NCC223852_FRO Submitted_20221117

CITY OF GREENSBORO
FINANCIAL RESPONSIBILITWOWNERSHIP FORM
SEDIMENTATION POLLUTION CONTROL ACT
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No person may initiate any land -disturbing activity covered by the Sedimentation Pollution Control Act before this form
has been completed and filed with the Sediment and Erosion Control Section of the City of Greensboro. (Please type
or print and, if questions are not applicable, place N/A in the blank).
Part A:
1. Project Name: JJAVDEI i jOAP-k
2. Location of land -disturbing activity: of iJ-W_'k-VPJ-iAVe- g W. ,A1J04DALf' Pg.
3. Approximate date land disturbing activity will be commenced: _A�5 4 r
4. Development type: Commercial Industrial Institutional_ MF residential SF residential C
5. Approximate acreage of land to be disturbed: J. °1 %y AL
6. Has an erosion and sediment control plan been filed? Yes_ No
7. Landowner(s) of Record (attach pages to list additional owners):
6JZAWViLLE gpMES, Lt.G
Name
73V9 W. rktCNDL`; ,¢Wr.� SuiT1�7 la
Current Mailing Address
6o-ZEASgogtr k' 2,71ic
City State Zip
8. Deed County: CJIL(--bR1)
356 202-850 ic"M-YIranyi��'�o►»e.cc��
Telephone Email
Current Physical Street Address
City State
Book: &SS7
Page: �-4(;
9. Person to contact should erosion and sediment control issues arise during land -disturbing activity:
Name: WILL YE_AgAlS
E-mail: wraav ns@r+�gr� �►�l,tj�l�orlc. �et+�i
Part B:
Telephone: 4334 ) zc.. $Sly
Other:
Zip
1. Company(ies) or firms) who are financially responsible for the land -disturbing activity (Provide a comprehensive
list of all responsible parties on an attached sheet.) If the company or firm is a sole proprietorship the name of the owner
or manager may be listed as the financially responsible party.
CgAkIVILLE
Name
73g9 W. R tT1PL-`' AVE •_ 56T N
Current Mailing Address
Telephone Email l
Current Physical Street Address
C;;zEETIa`�Gk'� i�L 27yiD
City State Zip City State Zip

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:
Name
Telephone Email
Current Mailing Address
Current Physical Street Address
City State Zip
City State Zip
(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
Telephone Email
Current Mailing Address
Current Physical Street Address
City State Zip
City State Zip
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
be any change in the information provided herein.
lw i l 13 Yeu r A& .� Awki(?j-er—
Type or print name Title or Authority
J3fa,k
Signat Date
Notary Public of the County of U (A l `wdl
State of N O I/ A car[) n C hereby certify that vol tf��d �j. v eA V-4 S �'
Personally accepted before me this day and under oath acknowledged that the above form was
executed by owner(s).
Witness my hand and notarial seal, this �S day of JMA 20_j'Z_
My Commission expires
Ca Nen
NOTARY PUBLIC
Guilford County, NC
My Commission Expires June 21, 2025

CITY OF GREENSBORO
WATER RESOURCES DEPARTMENT
SEDIMENT AND EROSION CONTROL SECTION
GREENSBORO
RESPONSIBILITY: The owner of any property within the City limits of the City of
Greensboro where a land -disturbing activity is taking place, shall be solely responsible for any
off -site damage to adjacent property or to City streets (mud and erosion in street), that may
have been caused by the lack of erosion control measures and poor maintenance. The soil
erosion measures detailed on your plans are the minimum required by the City of Greensboro.
When conditions become apparent the owner/developer may be required by the City of
Greensboro to have his/her engineers to design or redesign additional measures/devices to
assure land protection.
1. Erosion Control measures shall be installed prior to grading and according to plans or as
directed by the City of Greensboro's Erosion Control Inspector.
The approval of the Erosion Control plan does not mean that additional measures may
not be required to stop off -site sediment.
3. The Owner/Developer shall require the Contractor to take every reasonable precaution
throughout construction to prevent erosion of soil and sedimentation of streams, lakes,
reservoirs, other impoundments, ground surfaces or other property, as required by
Chapter 30, Soil Erosion and Sedimentation Control, of the Code of Ordinances, City of
Greensboro, North Carolina.
4. The Owner/Developer is responsible for maintaining the erosion and sediment control
devices for the duration of the construction.
a. Inspect the site after each rain and periodically to ensure workmanship is according
to plan and site is in compliance with the Erosion Control Ordinance.
b. Repair or replace damaged or inoperative devices as directed by the Soil Erosion
Inspector within a reasonable time or time set forth by the inspector.
c. Keep mud off city streets
5. If eroded soil from the site is deposited on adjacent property, public street or into a
waterway, the Owner/Developer shall be responsible for returning the adjacent property,
city street or waterway to its original condition satisfactorily to the City or the owner of
the property.
6. After placement of asphalt binder on newly constructed street the shoulder shall be
seeded within fourteen (14) days according to the Seeding Specifications.

