NCC243286_FRO Submitted_20241025

CITY OF GREENSBORO
FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
cuTsfP SEDIMENTATION POLLUTION CONTROL ACT
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: Brigham Road Warehouse Building
2. Location of land-disturbing activity: 717 Brigham Road
3. Approximate date land disturbing activity will be commenced: November 2023
4. Development type: Commercial_Industrial i Institutional_MF residential_SF residential
5. Approximate acreage of land to be disturbed: 7.09
6. Has an erosion and sediment control plan been filed? Yes ✓ No
7. Landowner(s) of Record (attach pages to list additional owners):
717 Brigham,LLC
Name Telephone Email
1400 Battleground Avenue,Suite 201
Current Mailing Address Current Physical Street Address
Greensboro NC 27408
City State Zip City State Zip
8. Deed County: Guilford Book: 8241 Page: 2791
9. Person to contact should erosion and sediment control issues arise during land-disturbing activity:
Name: Tyler Richardson Telephone: [phone]
E-mail: -E-/I er r e rAn3L,}ro f t,#+of•C6i N Other:
Part B: l
1. Corn pany(ies) or firm(s)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.
717 Brigham,LLC 336-549-4407
Name Telephone Email
1400 Battleground Avenue,Suite 201
Current Mailing Address Current Physical Street Address
Greensbor NC 27408
City State Zip City State Zip

1
r
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
j Current Mailing Address Current Physical Street Address
I
City State Zip City State Zip
11 (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
io give name and street address of the Registered Agent
Pracorp Inc 336-549-4407
Name Telephone Email
1400 Battleground Avenue
Current Mailing Address Current Physical Street Address
,
i• Greensboro NC 27408
City State Zip City State Zip
I 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.
Tyler Richardson Member,717 Brigham, LLC
rType or print name Title or Authority
,}-..k, \. -.�, !2-Jz°(23
Signature Date
I, - 5 1 k1LL.4Aq , a Notary Public of the County of ( '/L r_oli n
1 State of :Cc R T r/ Lh got,/ /z/f , hereby certify that T3'LF 4 X IC /l,¢A 10sr4/
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 II day of l'E4Ei'1e i,', 20-213
My Commission expires SC-i / 1. z 0 27 .
1 ,41,9_42., 1/1
JAMES R KELLAM
NOTARY PUBLIC
Guitfoxd Coi.nty
North Carolina
My Cortm h_n E�. i e$`')Pt r 15.
2f127
1

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.
2. 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.
9. 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: I2 (Zo(t3
Owner (Print): Tyler Richardson Date:
Project Address: 717 Brigham Road,Greensboro,NC 27409

City of Greensboro Sediment and Erosion Control
Plan and Grading Permit Submittal Checklist
GREENSBORO
Project Title: Brigham Road Warehouse Building
Disturbed Area: 7.09 Acres Plan Tracking Number: 2023-3390
All plans are required to meet the minimum design criteria set forth in the
North Carolina Erosion and Sediment Control Planning and Design Manual.
Required submittal for initial review:
X Completed grading permit application and financial responsibility/ownership form (in PDF format)
X Plan (In PDF format)
X Calculations for all sediment and erosion control measures (in PDF format)
Location information:
X Location map including roads,streets, drainage ways and relevant landmarks. A north arrow and scale
should be included.
X Latitude and Longitude at the project entrance in decimal degrees.
General site features:
X City of Greensboro cover sheet(Completed)
X Acreage of disturbance
X Total site acreage
X Soil types
X North Arrow and scale (Maximum of 1"= 60')
X Legend (Provide symbols for all measures and reference them to the construction details)
Property lines and ownership information for the site and adjoining properties
X Land use of surrounding areas
X Limits of disturbance
X Existing contours (topography)
X Proposed contours (topography)
X Hydrogeological features (rock outcrops,springs,seeps,wetlands,streams, lakes, ponds, dams etc.)
X Designation and buffer zones for hydrological features
X Existing and proposed road locations(include elevations and contours)
X Existing and proposed building or structure locations(include elevations and contours)

