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HomeMy WebLinkAboutNCC221945_FRO Submitted_20220524For TOWF Use Only Application #: Project Name: Date Received: Acres: Date Approved: Fees Paid: LAND DISTURBING (E&SC) PERMIT APPLICATION, PLAN CHECKLIST, & FINANCIALLY RESPONSIBLE OWNER (FRO) FORM NO PERSON MAY INITIATE ANY LAND -DISTURBING ACTIVITY ON 1/2 ACRE OR MORE BEFORE THESE FORMS, FEES, AND AN EROSION AND SEDIMENTATION CONTROL PLAN SEALED BY A NORTH CAROLINA REGISTERED PROFESSIONAL ENGINEER OR LANDSCAPE ARCHITECT HAVE BEEN COMPLETED AND APPROVED BY THE TOWN OF WAKE FOREST. MULTIPLE SINGLE FAMILY LOTS THAT DISTURB MORE THAN Y2 ACRE ALSO REQUIRE A PERMIT AND SHALL FOLLOW THE STANDARD PROCEDURES OUTLINED BELOW. SEE THE UNIFIED DEVELOPMENT ORDINANCE FOR ADDITIONAL INFORMATION AND FULL ORDINANCE REGULATIONS. NOTE: THE APPLICATION FEE OF $500.00 PER ACRE ROUNDED UP TO THE NEXT ACRE I.E.: 1.1 ACRES = 2 ACRES* $500 = $1,000) IS DUE AT TIME OF SUBMITTAL. IF FEES ARE NOT SUBMITTED THE PLAN WILL AUTOMATICALLY BE DISAPPROVED. DISCLAIMER: TOWN OF WAKE FOREST FEES AND CHARGES ARE SUBJECT TO CHANGE WITHOUT NOTICE. PLEASE CALL 919-435-9443 TO CONFIRM CURRENT FEES AND CHARGES. PART A: PROJECT INFORMATION PROJECT NAME Legacy Center Church 1. TAX PIN NUMBER 1831-31-2312 2. ZONING GR-3 3. LoCATION/ADDRESS OF TRACT 7102 Rabbit Run, Wake Forest NC 27587 4. SUBDIVISION N/A LOT# N/A 5. DEED BOOK 017680 PAGE 00670 *PLEASE PROVIDE A COPY OF THE MOST CURRENT DEED 6. PURPOSE OF DEVELOPMENT Church 7. TOTAL NUMBER OF UNITS N/A 8. PERCENT IMPERVIOUS SURFACE 18.85% 9. TOTAL TRACT ACREAGE: 10.010 before r/w dedication 10. TOTAL ACREAGE DISTURBED (INCLUDING OFF -SITE UTILITIES AND ROADWORK: 4.92 11. AMOUNT OF FEE ENCLOSED: ROUNDED UP ACREAGE 5.00 CHECK NUMBER DATE PAID * $500/ACRE = $ 2,500.00 DISCLAIMER: Town of Wake Forest fees and charges are subject to change without notice. Please call 919-435- 9443 to confirm current fees and charges. 12. PROPERTY OWNER(S) (PROVIDE LIST OF ADDITIONAL PROPERTY OWNERS ON AN ATTACHED SHEET): NAME Legacy Center Church, Inc. E-MAIL SobomaW@LegacyCenterChurch.org ADDREss270 Towerview Court, Cary NC 27513-3591 PHONE 919-675-9548 CELL 13. PERSON TO CONTACT SHOULD EROSION AND SEDIMENT CONTROL ISSUES ARISE DURING LAND -DISTURBING ACTIVITY: NAME Pastor Soboma Wokoma E-MAIL SobomaW@LegacyCenterChurch.org ADDRESS 270 Towerview Court, Cary NC 27513-3591 PHONE 919-675-9548 CELL 14. PLANS PREPARED BY EarthCentric Engineering Inc., Charles P. Koch P.E. ADDREss204 West Clay Street, Mebane NC 27302 EMAIL Phil. Koch@EarthCentric.com PHONE 919-563-9041 CELL 15. DOCUMENTS SUBMITTED (SUBMITTER TO PLACE A CHECK MARK IN THE BOX): FEES ($500 per acre rounded up, due upon 111 review) X FINANCIAL RESPONSIBILITY OWNER FORM X COMPLETED