NCC223046_FRO Submitted_20220826

GUILFORD COUNTY
FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
DEPARTMENT OF PLANNING AND DEVELOPMENT
A Grading Permit must be obtained before initiating any land -disturbing activity over one (1) acre (43,560 square feet). A
Grading Permit Application, this Financial Form, a Grading/Erosion Control Plan, a surety, good for one (1) year, and a
permit fee should be submitted 30 days prior to the planned commencement of the land -disturbing activity.
The above information should be submitted to:
Please type or print answers to the following:
Ear[ E. Davis 11- Inspections Division
Guilford County Planning and Development
Post Office Box 3427
Greensboro, KC. 27402 [phone]
Date: Au ust 25 2Q21
Name of Project: Belews Rid a Phase 2
Location of Project: 8900 Belews Creek Road
Acreage of Land to be Disturbed; 23.4
LATITUDE 36,2436 (In Degrees) LONGITUDE-80.0272 (in Degrees)
Purpose of Activity (street construction, co€nmercial building, parking lot, etc.): House construction for Residential Development
Landowner(s) of record:
Name: H&H Contractors of Fayetteville, LLC
Address: 7200 Falls of Neuse Rd.
Raleigh. NC 27616
Telephone: (Home)
(Office) 843-468-8271
(Fax)
(E-Mail) [e-mail]
Indicate County, Book, and Page where deed or instrument is tiled.
Guilford
Cotorty
Book
Name:
Address,.
Telephone; (Home)
(Office)
(Fax)
(E-Mail)
Page
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. 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. If the person financially responsible is not a resident of North Carolina,_a Noilli Carolina
anent must be designed. fed. If someone other than the owner is financially responsible, their signature is required below also.
Leon O'Rourke
Print or Type Name of Individual
Dlvlslon Manager, H&H Contractors of Fayetteville. NC
Title a ame of rnpany
�!l'pl
Owner's Signature
N. C. Agent's Signature (if applicable}
Additional Financially Responsible Party (if applicable)
No. E2 Grading Permit & Appl. Rev, December 2017 Page 3 of 6

67
PLEASE READ THE FOLLOWING INFORMATION.
If a Grading Permit is issued it is valid for up to one (1) year from the date it is issued. If circumstances warrant it, it may
be extended for six (S) months after the one (1) year peijod. Upon written notice the Grading Permit may be revoked for
failure to install devices as shown on the plan in a prompt fashion, or for failure to maintain the devices once they have been
installed. If Grading Permit is revoked, all other development permits and approvals are withheld until the property is once
again in compliance with Guilford 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 Guilford County's So!]
Erosion and Sedimentation Control Ordinance. This penalty is up to $5000.00 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).
STATE OF
COUNTY OF
(OMM SIGN TURF
1, a Notary Public of said County and State, do hereby certify that
j._,ec,a a,Rotj-Ve .. 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.
Witness my hand and official seal, this the day of Nate m, 20-44.
C�p4lii, .
Notary Public
My Commission Expires: ti rotary, Putilictf
Curnbodand C., -
County
My ConAT). EXP.
(SEAL)
STATE OF (ADDITIONAL FINANCIALLY RESPONSIBLE PARTY SIGNATtJR
COUNTY OF
I, a Notary Public of said County and State, 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.
Witness my hand and official seal, this the day of 20 _
My Commission Expires;
Notary Public
(SEAL)
No. E2 Grading Permit & Appl. Rev..... December 2017 Page 4 n

A
GUILFORD COUNTY GRADING PERMIT RL UIREM EaNTS
A grading permit trust be obtained before any area over 43,566 square feet (one (1) acre) is grubbed or graded.
The Inspections Division requires that four (4) copies of Elie Erosion Control/Grading Plan be submitted for review thirty (30) days
prior to commencement of activity.
An Application and Financial Ownership Responsibility corm must be submitted and signed by the property owner or one who has
power -of -attorney for the owner. North Coralina resident signature re aired. if erson financially res nonsible is not a
resident ofNorth _Carolina).
A surety is required before a grading permit can be issued. The amount is determined by multiplying $1,500.00 x acre(s) disturbed
($2,000.00 per acre for landfill). The ro erty Owner must provide this. A surety must be cash, cashier's check, performance bond,
Irrevocable letter of Credit, or escrow account payable to Guilford County.
Pay the appropriate grading permit fee see fee schedule), One (1) copy of the Erosion Control/Grading Plan must be sent to the Sol!
and Water ConservOlon District for their review if the disturbed area is greater than one (1) acres. Mail to: 3309 Burlington Road,
Greensboro, N.C. 27405, Telephone Number 336-375-5401.
COMPONENTS .FOR A COMPLETE EROSION CONTROL/GRADING PLAN
Name of Project
Nance, Address and Telephone
Number of Owner(s)
Engiucer, Architect or Surveyor's Seas
Engineer, Architect or Surveyor's Name,
Address and Telephone
North Arrow
Scale and legend of Symbols
Construction Sequence
Vicinity Map
Soil Type(s)
Adjoining Property Owner(s)
Tax Map Number(s)
Zone of Property
Total Acres in Tract
Area to be disturbed tl„ i,G� red with number of graded acres noted. (Easements are to, be included if they will be disturbed).
Area left undisturbed and condition of such (vegetated?) should be denoted with size indicated.
All creeks, rivers, ponds, lakes, railroad tracks, existing structures, etc., should be noted.
Proposed site improvements should be noted (roads, parking, easements, struc(ures, etc.). Submit one (I) copy of street profiles.
Temporary sediment control measures (design, locations, dimensions, calculations, cross -sectional details),
Permanent erosion control measures (design, locations, dimensions, calculations, cross -sectional details).
Stormwater° Network (swales, culverts, iniet and outlet structures with grades, elevations, dimensions and hydrologic calculations),
Include design storm,
Seeding specirications (seedbed preparation, lime, fertilize, seed, mulch and tack rates).
Topography, both before and after grading, with elevations noted off edge of property.
Watershed requirements are to be reflected on the Erosion ControVGrading Plan.
No. E2 Grading Permit & Appl, Rcv. December 2017 Page 5 of