NCC242748_FRO Submitted_20240913

r00vNT� Gaston County
9 »
I. .,h Gaston Natural Resources Department
1. 1303 Dallas-Cherryville Hwy. Dallas, N.C. 28034 Telephone: [phone]
+ 846 Cr
, Soil Erosion & Sedimentation Control
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 Gaston Day-Upper School
2. Location of land-disturbing activity
City Gastonia Highway/Street 2001 Gaston Day School Rd.Gastonia,NC 28056
Latitude 35.2007 Longitude -81.1411
3. Approximate date land-disturbing activity will commence Immediately-upon approval
4. Purpose of development (residential, commercial, industrial, etc.) School building-commercial
5. Total acreage disturbed or uncovered (including off-site borrow and waste areas) 1.45 ac
6. Amount of fee enclosed $$800.00
7. Soil Erosion &Sedimentation Plan Filed? Yes X Enclosed X No
8. Landowner(s) of Record (Use blank page to list additional owners)
Gaston Day School,Inc.
Name Name
2001 Gaston Day School Rd.
Mailing Address Mailing Address
Gastonia,NC 28056
City State Zip City State Zip
704.864.7744
Telephone Number Telephone Number
9. Indicate Deed Book and Page where deed(s) or instrument(s) are recorded
Deed Book 3514 Page 0655
Deed Book Page
10. Tax Map No. 3563040392(150366) Block Lot No.
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11. If the Financially Responsible Person (Part B.1.) is not the Landowner of
Record,then complete, sign, date,and notarize this section:
I Gaston Day School,Inc. , the Landowner of Record, authorize and give
permission to steelFab,Inc. the Financially Responsible
Party, to submit a draft erosion and sedimentation control plan and to
conduct the anticipated land disturbing activity.
Davidson Hobson NCSOS Registered Agent(Head of School)
Ty e or Print Name Title or Authority
08/13/2024
Signature Date
I, \.,/L.4 1 _ ( /i 11 4� a Nota u lic qf�the County of ( 'm A: ,State of North
Carolina,hereby certify that }
I\k.J ( ;ern + .�,FJ t) Aappeared personally before me this day
and being duly sworn acknowledged that ttp,above far was ex'u ed by hI .
Witness my hand and otarl{l seal, this 6' day of f4° i
2 t? �
(41— t
otary 'LAL ummisstoirExpires
Susan E 6tbson
NOTARY PUBLIC
Gaston County,NC
PART B: My'Commission Expires October 21,2028
Person(s)or firm(s)who are financially responsible for this land-disturbing activity.
SteelFab,Inc. Justin Heitz
Name Contact Name for Inspection Reports
3025 Westport Rd. [e-mail]
Street and Mailing Address Email Address
Charlotte,NC 28206 7048062343
City State Zip Telephone Number
704.398.6103 7043640120
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.
N/A
i Name
Street and Mailing Address Email Address
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.
n
N/A
Name
Street and Mailing Address Email Address
City State Zip Telephone Number
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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.
Marsh Sponsor President
Type or Print Name Title or Authority
�� Ar's 08,13.24
Signal ( Gate
1, Lt.Sa_ V- q , a Notary Public of the County of 64 5 fl . State of North
Carolina,hereby certify that i t,v6ln t ,� rL appeared personally before me this day
rti
and being duly sworn acknowledge jfp form as executed by him.
Wit s my hand and notarial se `this 4 *If ui_st , 2 vatr
J "°�. 1 03-�� do -(o
Notary Li
��� . .� A� SEAt� 7 w My Commission Expires
Erosion and Seth ntroi Permit Submittal Checklist
410
vk7.E `. mil"�a
FRO has created a Citizens Self Service
Completed, Signed, and Notarized FRO (CSS) Portal Account and the account has
p 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) Tel Copy of most current Deed for the site
Landowner of Record Authorization Letter `�'g Name and contact Information of NC
I' (if the FRO Is not the landowner of record) ''. i 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)
�� �., .,� eeiht.' � i"' 1.a ,I -tr ..- � k{ t't6; ��x z ?."13 `gv.�c } _ g * -v71
rrr:�y oe41/ _ 'it.,+° ' s �. Q vr R,,,£;1 Rv.,.➢ �t.. ae,fi7E.Y*'the ;4: * � ' " +°..
Project Location Q Roads,Streets
✓ North Arrow Scale
Adjoining lakes, streams,or other major
drainage ways Property lines
Legend 1u Existing Contours
Vs# Proposed Contours Limit and acreage of disturbed area
Planned and existing building(s) location 7.7 Planned and existing road(s)location and
and elevations - elevations
ve Lot and/or building numbers I Land use of surrounding areas
Rock outcrops aa/ Seeps or springs
Wetland limits I I Easements
Streams, lakes, ponds, drainageways,
dams;also, any official wetland, stream, ✓ Boundaries of the total tract
and/or watercourse delineation report(s)
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..,n . 'r.;, '.a:
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
aZ 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.
�0 Stockpiled topsoil or subsoil location(s) Vr Street profiles
aa
;mamY.z'_ � ���`' '"�� 4; � ��7„;:."•wF '�' ^'"ss+
Planned vegetation with details of plants,
[� � seed,mulch,fertilizer NOTE: Plan should
IM I Areas and acreage to be stabilized I"' i include provisions for groundcover in
accordance with NPDES Construction
Stormwater General Permit NCG010000
tSpecifications of permanent and Method of soil preparation
temporary vegetation
L, AC' .. . . -141 • - e ' ;_a ari ze
Existing and planned drainage patterns
(Include offsite areas that drain through I /1 Size of areas to be disturbed(acreage)
.,..--, project)
Size and location of culverts and sewers V 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
✓i details of energy dissipaters below culverts Soil information below culvert and storm sewer
and storm sewer outlets(for rip-rap outlets
aprons, include stone elzes(dlameters)
and apron dimensions)
Design calculations and construction ........ Name of receiving watercourse or name of
I details to control groundwater i.e., seeps, ✓ municipal operator(only where stormwater
high water table,etc. — discharges are to occur)
a‘aVi a ', ` IrFe t a 'mar +
::tau, § _ X�. g{xr �I#at � o,i
C'._,. Legend Location of temporary and permanent
measures
ve Construction drawings and details for Design calculations and construction details
temporary and permanent measures , for sediment basins and other measures
7 Maintenance requirements during fir" Person responsible for maintenance during
construction I- construction
Maintenance requirements and
(� responsible person(s)for permanent
L measures
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•
'vx 41. :srf r,r1ty?}x' .i.:: ti k�-'r„.}7' 'e . fir. $ry r3 sy • l.rr�1 •�: -.i Z "�4rp "` �„�[e i'�s`l. .4.*°
LIIAc,fr, Rdai :giL�c� "aC+aL,.4y. A�_' A� sA.4 1A 4 S t , , .� '� m�w};t7'..t^ �t "„ �
�, 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
IF control initiation of the land-disturbing activity and
removal of measures after areas they serve
have been permanently stabilized)
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