7. Temporary or permanent groundcover shall be provided on all perimeter areas and
slopes 3:1 or greater within 7 calendar days following completion of any phase of
grading. Provide groundcover for all disturbed areas within 14 calendar days following
completion of construction or development.
8. The Owner/Developer must plan site work so stone placement on drive entrance,
driveway and parking lot can start immediately after fine grading.
The Owner or Responsible Party is responsible for the long-term maintenance of the
groundcover on the property. Groundcover must be maintained to a degree that
prevents soil erosion and sedimentation at all times. The City of Greensboro has the
authority to require changes in the owner's groundcover maintenance plan in order to
stop soil erosion and sedimentation at any time.
Section 30-5-5.4 (B) — Specific Civil Penalties
Any person who violates any of the provisions of this chapter, or rules or orders adopted or
issued pursuant to this chapter, or who initiates of continues a land -disturbing activity for which
an erosion control plan is required except in accordance with the terms, conditions, and
provisions of an approved plan, shall be subject to a civil penalty of up to five thousand dollars
($5000.00) per day. No penalty shall be assessed until the person alleged to be in violation has
been notified of the violation by registered or certified mail return receipt requested, or other
means. The notice shall describe the violation with reasonable particularity, give the person a
reasonable time period to correct the violation and state that failure to correct the violation will
result in assessment of a civil penalty of up to five thousand ($5000.00) per day or other
enforcement action including criminal penalties. Each day of continuing violation shall constitute
a separate violation. The city council shall determine the amount of the civil penalty to be
assessed under this subsection and shall make written demand for payment upon the person in
violation, and shall set forth in detail a description of the violation for which the penalty has been
imposed. In determining the amount of the penalty the governing body shall consider the
degree and extent of harm caused by the violation and the cost of rectifying the damage. If
payment is not received or equitable settlement reached within thirty (30) days after demand for
payment is made the matter shall be referred to the city attorney for institution of a civil action in
the name of the city in the appropriate division of the general courts of justice for recovery of the
penalty. Any sums recovered shall be used to carry out the purposes and requirements of this
chapter.
Signature: Date:
Owner (Print): Gi�gr1'yilLf_ ifbi✓lrS Date: v( °f laGd a,
Project Address: WFgiL--►✓PLYAVE, W. QVvrJpALE D9 , KEE-7k69o1ZQ w 2 7ja3

City of Greensboro, NC
Grading Permit Application
2nl EWtORO
cuoux.
Owner Information: Permit #:
Company 6RAN'01_l,E 140HES PLC. Contact Wii.L IJ A&Z s Pgg-5 i F4
Address 7399 iJ, E9iL-� 0LY A� F� 0 Sul Tc H Phone No. (334,) ZCZ' 8514
GREEIJS BO96 TtC 27q1Ci
Project Information:
Project Name HAYVAN ?ARK
Address ad.t=1Zic`n1D1.. AyEW)Ir A14D
W AVL)141)A LG niz l�IF
Area Graded 1.75 Acres and/or sq.ft.
Proposed Use of Property j;* 5A1_E
Email W, eawhS QMX 4"Y)1/1k lie Lome com
,�
Latitude 3/c , Og `l i Z 2 Longitude -79.83S 3 y7a
Tax Map 239et..,23epoi.92.39Q. f 2;96
Site Area 1.'l2.q Acres and/or sq.ft.
Zoning PJD 1 C(2'52)
7
Brief Description of Project Location T416 iS i.e.CAijW A-rTj4L' dF
d E4c- pL� AVE?U,'E A)40 W. AVatal hc.K DRt ✓"FT41S s/ 7E /5 d N LoPr'0 517C QF r,_lr-AJPL' CpTa,
Brief Description of Development Plan 7 /4 i.S D E CLopt%J EW'1 Cog51 TS of 23 T owNHOME UtJ T Fo
SALT W+TN Fg jVATE DetW3=S.
If this application is approved by the properly designated authorities and a grading permit issued, the undersigned does hereby agree to
comply with all applicable City regulations under the Greensboro Soil Erosion and Sedimentation Control Ordinance as described in
Chapter 30-12-6 of the Greensboro Land Development Ordinance.
Before beginning any grading operation, call for an on -site pre -construction meeting, and when area has been protected, call for final
inspection.
Signature of owner, developer, or agent: Date: 141jr,/a
Approved by
Permit No.
Tracking No.
Surety Amount
Surety Number
Temporary Measures Approved
Final Inspection Approved _
Date Approved
FOR OFFICE USE
Date
Date
Tracking Type: TRC Grading
Surety Type: LOC SCB HOD Check
Surety Expiration Date
Date
Date

