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Home My WebLink AboutNCC231798_FRO Submitted_20230612 GUILFORD COUNTY GRADING PERMIT APPLICATION GRADING PERMIT APPLICATION Please type or print answers: Return to:Earl E.Davis II Inspection Planning and Development Post Office Box 3427 Greensboro,NC 27402 (336)641-3334 or(336)641-3880(fax) NAME OF PROJECT: DUTCH FARMS MITIGATION SITE DATE: March 20,2023 LOCATION OF PROJECT: Fields Farm Road,Clay Township.Lat: 35.93167 Long:-79.69869 ACREAGE TO BE DISTURBED: 17.0 ACRES OR( SQ.FEET) TOTAL ACREAGE IN TRACT: ' Project site is contained within a 16.573 acre conservation easement spanning across 3 properties(Parcels 122781.122793,and 122794)that total 82.50 ACRES IS THIS PROPERTY IN A DESIGNATED WATERSHED? Yes-Lake Mackintosh(Big Alamance Creek)WS-IV If so,the project must comply with Guilford County Regulations prior to a Grading Permit being issued. WHAT TYPE OF UTILITIES WILL GO IN DURING CONSTRUCTION?(Water,Sewer,Power,Cablevision, Telephone,etc.) NONE-Stream and Wetland Restoration Project ENGINEER/ARCHITECT/SURVEYOR: Name: DRG Services,P.C. Address: 3101 Poplarwood Court,Suite 120,Raleigh,NC 27604 Telephone: 919.645.4352 Fax: E-Mail: kwilliams()davey.com The Property Owner and additional Financially Responsible Party (if any) do hereby agree to comply with all applicable Guilford County Regulations pertaining to development if a Grading Permit is issued. The Property Owner and additional Financially Responsible Party furthermore, do hereby agree to be responsible for the timely installation and maintenance of erosion control devices throughout the duration of this project. A copy of the Guilford County Development Ordinance is available from the Guilford County Planning and Development Department. OWNER OF PROPERTY: NORTH CAROLINA AGENT(if applicable) Name: 7 he Hauserfields Living Trust(c/o Larry Dean Fields) Name: Address: 5303 Ventura Drive.Greensboro.NC 27406 Address: Telephone: (Home) (Office) 336.337.0777 Telephone: (Home) (Fax) (Office) (E-Mail) (Fax) 7� (E-Mail) Print Name: R/2 D• Signature: — 3 ADDITIONAL FINANCIALLY RESPONSIBLE PARTY: Name: Davey Resource Group,Inc. Telephone: (Home) 919.723.8350 Address: 12637 Scenic Way (Office) Raleigh,NC 27614 (Fax) (E_Mail) dacid.godley,)davey.com Print Name: vi G ev, / Signature: II/ No.E2 Grading Permit&Appl. Rev.December 2017 Page 2 of 6 J 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: Earl E.Davis II-Inspections Division Guilford County Planning and Development Post Office Box 3427 Greensboro,N.C. 27402(336)641-3334 Please type or print answers to the following: Date: March 20,2023 Name of Project: DUTCH FARMS MITIGATION SITE Location of Project: Fields Farm Road. Clay Township Acreage of Land to be Disturbed: 17.0 Acres LATITUDE 35.93167 (In Degrees)LONGITUDE -79.69869 (In Degrees) Purpose of Activity(street construction,commercial building,parking lot,etc.): Stream Restoration Construction Landowner(s)of record: Name: The Hauserfields Living Trust(c/o Larry Dean Fi fi le. Address: 5303 Ventura Drive Address: Greensboro,NC 27406 Telephone: (Home) 336.337.0777 Telephone: (Home) (Office) (Office) (Fax) (Fax) (E-Mail) (E-Mail) Indicate County,Book,and Page where deed or instrument is filed. Guildford 8357 594 County Book 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 North Carolina agent must be designed. If someone other than the owner is financially responsible, their signature is required below also. Z9y 1-671cif Print or Type lame of Individual J N. e (if applicable) Title d Nam o Co a Additiona Ft cially Responsible Party (if applicable) O i e No.E2 Grading Permit&Appl. Rev.December 2017 Page 3 of 6 ( 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(6)months after the one(1)year period. 