NCC241590_FRO Submitted_20240606

c,p°ivTA Gaston County
R. 'z' .c. •�t Gaston Natural Resources Department
1303 Dallas-Cherryville Hwy. Dallas, N.C. 28034 Telephone: [phone]
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4.tdRAL-.s�o\ Soil Erosion & Sedimentation Control
al 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)
PART A;
1. Project Name Hudson Commons
2. Location of land-disturbing activity
City Gastonia Highway/Street E.Hudson Blvd. (SR 1255)
Latitude 35.2330152 Longitude -81.1275215
3. Approximate date land-disturbing activity will commence 01/01/2024
4. Purpose of development (residential, commercial, industrial, etc.) Commercial(Self-Storage)
•
5. Total acreage disturbed or uncovered (including off-site borrow and waste areas) 5.00
6. Amount of fee enclosed $2,000.00
7. Soil Erosion & Sedimentation Plan Filed? Yes I Enclosed I__ No,
8. Landowner(s) of Record (Use blank page to list additional owners)
LeoTerra Hudson, LLC
Name Name
110-A Shields Park Drive
Mailing Address Mailing Address
Kernersville NC
City State Zip City State Zip
[phone]
Telephone Number Telephone Number
9. Indicate Deed Book and Page where deed(s)or instrument(s) are recorded
Deed Book 5446 Page 1723-1727
Deed Book Page
10. Tax Map No. Block Lot No.
Page I

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 landowner's 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.
LeoTerra Hudson,LLC Kat Lyons
Name Contact Name for Inspection Reports
110-A Shields Park Drive kat,[e-mail]
Street and Mailing Address Email Address
Kernersville NC 212R4 [phone]
City State Zip Telephone Number
[phone]
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.
Name
Street and Mailing Address Email Address
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.
li
George Price
Name
110-A Shields Park Drive
Street and Mailing Address Email Address
Kernersville NC 27284 [phone]
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.
Christoph, yons Manager
Type .,0, ►!• Title or Authority
1 2-il T-13
Signature Date
I, Dana Sandkn.. , a Notary Public of the County of Guilford , State of North
Carolina, hereby certify that Christopher Lyons appeared personally before me this day
and being duly sworn acknowledged that ,terabo p form was executed by him.
Witness my hand and notarial seal, th.S" iI SANWr of December , 2 023
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(.....i."..?4-P .i..Q • ;inisio� 0
:cps. =12/26/2024
Notary _ :-�� lit m'• (nity Commission Expires
G''.o '2VSLIG V
O fi•ber 26 1:-/-k• Page 2
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Erosion and Sedimentation Control Permit Submittal Checklist
Document Submittal Requirements
FRO has created a Citizens Self Service (CSS)
Completed, Signed, and Notarized FRO Portal Account and the account has been
✓ Form (to be signed by person financially verified
responsible for the project and no item
should be left blank, mark N/A if needed) Copy of most current Deed for the site
Landowner of Record Authorization Letter Name and contact information of NC Registered
(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 Calculations (utilize remaining checklists to
ensure complete submittal)
Plans - Location Information and General Site Features
Project Location 7 Roads, Streets
North Arrow 177r Scale
I Adjoining lakes, streams, or other major
drainage ways Property lines
Legend Existing Contours
Proposed Contours Limit and acreage of disturbed area
I
Planned and existing building(s) location • Planned and existing road(s) location and
and elevations elevations
Lot and/or building numbers Land use of surrounding areas
Rock outcrops Seeps or springs
Wetland limits Easements
Streams, lakes, ponds, drainageways,
✓ dams; also, any official wetland, stream, 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
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.
Stockpiled topsoil or subsoil location(s) Street profiles
Plans-Vegetative Stabilization
Planned vegetation with details of plants, seed,
, mulch, fertilizer NOTE: Plan should include
Areas and acreage to be stabilized provisions for groundcover in accordance with
NPDES Construction Stormwater General
Permit NCG010000
Page 3

I Specifications of permanent and temporary ❑ Method of soil preparation
vegetation
Plans - Site Drainage Features
Existing and planned drainage patterns
(include offsite areas that drain through )k-1 Size of areas to be disturbed (acreage)
project)
IX Size and location of culverts and sewers X Soils information (type, special characteristics)
Design calculations and construction for Design calculations, cross-sections, and method
X culverts and storm sewers 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
) 1 storm sewer outlets (for rip-rap aprons, ]
include stone sizes(diameters) and apron outlets
dimensions)
Design calculations and construction details Name of receiving watercourse or name of
❑ to control groundwater i.e., seeps, high )Ei] municipal operator(only where stormwater
water table, etc. discharges are to occur)
Plans - Erosion Control Measures
LX Legend X1 Location of temporary and permanent measures
>7 Construction drawings and details for ¶ Design calculations and construction details for
temporary and permanent measures sediment basins and other measures
Maintenance requirements during Person responsible for maintenance during
f Xconstruction XI construction
❑ Maintenance requirements and responsible
person(s) for permanent measures
Plans - Other Requirements
❑ Narrative describing construction sequence Narrative describing the nature and purpose of
(as needed) the construction activity
Construction sequence related to sedimentation
and erosion control (include installation of
land-
LI Bid specifications regarding erosion control critical measures prior to initiation of the
disturbing activity and removal of measures
after areas they serve have been permanently
stabilized)
Page 4