PLAN CHECKLIST X PLANS (to be submitted with construction set) X E&SC CALCULATIONS (1 copy) X STORMWATER CALCULATIONS (1 copy) X MAINTENANCE AND OPERATION AGREEMENT X NCDOT Encroachment/Driveway Permit X DWQ 401 Permit N/A USACOE 404 Permit N/A NCGO10000 Permit COC EROSION & SEDIMENT CONTROL SURETY APPROXIMATE DATE LAND -DISTURBING ACTIVITY WILL COMMENCE: ASAP THE SOIL EROSION AND SEDIMENTATION CONTROL PLAN, supporting documents, maps and computations submitted for the above tract conform to the requirements of all applicable sections of the Town of Wake Forest Erosion & Sedimentation Control Ordinance outlined in the UDO. y�Y 03 --01-00;21 SIGNATURE FTITLE DATE PART B. FINANCIALLY RESPONSIBLE OWNER (FRO)/PERSONS INFORMATION 1. PERSON(S) OR FIRMS WHO ARE FINANCIALLY RESPONSIBLE FOR THE LAND -DISTURBING ACTIVITY PROVIDE A COMPREHENSIVE LIST OF ALL RESPONSIBLE PARTIES ON AN ATTACHED SHEET: Legacy Center Church Inc. NAME EMAIL 270 Towerview Court ADDRESS Cary, NC 27513-3591 CITY 919-675-9548 PHONE STATE ZIP CODE CELL 2. IF THE FINANCIALLY RESPONSIBLE PARTY IS NOT A RESIDENT OF NORTH CAROLINA, GIVE NAME AND STREET ADDRESS OF THE DESIGNATED NORTH CAROLINA AGENT: NAME ADDRESS CITY PHONE STATE CELL EMAIL ZIP CODE 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: Pastor Soboma Wokoma SobomaW@LegacyCenterChurch.org NAME OF REGISTERED AGENT 270 Towerview Court ADDRESS Cary, NC 27513-3591 CITY STATE ZIP E-MAILADDRESS 919-675-9548 PHONE FAX 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. Soboma Wokoma NAME SIGNATURE Pastor TITLE OR AUTHORITY d3 01 —moat DATE I, '%/2/II•�/5 �jl�'2k L-fiy` , a Notary Public of the County of kA , State of North Carolina, hereby certify that ay 64MA �/✓�yo PvtA 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 A+4 e-V , 20 4 r _ ;otaryv My commission expires Pe- lS,yzz— Travis Barkley NOTARY PUBLIC Wake County, NC My Commission Expires February 15, 2022 TOWN of WAKE FOREST LAND DISTURBING (E&SC) PERMIT PLAN SUBMITTAL CHECKLIST (SUBMITTERTO PLACE A CHECK MARK NEXT TO EACH ITEM) 1. LOCATION/VICINITY MAP 2. EXISTING AND PROPOSED COUNTOURS, INCLUDING OFFSITE X 3• CLEARLY DELINEATED BOUNDARIES OF LAND DISTURBANCE WITH ACREAGE El4. SOILS AREA MAP 5. DRAINAGE AREA MAP 6. EXISTING UTILITY EASEMENTS, STORM DRAINAGE, BASINS, LEVEL SPREADERS 7. EXISTING LOT LINES, LOT NUMBERS, SURROUNDING PROPERTY OWNERS 8. STREAM CENTERLINES, STREAM BUFFERS, WETLANDS, FLOODPLAINS X� g TEMPORARY EROSION CONTROLS TO BE SHOWN ON PLANS: 1. EROSION CONTROL CALCULATIONS (SEDIMENT BASIN, SEDIMENT TRAP, SKIMMER, DITCH, ETC...) 2. SKIMMER BASINS REQUIRED FOR DRAINAGE AREA OVER 5 ACRES 3. IF PAM IS TO BE USED ONSITE FOR ANY APPLICATIONS, CALCULATIONS FOR APPLICATION RATES AND SPECIFICATIONS MUST BE SHOWN. IN ADDITION, SOIL