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 a 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 Soil 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 ikC— l (O ' SIG COUNTY OF 6..;14,G I, Notary Public of said County and State,do hereby certify that Lofty12 /¢/c)S personally appeared before me this day and under oath acknowledged reading the inforaiation above and acknowledged that the above form was executed by him or her. Po/ .n Witness my hand and official seal,this the 23 day of /�'(a ,20 Z5. /---) 1 HI Notary PuilCbli .,,o�N_C_A_N,y#.,,, My Commission Expires: .�- //—/S ZG -o;N-... .,a�, (SEAL) , %�. AUBI-\G �V,- *************************************-°,,,9�1'F COON `�,``` STATE OF NC--- (ADDITIONAL FINANCIALLY RESPONSIBLE PARTY SIGNATURE) /A/ COUNTY OF a4;160P d I I,a Notary Public of said County and State,do hereby certify that ( k) (,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 3 ' ay MO 0 23. scrii / Notary Pub c ,•`'��vNCAN�.9''•; c •-;1 My Commission Expires: �/•�O TA R y\� Il f3 —4 (SEAL) ' - j0(/BL\G •'0 . No.E2 Grading Permit&Appl.Rev. December 2017 ��'","ii''i,"',,` Page 4 of 6 GUILFORD COUNTY GRADING PERMIT APPLICATION GRADING PERMIT APPLICATION Please type or print answers: Return to:Earl E.Davis II Inspection Planning and Development Post Office Box 3427 Greensboro,NC 27402 (336)641-3334 or(336)641-3880(fax) NAME OF PROJECT: DUTCH FARMS MITIGATION SITE DATE: March 20,2023 LOCATION OF PROJECT: Fields Farm Road,Clay Township,LaL 35.93167 Long:-79.69869 ACREAGE TO BE DISTURBED: 17.0 ACRES OR( SQ.FEET) TOTAL ACREAGE IN TRACT: Project site is contained within a 16.573 acre conservation easement spanning across 3 properties(Parcel%122781.122793,and 122794)that total 82.50 ACRES IS THIS PROPERTY IN A DESIGNATED WATERSHED? Yes-Lake Mackintosh(Big Alamance Creek)WS-IV If so,the project must comply with Guilford County Regulations prior to a Grading Permit being issued. WHAT TYPE OF UTILITIES WILL GO IN DURING CONSTRUCTION?(Water,Sewer,Power,Cablevision, Telephone,etc.) NONE-Stream and Wetland Restoration Project ENGINEER/ARCHITECT/SURVEYOR: Name: DRG Services,P.C. Address: 3 101 Poplarwood Court,Suite 120,Raleigh,NC 27604 Telephone: 919.645.4352 Fax: . E-Mail: kwilliamsAdavev.com The Property Owner and additional Financially Responsible Party (if any) do hereby agree to comply with all applicable Guilford County Regulations pertaining to development if a Grading Permit is issued. The Property Owner and additional Financially Responsible Party furthermore, do hereby agree to be responsible for the timely installation and maintenance of erosion control devices throughout the duration of this project. A copy of the Guilford County Development Ordinance is available from the Guilford County Planning and Development Department. OWNER OF PROPERTY: NORTH CAROLINA AGENT(if applicable) Name: Beverly Fields Name: Address: 7225 Company Mill Road.('lim ac,NC 27233 Address: Telephone: (Home) 33C— 17—75,0 (Office) Telephone: (Home) (Fax) (Office) (E-Mail) (Fax) jj�� (E-Mail) Print Name:80 E'RL4 6'1_as Signat - ADDITIONAL FINANCIALLY RESPONSIBLE PARTY: Name: Davey Resource Group,Inc. Telephone: (Home) 919.723.8350 Address: 12637 Scenic Way (Office) Raleigh,NC 27614 (Fax) (E-mai1) david.godlcy@davcy.com Print Name: Eidc,.1Signature: 11.