X Lot numbers, building numbers and/or addresses
X Planned and existing utilities and easements (Include any pipe sizes, materials, etc.)
X Soil stockpile areas (Must be within the site's sediment and erosion control measures)
X Borrow and/or waste areas (Note: If the same person conducts the land-disturbing activity&any related
borrow or waste activity,the 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 Waste Management. If the land-disturbing activity and any related borrow or
waste activity are not conducted by the same person,they shall be considered separate land-disturbing
activities and must be permitted either through the Sedimentation Pollution Control Act as a one-use
borrow site or through the Mining Act.)
Site drainage features:
X Drainage delineation maps for existing and planned drainage patterns. Include off-site areas that drain
through the project as well as areas below the project that will be directly affected by drainage from the
site.
X Drainage delineation maps to all proposed sediment and erosion control measures
X Location and details for existing and proposed storm sewer systems and culverts
X Location and contours for existing and planned channels
Sediment and erosion control measures and site stabilization:
X Location and detail of construction entrance(City of Greensboro standard#217 or 436)
X Location and detail of silt fence(See section 6.62 in the N.C. Erosion and Sediment Control Planning and
Design Manual for acceptable usage and maximum slope length for silt fence applications.) (City of
Greensboro standard#430)
X Location,detail and calculations for sediment traps (See section 6.6 in the N.C. Erosion and Sediment
Control Planning and Design Manual for options and acceptable usage.)
X
Location and method of protection for storm inlets (See section 6.5 in the N.C. Erosion and Sediment
Control Planning and Design Manual for options and acceptable usage.) (City of Greensboro Standard#
430)
X Location, detail and method of stabilization for channels. Include calculations,specifications for proposed
liners and staple patterns. (See section 6.3 in the NC Erosion and Sediment Control Planning and Design
Manual for options and acceptable usage.)
X Location, detail and method of stabilization for temporary and permanent diversions. (See section 6.2 in
the N.C. Erosion and Sediment Control Planning and Design Manual for options and acceptable usage.)
X Location and detail for slope drains (See section 6.32 in the NC Erosion and Sediment Control Planning
and Design Manual for options and acceptable usage.)
X Design detail for partially installed storm sewers(City of Greensboro Standard#443)

X Method of stabilization for slopes that are greater than 2:1. (Methods of stabilization for slopes steeper
than 2:1 must be shown in detail, and vegetative cover alone is not acceptable. Retaining walls greater
than 5 feet in height require review and permits through Building Inspections)
X Location, details and calculations for all other proposed sediment and erosion control measures
X Specific details and sequencing for any work proposed to be done in streams (See section 6.7 in the N.C.
Erosion and Sediment Control Planning and Design Manual. Copies of all required permits from Federal
and State agencies are required)
Stabilization:
X Provision for ground cover on exposed slopes that are 3:1 or steeper, perimeter slopes,fill slopes, slopes
greater than 50 feet in length,swales, dikes, ditches and high quality water zones within 7 days, and all
other areas within 14 days
X Temporary seeding specifications including method of soil preparation,seed and soil supplement types
and amounts, mulch types and amounts, and method of anchoring (matting or tacking materials)
X Permanent seeding specifications including method of soil preparation,seed and soil supplement
types and amounts, mulch types and amounts,and method of anchoring(matting or tacking
materials)
Other information:
X Construction Sequence related to sediment and erosion control (This is site specific. Should include a pre-
construction meeting, installation of measures and inspection of measures prior to initiation of land
disturbance,specifics related to grading and development of the site including relevant utility installation,
stabilization of drive and parking areas,stabilization of other areas as applicable, removal of temporary
measures, and a final inspection to close the grading permit.)
X Provisions for monitoring and self-inspection requirements of the NPDES NCG0100000 permit. It should
be noted that self-inspection requirements are required until the site is stable and the grading permit is
closed.
Required submittal prior to permitting:
X Grading permit application and financial responsibility/ownership forms (original signed and notarized)
X Plan (Sealed, signed, and including all pages and information contained in electronic submittals)
X Surety (Sites with 5 acres or more disturbed require a surety of$2000.00 per disturbed acre)
n/a Copies of all permits from Federal and State agencies (Army Corps 404 permit and Water Quality 401
certification where required)