams; also, any official wetland, stream, n Boundaries of the total tract
and/or watercourse delineation report(s)
Plans - Borrow and Waste Areas
If the same person conducts the land-disturbing activity and any related borrow or waste activity shall
constitute part of the land-disturbing activity unless the borrow or waste activity is regulated under the
I 1 Mining Act of 1971, or is a landfill regulated by the Division of Solid Waste Management. If the land-
disturbing activity and any related borrow or the same person does not conduct waste activities, they
be considered separate land-disturbing activities.
I I Stockpiled topsoil or subsoil location(s) I� I Street profiles
Plans-Vegetative Stabilization
Planned vegetation with details of plants, seed,
mulch, fertilizer NOTE: Plan should include
✓ Areas and acreage to be stabilized n provisions for groundcover in accordance with
NPDES Construction Stormwater General
Permit NCG010000
Page 3

Specifications of permanent and temporary
vegetation C Method of soil preparation
Plans-Site Drainage Features
� Existing and planned drainage patterns
I I (include offsite areas that drain through I- I Size of areas to be disturbed (acreage)
project)
✓ Size and location of culverts and sewers ✓ Soils information (type, special characteristics)
Design calculations and construction for Design calculations, cross-sections, and method
culverts and storm sewers IV I of stabilization of existing and planned channels
(include temporary linings)
Design calculations and construction details
of energy dissipaters below culverts and Soil information below culvert and storm sewer
I 1 storm sewer outlets (for rip-rap aprons, I I outlets
include stone sizes(diameters) and apron
dimensions)
Design calculations and construction details Name of receiving watercourse or name of
to control groundwater i.e., seeps, high i/ municipal operator(only where stormwater
water table, etc. discharges are to occur)
Plans- Erosion Control Measures
I- I Legend n Location of temporary and permanent measures
WIConstruction drawings and details for Design calculations and construction details for
`�' I temporary and permanent measures sediment basins and other measures
V Maintenance requirements during Person responsible for maintenance during
construction construction
WIMaintenance requirements and responsible
person(s)for permanent measures
Plans-Other Requirements
✓ Narrative describing construction sequence I i Narrative describing the nature and purpose of
(as needed) the construction activity
I Construction sequence related to sedimentation
and erosion control (include installation of
I? I Bid specifications regarding erosion control v critical measures prior to initiation of the land-
disturbing activity and removal of measures
after areas they serve have been permanently
stabilized)
Page 4