• / f No.E2 Grading Permit&Appl. Rev.December 2017 Page 2 of 6 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 (I) 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: Earl E. Davis II-Inspections Division Guilford County Planning and Development Post Office Box 3427 Greensboro,N.C.27402(336)641-3334 Please type or print answers to the following: Date: March 20,2023 Name of Project: DUTCH FARMS MITIGATION SITE Location of Project. Fields Farm Road, Clay Township Acreage of Land to be Disturbed: 17.0 Acres LATITUDE 35.93167 (In Degrees)LONGITUDE -79.69869 (In Degrees) Purpose of Activity(street construction,commercial building,parking lot,etc.): Stream Restoration Construction Landowner(s)of record: Name: Beverly Fields Name: Address: 7225 Company Mill Road Address: Climax,NC 27233 Telephone: (Home) - 4-- Telephone: (Home) (Office) 33C- 317 -7,J 'Q (Office) (Fax) (Fax) (E-Mail) (E-Mail) Indicate County,Book,and Page where deed or instrument is filed. Guildford 7587 2556 County Book 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 North Carolina agent must be designed. If someone other than the owner is financially responsible, their signature is required below also. LY FI aI-1 S Print or Type Name of Individual N.1)2. �''is ; a . e (If applicable) D14.9A!�l2_ It le and Name of co any Additional Fi .ncially Responsible Party (if applicable) Owner's Signat No.E2 Grading Permit&Appl. Rev.December 2017 Page 3 of 6 / 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(6)months after the one (1) year period. 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 a 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 Soil 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 06t Cci{a/i.,c, WNER'S SI 1A� TURE) COUNTY OF 6,,:� .„) O �t.t�iL�/ I,a Notary Public of said County and State,do hereby certify that �� 3evec I y f e ds personally appeared before me this day and under oath acknowledged reading the information al4ove and acknowledged that the above form was executed by him or her. Witness my hand and official seal,this the 2.5r J day of Met, ,20Z� Notary Public JNCA/N�y My Commission Expires: f O - -,-q //-1 -Z‘ ;�? °TAR 1, s, c= (SEAL) V LL pUBI.\G ..15 L , i ` ***********************************L 1 -4.,,`� 4`'�F COUN"( ,,, STATE OF (grolkg (ADDITIONAL FINANCIALLY RESPONSIBLE PARTY SIGNATURE) a�'/ COUNTY OF G�;1.4,r) Ii a Notary Public of said County and State,do hereby certify that A. c) di, ersonally appeared before me this day and under oath acknowledged reading the information above and acknowle ged that the above form was executed byJim or her. Witness my hand and official seal,this the ZS r d y of , 20 _S. ,•e.\p1CAN tiq Notary Publ' ,� . ?, . My Commission Expires: _r'Z,' 01.A R y '� f /i- IS-z' (SEAL) -' . �(� 'V P FCOv Permit&A I.Rev. December 2017 ,,��•' ��1,,,,, No.E2 Grading PP Page 4 of 6 GUILFORD COUNTY GRADING PERMIT APPLICATION GRADING PERMIT APPLICATION Please type or print answers: Return to:Earl E.Davis II Inspection Planning and Development Post Office Box 3427 Greensboro,NC 27402 (336)641-3334 or(336)641-3880(fax) NAME OF PROJECT: DUTCH FARMS MITIGATION SITE DATE: March 20,2023 LOCATION OF PROJECT: Fields Farm Road,Clay Township.Lat:35.93167 Long:-79.69869 ACREAGE TO BE DISTURBED: 17.0 ACRES OR( SQ.FEET) TOTAL ACREAGE IN TRACT: Project site is contained within a 16.573 acre conservation easement spanning across 3 properties(Parcels 122781,122793,and 122794)that total 82.50 ACRES IS THIS PROPERTY IN A DESIGNATED WATERSHED? Yes-Lake Mackintosh(Big Alamance Creek)WS-IV If so,the project must comply with Guilford County Regulations prior to a Grading Permit being issued. WHAT TYPE OF UTILITIES WILL GO IN DURING CONSTRUCTION?(Water,Sewer,Power,Cablevision, Telephone,etc.) NONE-Stream and Wetland Restoration Project ENGINEER/ARCHITECT/SURVEYOR: Name: DRG Services,P.C. Address: 3101 Poplarwood Court,Suite 120,Raleigh,NC 27604 Telephone: 919.645.4352 Fax: E-Mail: kwilliams(adavev.com The Property Owner and additional Financially Responsible Party (if any) do hereby agree to comply with all applicable Guilford County Regulations pertaining to development if a Grading Permit is issued. The Property Owner and additional Financially Responsible Party furthermore, do hereby agree to be responsible for the timely installation and maintenance of erosion control