Loading...
HomeMy WebLinkAboutNCC242618_FRO Submitted_20240827 /�oUNTp Gaston County /�R. .�'• : . to Gaston Natural Resources Department �� I •�1h 1303 Dallas-Cherryville Hwy. Dallas, N.C. 28034 Telephone: 704-922-4181 t►��°n°z Soil Erosion & Sedimentation Control w ai 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 HEYCO 2. Location of land-disturbing activity City DALLAS,NC Highway/Street 5134 APPLE CREEK PARKWAY Latitude 35.31722 Longitude -81.1833 3. Approximate date land-disturbing activity will commence August 12th,2024 4. Purpose of development (residential, commercial, industrial, etc.) INDUSTRIAL 5. Total acreage disturbed or uncovered (including off-site borrow and waste areas) 10.00 6. Amount of fee enclosed$4,000 7. Soil Erosion & Sedimentation Plan Filed? Yes Enclosed x No 8. Landowner(s)of Record (Use blank page to list additional owners) MDTH Circuit LLC N/A Name Name 1301 E.Pocket Road N/A Mailing Address Mailing Address Florence SC 28052 N/A N/A N/A City State Zip City State Zip 864-454-2902 N/A Telephone Number Telephone Number 9. Indicate Deed Book and Page where deed(s)or instrument(s)are recorded Deed Book 5476 Page 1945-1948 Deed Book N/A Page N/A 10. Tax Map No. 311883 Block Lot No. 8 Page 1 11. If the Financially Responsible Person (Part BA.) is not the Landowner of Record, then complete, sign, date, and notarize this section: , the Landowner of Record, authorize and give permission to , the Financially Responsible Party, to submit a draft erosion and sedimentation control plan and to conduct the anticipated land disturbing activity. Type or Print Name Title or Authority Signature Date , a Notary Public of the County of ,State of North Carolina, hereby certify that appeared personally before me this day and being duly sworn acknowledged that the above form was executed by him. Witness my hand and notarial seal, this day of , 2 Notary SEAL My Commission Expires PART B; Person(s)or firm(s)who are financially responsible for this land-disturbing activity. MDTH Circuit LLC William Keener(Bill) Name Contact Name for Inspection Reports 1301 E.Pocket Road bkeener@marlborodevelopment.com Street and Mailing Address Email Address Florence SC 28052 864-414-8580 City State Zip Telephone Number 843-454-2902 NA Telephone Number Fax Number 1. If the Financially Responsible Party is not a resident of North Carolina, give the name and street address of a North Carolina agent. Bell Carrington Price&Gregg PLLC(Care of Brian Price) Name 5550 77 Center Drive,Suite100 bprice@bellcarrington.com Street and Mailing Address Email Address Charlotte NC 28217-0700 864-312-5812 City State Zip Telephone Number 2. 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. Name Street and Mailing Address Email Address City State Zip Telephone Number Page 2 3. 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. William Keener Vice President of Construction Type or Print Name /¢• Title or Authority Gt/i/r.•4C K//) - _ 08-13-2024 Signature Date Sowt11 Brian Nash , a Notary Public of the County of$ At bv.f`a} ,State ofNePth Carolina, hereby certify that William Keener appeareapersonally before me this day and being duly sworn acknowledged that the above form was exe uted by him. Witness my hand and notarial seal, this /3 day of IQws5w3 . 2 O o2y• ,J. I.. /ZJ3///o a.9 Nota r qr4 SEAL My Commi ion E pires r • BRIAN M.NASH IONINR1OU',O MEOfIIMINCIAMMA ,,.0).n My Commission Empires 1213112021 ""'rrN. Erosion and Sedimentatio Control Permit Submittal Checklist Document Submittal Requirements FRO has created a Citizens Self Service Completed, Signed, and Notarized FRO (CSS) Portal Account and the account has Form (to be signed by person financially been verified responsible for the project and no item should be left blank, mark N/A if needed) i/ Copy of most current Deed for the site Landowner of Record Authorization Letter Name and contact information of NC (if the FRO is not the landowner of record) Registered 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 i/ Roads, Streets I I North Arrow 1/ Scale Adjoining lakes, streams, or other major drainage ways 1/ Property lines Legend 1/ Existing Contours %/ Proposed Contours i/ Limit and acreage of disturbed area 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 j/ Seeps or springs 4/ Wetland limits 1/ Easements Streams, lakes, ponds, drainageways, 1/ dams; also, any official wetland, stream, 1,/ Boundaries of the total tract and/or watercourse delineation report(s) Page 3 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 • Areas and acreage to be stabilized ./ include provisions for groundcover in accordance with NPDES Construction Stormwater General Permit NCG010000 Specifications of permanent and ✓ temporary vegetation ✓ Method of soil preparation Plans-Site Drainage Features Existing and planned drainage patterns i/ (include offsite areas that drain through 4/ Size of areas to be disturbed (acreage) project) i/ Size and location of culverts and sewers i/ Soils information (type, special characteristics) Design calculations and construction for Design calculations, cross-sections, and ✓ culverts and storm sewers ✓ method of stabilization of existing and planned channels (include temporary linings) Design calculations and construction details of energy dissipaters below culverts Soil information below culvert and storm sewer • and storm sewer outlets (for rip-rap ✓ outlets aprons, include stone sizes(diameters) and apron dimensions) Design calculations and construction Name of receiving watercourse or name of • details to control groundwater i.e., seeps, i/ municipal operator(only where stormwater high water table, etc. discharges are to occur) Plans - Erosion Control Measures t/ Legend ✓ Location of temporary and permanent measures ✓ Construction drawings and details for ✓ Design calculations and construction details temporary and permanent measures for sediment basins and other measures ✓ Maintenance requirements during ✓ Person responsible for maintenance during construction construction Maintenance requirements and ✓ responsible person(s)for permanent measures Page 4 Plans -Other Requirements ✓ Narrative describing construction ✓ Narrative describing the nature and purpose of sequence (as needed) the construction activity Construction sequence related to sedimentation and erosion control (include ✓ Bid specifications regarding erosion ✓ installation of critical measures prior to control initiation of the land-disturbing activity and removal of measures after areas they serve have been permanently stabilized) Page 5