DRIVEWAY PERMIT APPLICATION CITY OF GREENSBORO, NC
ZIP /, ZYi`S ; vie's 1 407 . 21 d 9I 2-101 1�13 -cb, Z 9IS', 2K 17, 3247
LOCATION OF PROPERTY 310�i :�ll/t 32/5;- 3Z13y Cc" 3217� 321 q�
32t/� 31Z3,. 7z25, 32y.i, �22�� 3131�
Access requested from 3 Z 3 3 f 2 35, 32 37 WDFW P,49 K LAVE to i�l E5T AJiSN t7A Lr= P2l 1/E
Street Address Street Name
DEVELOPMENT TYPE
Q, ESIDENTIAL� COMMERCIAL INDUSTRIAL CHURCH/SCHOOL OTHER
r
DRIVEWAY 1: Proposed width 2q feet, centerline located IqO feet north / sout j east / west (circle one) of the intersection of
14ES Fgli:-WAL. AVC),JUE and WeST 4Vb; A4LE DF.iV•E'
Street Name Street Name
DRIVEWAY 2: Proposed width feet, centerline located feet north / south / east / west (circle one) of the intersection of
Street Name
DRIVEWAY 3: Proposed width feet, centerline located
Street Name
AGREEMENT
and
and
Street Name
feet north / south / east / west (circle one) of the intersection of
Street Name
I, the undersigned applicant, on behalf of the named property owner, request permission to construct driveway(s) on public right-of-way at
the above location(s) and agree to the following:
• to construct driveway(s) In absolute conformance with current City standards and approved plans as applicable;
• to provide necessary sight distance easements if deemed necessary by the City;
• to promptly repair areas disturbed by construction in City right-of-way;
• to provide and be responsible for work zone traffic control measures In and adjacent to City right-of-way in conformance with
guidelines established by the City of Greensboro's WonkAree ?traffic Control yancfbook (W4 tCN), and the /.yant al en
lrn/ralm Tralia'r QIhIM/ heWr*& (MLTCb, M1/111Jneun7 L'dition),
• to maintain driveway(s) In a manner so as not to interfere with or endanger public travel;
• to indemnify and save harmless the City of Greensboro from all damages and claims for damage that may result from this
construction; and
• to notify the City of Greensboro Department of Transportation not less that 48 hours prior to beginning work.
I understand that any permit issued based on this application becomes void If construction of the driveway(s) is not completed within one (1)
year of the aaorovai date shown on the hermit.
Owner 69A4VILL6' /401yE5'.1;,LC
Address 73Y9 rJ•l=Qr ilJt�AVE-/ Sl1/7E H
city G @(L ew'-s 0w State A)C Zip 27'//0
Tel No. (?3J4 Zot_ U/1 FAX No.
Signature 4e4 �f,' Date
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Mt/CE 1(&J,49c.E w/
Applicant CPT C-W6J9 uV AAtD SyeV,5Y1A16r
Address y460 'TVVIV6. 5ra >^
City H1614 Pa IA17' State AAC Zip Z726S
Tel No. (336) R1I-9900 FAX No. (334)W -9780
Signature 10 Date _qj7 /91 3Z
PROVIDE A SKETCH OF PROPOSED DRIVEWAY(S) ON REVERSE SIDE OR ATTACH SITE PLANS. SUBMIT THREE (3) COPIES OF
COMPLETED APPLICATION AND PLANS TO THE DEPARTMENT OF TRANSPORTATION, P.O. BOX 3136, GREENSBORO, INC
27402-3136. CALL [phone] FOR ADDITIONAL INFORMATION.
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