devices throughout the duration of this project. A copy of the Guilford County Development Ordinance is available from the Guilford County Planning and Development Department. OWNER OF PROPERTY: NORTH CAROLINA AGENT(if applicable) Name: Randy Steve Fields and Cindy Fields Name: Address: 6705 Fields Farm Rd.Climax.NC 27233 Address: Telephone: (Home) (Office) 336.674.6858 Telephone: (Home) (Fax) (Office) (E-Mail) (Fax) (E-Mail) Print Name: p _grew.Fe/d.c a inA Ft eL4 Signature Cms. A,:4Q1 ADDITIONAL FINANCIALLY RESPONSIBLE PARTY: Name: Davey Resource Group,Inc. Telephone: (Home) 919.723.8350 Address: 12637 Scenic Way (Office) Raleigh,NC 27614 (Fax) (E-Mail) david.godley@davcy.eom Print Name: avi Go Signature: No.E2 Grading Permit&Appl. Rev.December 2017 Page 2 of 6 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 (I) 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: Earl E. Davis II-Inspections Division Guilford County Planning and Development Post Office Box 3427 Greensboro,N.C.27402(336)641-3334 Please type or print answers to the following: Date: March 20,2023 Name of Project: DUTCH FARMS MITIGATION SITE Location of Project: Fields Farm Road,Clay Township Acreage of Land to be Disturbed: 17.0 Acres LATITUDE 35.93167 (In Degrees)LONGITUDE -79.69869 (In Degrees) Purpose of Activity(street construction,commercial building,parking lot,etc.): Stream Restoration Construction Landowner(s)of record: Name: Randy Steve Fields and Cindy Fields Name: Address: 6705 Fields Farm Road Address: Climax,NC 27233 Telephone: (Home) 336.674.6858 Telephone: (Home) (Office) (Fax) (Office) (Fax) (E-Mail) Indicate County,Book,and Page where deed or instrument is filed. Guildford 7587 2550 County Book 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 North Carolina agent must be designed. If someone other than the owner is financially responsible, their signature is required below also. Print or Type Name of Individual N. el' f n e(if applicable) Ownu5 4 , Title and Name'`of Company Additio a1 Fi, ncially Responsible Party (if applicable) 1.1Wt.11CPC. 14fA CAMAILI 444140 No.E2 Grading Permit&Appl. Rev.December 2017 Page 3 of 6 / / 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 (6)months after the one(1)year period. 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 a 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 Soil Erosion and Sedimentation Control Ordinance. This penalty is up to$5000.00 per day and is assessed daily for every day the property is in violation. (Interfering with or hampering an inspection can result in a civil penalty without written notice). ************************************* STATE OF Itj OWNER'S SIGNATURE) ..1 i n_�_1 COUNTY OF (4;11 rJ �� 4 �XQ ) I,a Notary Public of said County and State,do hereby certify that .k4,1 S. P 4)s L C1.,�y 7-;e/r)c personally appeared before me this day and under oath acknowledged reading the information above and acknowledged that the above form was executed by him or her. Witness my hand and official seal,this the Z3 r� day of /__ ,2023. Notary P li "N �CAN ,,,,,,,,� My Commission Expires: 0 . ,'44,.", if—lc— ?c _O'Z, 'OSAR y ,;��-: (SEAL) \G '0, y' PUBS' •'2: *********************************** VI9 `.._- kik4 f•ff1 � STATE OF _ (ADDITIONAL FINANCIALLY RESPONSIBLE PARTY SIGNATURE)Li 1 , COUNTY OF to H;'•i rd I,a Notary Public of said County and State,do hereby certify that D14,,0 Cry personally appeared before me this day and under oath acknowledged reading the information above and acknowledged that the above form was executed by im or her. Witness my hand and official seal,this the Z5' of a 20 Notary Publi NCAN °,,, My Commission Expires: �.��Q� ••.y�q1 �'% /I/S (SEAL) '0,' 01 A R y '%°./411 3 ..c No.E2 Grading Permit&Appl.Rev. December 2017 1(1;,1$.CO� �. ` Page 4 of 6 /,,,,,,,puttvvvvvo