NCC222038_FRO Submitted_20220614

oKUfl- IO N 0V ENGINEERING DEPARTMENT
1 011y 128 South Main Street - PO Box 8 Holly Springs, NC 27540
Springs [phone] • FAX [phone]
^IOR I11 f,A R01..1`1 ,4
Application for Construction Drawing Plan Approval, Erosion & Sedimentation Control Plan Approval, NPDES Stormwater
Review, Land Disturbance Permit Issuance, and Statement of Ownership and Financial Responsibility:
(Check All That Apply)
® Construction Drawing Plan Review XD Erosion & Sedimentation NPDES Stormwater Review
Control Plan Review
1. Project Name, Project ID, and Phase: Sutton Property Phase:
2. Description of Construction/Land Disturbance:
Construction of 13 single family lots
3. Landowner(s) of Record: (Use additional pages if necessary and attach to application)
Sire Development
Name Name
5509 Den Heider Way
Address
Raleigh, NC 27606
Address
City, State, Zip City, State, Zip
919-868-4462
Telephone Fax Telephone Fax
[e-mail]
Mobile Phone Email Address Mobile Phone Email Address
4. Future Landowner(s), If Applicable: (Use additional pages if necessary and attach to application)
Name Name
Address Address
City, State, Zip City, State, Zip
Telephone Fax Telephone Fax
Mobile Phone Email Address Mobile Phone Email Address
5. List Book & Page where Deed or Instrument is Filed in Wake County:
Location Description: 4020 Berman Edge Drive, Holly Springs, NC
Parcel Identification Number (PIN): 0648496119 Tax Map, Block, and Lot Number:
Book: 17225 Page: 00098 Book: Page:
6. Person(s) or Firm(s) Financially Responsible for Land -Disturbing Activity
Jeff Rider
5509 Den Heider Way Name
Address Address
Raleigh, NC 27606
City, State, Zip City, State, Zip
Telephone Fax Telephone Fax
Mobile Phone Email Address Mobile Phone Email Address
9001
5/2/14

Application for Construction Drawing Plan Approval, Erosion & Sedimentation Control Plan Approval, A!PDES
Stormwater Review, Land Disturbance Permit Issuance, and Statement of Ownership and Financial ResponsibiW..
7. Registered Agen% if any, for Person(s) or Firm(s) Financially Responsible:
(NOTE: A North Carolina agent is required if the applicant is not a resident of North Carolina.)
Name
Address
City, State, Zip
8. Plans Prepared By:
The Spaulding Group
Name of Firm/Person
5318 Buming Oak Ct.
Address
Raleigh, NC 27606
City, State, Tip
9. Site/Project Information:
Total Size of Tract:
Length of Sidewalk:
Length of Water Line:
Length of Greenway:
acres
1 / T linear feet
-7-fB linear feet
# Stormwater BMPs < 5 acres:
Telephone
Mobile Phone
Email Address
Fax
919-669-1078
Telephone Fax
Mobile Phone
Email Address
Area Disturbed: 4: 73 acres ftz
Length of Streets: 8S%1 linear feet
Length of Sewer Line: 7'6` J linear feet
Length of Stormwater: 7Y1 linear feet
# Stormwater BMPs > 5 acres:
Latitude: 35" 34 3 - 6.- / Longitude: ?Y jy 6'9 �1ry 11,1
FEMA/FIRM Map #: TZUO(o4%Yi'oa Panel #: U 1�1 }% Effective Date:
Total Post Development Impervious Surface: Fe
10. Approximate Date Land Disturbance Will Begin:
11. Signature and Witness: Theja4ove Information is true and correct to the best of my knowledge and
belief s providgd�iy rn-444 er oath.
Ie of Person Financially Responsible Type or Print Name Legibly
Title or Authority D
I,iC,V^i�i� �I', a Notary Public of the County of hereby certify
that _ 1"-�4 q�.t�r ..__ personally before me this day and under oath acknowledged that
this Application for Construction Drawing Plan Approval and Erosion & Sedimentation Control Plan Approval/Land
Disturbance Permit Statement of Ownership and Financial Responsibility was executed by him or her.
Witness my hand and notarial seal, this 2 Z. day of _I `� Wtrn trT —, 20 Z l .
Signature of Notary Public My Commission Expires
SEAL ,L'.,a,,,•,''
'NOTA/i;,. '
pU \G
59001
14 ,•�'�'�i,,C U N�` j �������
FOR OFFICE USE ONLY
Date Completeness Verified:
Project Number: PN-
Fees Paid:
0 Construction Drawing Review Fees
0 Erosion & Sedimentation Control
Plan Review Fees