TESTS MUST BE TAKEN TO DETERMINE CORRECT SOIL CHARGE AND PRODUCT TYPE PRIOR TO USE. X� 4. CONSTRUCTION ENTRANCE 50 FOOT MINIMUM WITH WOVEN 20 # TENSILE STRENGTH FABRIC UNDERNEITH 5. SILT FENCE - METAL POSTS WITH WIRE SPACED AT 6 FEET 6. HARDWARE CLOTH OUTLETS (SPECIAL SEDIMENT CONTROL FENCE) 7. TREE PROTETION FENCE WITH "DO NOT ENTER TREE PROTECTION AREA" SIGN IN ENGLISH AND SPANISH i. REQUIRED AROUND PERIMETER OF PROPERTY ii. REQUIRED AT BUFFER ZONES iii. REQUIRED IN TREE SAVE AREAS (AROUND DRIP LINE) 8. DIVERSION DITCHES El9. INLET PROTECTION 10. EROSION El11. PERMANENT EROSION/STORMWATER CONTROLS i. STORMWATER CALCULATIONS, Q PRE, Q POST, % IMPERVIOUS ii. PROPOSED STORMWATER EASEMENTS (RECORDED) iii. MAINTENANCE AND OPERATION AGREEMENT iv. PROFESSIOANLLY SURVEYED AND ENGINEER STAMPED AS- BUILTS OF STORMWATER PONDS/1310 CELLS, LEVEL SPREADERS, STORM DRAINAGE INVERTS, TOPS, GRATES, SLOPES, LENGTH, SIZE, ETC... V. PERMANENT DITCHES WITH MATTING ] 10. EROSION PERMIT NOTES: (please add to plans) 1. A LAND DISTURBING (E&SC) PERMIT IS REQUIRED FOR PROJECTS OVER 0.50 ACRE. IF MULTIPLE LOTS WITH LAND DISTURBANCE OVER 0.50 ACRE TOTAL ARE EITHER CONTIGUOUS OR NON-CONTIGUOUS IN THE SAME SUBDIVISION, BY THE SAME BUILDER/OWNER, A LAND DISTURBING PERMIT IS REQUIRED. THE COST OF THE PLAN REVIEW AND PERMIT IS $500/ACRE ROUNDED UP (1.1 ACRES = 2 ACRES @ $500/ACRE = $1,000). THE FEE IS DUE ATTIME OF PLAN SUBMITTAL. DEVELOPER IS RESPONSIBLE FOR INFORMING BUILDER OF E&SC PERMIT REQUIREMENTS ON INDIVIDUAL LOTS. DISCLAIMER: Town of Wake Forest fees and charges are subject to change without notice. Please call 919-435-9443 to confirm current fees and charges. 2. IF ADDITIONAL ACREAGE IS ADDED TO AN EXISTING PERMIT REVISED FORMS, PLANS, AND ANY ADDITIONAL FEES MUST BE SUBMITTED. 3. IF OWNERSHIP OF A PROPERTY HAS CHANGED A REVISED FRO MUST BE SUBMITTED. 4. IF A PROPERTY IS TAKEN OVER BY THE BANK, THE BANK SHALL CONTACT THE TOWN AND REPAIR ALL EROSION CONTROL MEASURES TO TOWN/NCDENR STANDARDS. THEY SHALL ALSO SUBMIT ANEW FRO FORM. 5. IF A PROJECT IS NOT COMPLETE WITHIN TWO YEARS, THE PLANS MUST BE RENEWED AT $250/ACRE. A REVISED SET OF PLANS MAYBE SUBMITTED IF ACREAGE HAS ALREADY BEEN DEVELOPED AND A CERTIFICATE OF OCCUPANY HAS BEEN ISSUED. 6. AN EROSION PRECONSTRUCTION MEETING MUST BE HELD WITH THE TOWN OF WAKE FOREST PRIOR TO START OF ANY WORK, INCLUDING INSTALLATION OF EROSION CONTROL MEASURES, DEMOLITION, CUTTING TREES, AND GRUBBING. CALL ENGINEERING AT (919) 435-9443 TO SET UP A MEETING. ALL PLANS MUST BE SIGNED AND COPIES RETURNED TO THE TOWN 1 WEEK PRIOR TO PRECONSTRUCTION MEETING. 7. THE OWNER, GENERAL CONTRACTOR, GRADING COMPANY, AND EROSION CONTROL INSTALLER MSUT BE PRESENT AT THE PRECONSTRUCITON MEETING. 