SW6111101_COMPLIANCE_20111118

STORMWATER DIVISION CODING SHEET
POST -CONSTRUCTION PERMITS
PERMIT NO.
SW
DOC TYPE
❑ CURRENT PERMIT
❑ APPROVED PLANS
❑ HISTORICAL FILE
COMPLIANCE EVALUATION INSPECTION
DOC DATE
2`1/11W
YYYYMMDD

Patterson, Robert
From:
Patterson, Robert
Sent:
Friday, November 18, 2011 10:02 AM
To:
'Tom Goodwin'
Subject:
Wedgefield Subdivision Ph. II
Tom,
Have a question about the off -site DAs that are routed to the pond. The application and plans state that the BUA in the
off -site DAs is zero, but it appears to include a portion of Carolina Dr. Also, a future build out must be estimated and
BUA included for the currently undeveloped off -site area being routed to the pond. Can you please clarify?
Thanks.
Robert D. Patterson, PE
Environmental Engineer
NCDENR I DWQ I Stormwater Permitting
1617 Mail Service Center, Raleigh, NC 27699-1617 Mail 1 512 N. Salisbury St, Raleigh, NC 27604 19� Floor LOCNLIOn &. Pnreel5
[phone] Phone [phone] I,as I Robert. Pattersonnncclenr.eov Ismail I http://portal.ncdetir.ork/web/wa/ws/su Wcbsitc
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FINANCIAL RESPONSIBILITYIOWNERSHIP FORM
V SEDIMENTATION POLLUTION CONTROL ACT N011 it
No person may initiate any land -disturbing activity on one or more acres as covered by the Act before this ..
form and an acceptable erosion and sedimentation control plan have been completed and approved by the
Land Quality Section, N.C. Department of Environment and Natural Resources. (Please type or print and, Lp�
the question is not applicable or the e-mail and/or fax information unavailable, place NIA in the blank.) DEN R _ FR®
Part A. NOV U J (u"
i
1. Project Name Wedgefield Subdivision,
�e ems— S7
2. Location of land -disturbing activity: County Hoke City or Township McLauchlan
Highway/Street: Carolina Drive Latitude 35.0359 Longitude-79.1157
3. Approximate date land -disturbing activity will commence: November 2011
4. Purpose of development (residential, commercial, industrial, institutional, etc.): Residential
5. Total acreage disturbed or uncovered (including off -site borrow and waste areas): 36.35 \
6. Amount of fee enclosed: $2,405.00 . The application fee of $65.00 per acre (rounded
up to the next acre) is assessed without a ceiling amount (Example: a 9-acre application fee is $585).
7. Has an erosion and sediment control plan been filed? Yes No Enclosed X
8. Person to contact should erosion and sediment control issues arise during land -disturbing activity:
Name R. Carroll Thomas E-mail Address [e-mail]
Telephone [phone] Cell# 910476-6000 Fax# [phone]
9. Landowner(s) of Record (attach accompanied page to list additional owners):
Raymond Carroll Thomas
Name
605 S. Reilly Road
Current Mailing Address
910-864-0864 910-484-6800
Telephone Fax Number
605 S. Reilly Road
Current Street Address
Fayetteville NC 28314 Fayetteville NC 28314
City State Zip City State Zip
10. Deed Book 727 Page No. 112-117,623-625 Provide a copy of the most current deed.
Part B.
1. Person(s) or firm(s) who are financially responsible for the land -disturbing activity (Provide a
comprehensive list of all responsible parties on an attached sheet):
Raymond Carroll Thomas
Name
605 S. Reilly Road
Current Moiling Address
Fayetteville NC 28314
City State Zip
dloes(a)nc.rr.com
E-mail Address
605 S. Reilly Road
Current Street Address
Fayetteville NC 28314
City Slate Zip
Telephone [phone]
Fax Number 910-484-6800

2. (a) If the Financially Responsible Party is not a resident of North Carolina, give name and street address
of the designated North Carolina Agent:
Email Address
Current Mailing Address Current Street Address
City Stale Zip City State Zip
r. t
Telephone Fax Number
(b) 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 name and street address of the Registered Agent:
Name of Registered Agent E-mail Address
Current Mailing Address
City State Zip
Telephone
Current Street Address
City State Zip
Fax Number
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
the authority to execute instruments for the Financially Responsible Person). I agree to provide
corrected information should there by any change in the information provided herein.
R. Carroll Thomas Owner
Type or Print NNNTitle or Authority
/ill
ig� Date
I. G� I /•ZQ.� L Loe-c , a Notary Public of the County of U- y. e
State of North Carolina, hereby certify that /� (,� ran// 77h / w 5 appeared
personally before me this day and being duly sworn acknowledged that the above form was
executed by him. A I
Witness my hand and notarial seal, this �_ day of y `fQ f/;am �?-1- 20
NoTAgy*N Notary
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