8. THE E&SC PERMIT WILL BE DISTRIBUTED AT THIS MEETING. 111. E&SC CONSTRUCTION SEQUENCE NOTES: (please add to plans) 1. PRIOR TO SCHEDULING THE PRECONSTRUCTION MEETING, THE EROSION AND SEDIMENT CONTROL SURETY MUST BE SUBMITTED TO THE TOWN OF WAKE FOREST. THE NCG010000 CERTIFICATE OF COVERAGE MUST BE OBTAINIED BY THE PERMITTEE, WHEN APPLICABLE. A COPY OF THE COC MUST BE SUBMITTED TO THE TOWN. 2. AFTER THE PRECONSTRUCITON MEETING IS HELD, THE CONTRACTOR CAN INSTALL INITIAL EROSION CONTROL MEASURES ONLY. THIS INCLUDES BUT IS NOT LIMITED TO CONSTRUCTION ENTRANCE, SILT FENCE, PERIMETER DIVERSION DITCH, CHECK DAMS (ROCK OR WADDLE TYPE), TREE PROTECTION FENCE, EXISITNG INLET PROTECTION, SKIMMER SEDIMENT BASINS, AND SEDIMENTTRAPS. CLEAR ONLYAS NECESSARYTO INSTALLTHESE MEASURES. 3. CONTRACTOR IS RESPONSIBLE FOR E&SC WEEKLY INSTALLATION AND MAINTENANCE LOG INCLUDING DATES OF TEMPORARY/PERMANENT GROUND COVER, A RAIN GAGE, COPY OF TOWF SIGNED PLANS ONSITE, REVISED SIGNED PLANS, NPDES LOG, AND CONSTRUCTION BOX MUST BE PRESENT AND EASILY ACCESSABLE ONSITE. 4. ONCE MEASURES ARE INSTALLED, CONTRACTOR/FRO TO CALL TOWF FOR AN INITIAL INSPECTION. IF SITE PASSES INSPECTION, A CERTIFICATE OF COMPLIANCE WILL BE ISSUED. CONTRACTOR CAN NOW BEING CLEARING, GRUBBING, AND GRADING. 5. CONTRACTOR TO MAINTAIN ACCESS ROAD FOR EMERGENCIES AT ALL TIMES. 6. PHASE PROJECT TO LEAVE AS LITTLE GROUND OPEN AS POSSIBLE. 7. TEMPORARILY SEED, STRAW AND TACK OR HYDROSEED WITHIN 14 DAYS OF ANY PHASE OF GRADING, INCLUDING SLOPES. SEED BASINS AND DITCHES IMMEDITEALY AFTER CONSTRUCTION. 8. PRIOR TO REMOVAL OF TEMPORARY MEASURES, TOWN MUST APPROVE REMOVAL. ALL AREAS ABOVE TEMPORARY MEASURE MUST HAVE 85% GROUND COVER. 9. THE TOWN OF WAKE FOREST CONSTRUCTION INSPECTOR WILL EVAULATE THE SITE ATLEAST ONCE A MONTH. A COPY OF THE INSPECTION FORM WILL BE EMAILED TO THE FRO. THE WEEKLY EROSION LOG AND NPDES LOG MUST BE ONSITE AND AVAILABLE FOR REVIEW. 10. IF THE SITE IS FOUND OUT OF COMPLIANCE A NOTICE OF VIOLATION WILL BE ISSUED GIVING THE CONTRACTOR/FRO 7 WORKING DAYS TO REMEDY THE PROBLEM. IF THE SITUATION IS NOT RESOLVED WITHIN THE TIME PERIOD A FINE MAY BE ISSUED. 11. IF SEDIMENT LEAVESTHE SITE A FINE MAY BE ISSUED UP TO $5,000 PER DAY PER VIOLATION. IF SEDIMENT ENTERS A BUFFER, STREAM, OR WETLAND NCDWQ WILL BE NOTIFIED. THEY MAY ISSUE FINES UP TO $25,000 PER DAY PER VIOLATION. 12. CALL THE TOWN UPON COMPLETION FOR A FINAL EROSION INSPECTION. A PUNCHLIST MAY BE GENEREATED ADDRESSING ANY REMAINING ITEMS. THERE MUST BE 85% GROUNDCOVER ON THE ENTIRE SITE PRIOR TO A CERTIFICATE OF OCCUPANCY. IF THE SITE IS FOUND TO BE IN COMPLIANCE AN EROSION CERTIFICATE OF COMPLETION WILL BE ISSUED. AFTER THE COMPLETION OF THE PROJECT, SUBMIT A NOTICE OF TERMINATION TO END COVERAGE UNDER THE NCG01000 PERMIT.