NCC223808_FRO Submitted_20221114

JCN
Durham City/County (office Use Only)
Sedimentation and Erosion Control
FINANCIAL RESPONSIBILITY/OWNERSE" FORM
WITH LANDOWNER CONSENT FORM
No person may initiate any land -disturbing activity covered by the Durham City -County Unified Development Ordinance before a
Land Disturbing Permit is issued by the Sedimentation and Erosion Control Office. Issuance of a Land Disturbing Permit does not
relieve the permittee of the obligation to obtain any other licenses, permits and approvals as may be required by Federal, State,
County or Municipal governments. This office must be notified in writing of any change to the information on this form.
PLEASE TYPE OR PRINT
I. Project name: 509 Sherron Road
2. Road location of land -disturbing activity: 509 Sherron Road Durham NC 27703
Tax Map - Block - Parcel: Parcel ID: 165285 PINS: 0850-87-11-7486
3. Square footage of land to be disturbed or uncovered: 261,360 SF 6.00 AC
4. List below the landowner of record. Each landowner must complete Item 8.
(If there are multiple owners, please list on a separate page):
Greenwood Homes - Raleigh,LLC
Name
1628 Hidden Leaf Court
Address
Ralei h NC 27606
City State Zip
703 856-7081 eor e &greenwoodhomes corn
Telephone Fax Email
5. List the person or entity financially responsible for this land -disturbing activity: The financially responsible parry shall
be (1) the developer or other person who has or holds themselves as having financial or operational control over the land -
disturbing activity and/or (2) the land owner or person in possession or control of the land when they have directly or
indirectly allowed the land -disturbing activity or have benefited from it and (3) the named parry on the Land Disturbing
Permit.
Greenwood Homes - Rnleig
D,h LLC
Name
1628 Hidden Leaf Court
Street Address
Raleigh NC 27606
City State Zip
703 856-7081 georgeggreenwoodhomes.carn
Telephone Fax Email
The Sedimentation and Pollution Control Act (Act) and the Durham City -County Unified Development Ordinance
(Ordinance) includes, but is not limited to, the following legal obligations of the financially responsible party:
• Maintain a set of approved sedimentation and erosion control plans, if required, on site.
■ Display permit on site.
■ Understand and implement any required plan, including the construction sequence and details.
■ Inspect, maintain and repair sedimentation and erosion control measures, especially after rainfall events.
• Provided adequate ground cover or otherwise stabilize all areas that have not been actively graded within 21 calendar
days.
201 E. Main St, 5tn Floor, Durham, N.C. 27701 • [phone] • Fax [phone]
www.co.durham.nc.us/ceng

■ Plan and conduct all land -disturbing activity so as to prevent off -site sedimentation.
6. For business applicants, list below the North Carolina registered agent for the financially responsible entity:
_George Weller
Name
1628 Hidden Leaf Court
Street Address
Raleigh NC 27606
City State Zip
703) 856-7081 geore(a��reenwoodhomes com
Telephone Fax Email
7. The above information is true and correct to the best of my knowledge and belief and was provided by me while under oath. I
understand that the person or entity listed on Line 5 above will be: (1) the owner of the Land Disturbing Permit when issued;
(2) responsible for ensuring compliance with the Act and Ordinance; and, (3) will be the only person or entity with standing to
appeal any action taken or decision made by the Sedimentation and Erosion Control Office.
Date 1
Type or Print Name
[phone] Partner
Telephone Fax Title orAnihority
Email
Business AAplieant (Provide corporate resolution on signatory authority)
State of
a Notary Public of the County of
hereby certify that
personally came before me this day and acknowledged that he is
of
Witness my hand and official seal, this
My commission expires
and acknowledged, on behalf of
the due execution of the foregoing instrument.
20
day of
Notary Public
20
Individual A licant Q
1, _�� 1 4'11_r; 4 , a Notary Public of the County of
State of ALC�t4 CAO'QiJa , hereby certify that 6�q 4,t,e LJ67
personally appeared before me this date and under oath acknowledged that the above form was executed by them.
Witness my hand and official seal, this
day of 40G,S_t- 20
lk �_7
Nota Public
My commission expires 5d :iylR� O 20;(57
LAND DISTURBING PERMITS ARE NON -TRANSFERABLE
R. PNF�'�%,,
'm 01AR),'% '-
•-

Provide a Notarized Item 8 for each landowner listed in Item 4.
S. Land Owner Consent. As a landowner, I provide my consent for land -disturbing activities to occur on the property listed in
Item 2 by the person or entity listed in Item 5.
Z cl o 111-11—
Date Type or Print Name
_ 703 856-7081 Partner
Telephone Fax Title or Author
eor
e reenwoodhomes.com
Email
Business Landowner (Provide corporate resolution on si natory authority)
I,
State of
a Notary Public of the County of
hereby certify that
personally came before me this day and acknowledged that he is
of
and acknowledged, on behalf of
the due execution of the foregoing instrument.
Witness my hand and official seal, this day of 20
My commission expires
20
Notary Public
Individual Landowner(
a Notary Public of the County of Wa K
State of G� �j� %(� �`} , hereby certify that �E`G �it 129 n bj'k-ctre-
personally appeared before me this date and under oath acknowledged that the above form was executed by them.
Witness my hand and official seal, this �\ ay cXU5 � 20
ofNota Public
My commission expires20
SE-03
Rev.07/06
o°� N R. ply`co,,
Z O TA R _

From: Chris Mehl
Sent: Tuesday, August 30, 2022 9:03 AM
To: George Weller
Cc: Jarrod Edens
Subject: RE: 509 Sherron Road
Hi George,
We are finishing up the Erosion Control Plan package for submittal to Durham County, but need
your assistance with a couple of items.
On the attached FRO form, please confirm (or correct) the information in items #4, #5, #6, #7,
and #8, sign, date, and notarize as the business applicant (#7), and sign, date and notarize as the
business landowner (#8).
Also, please pay the following plan review fee. Go to:
htWs://www.dconcgov/county-departments/departments a e/engineering and environmen al
services stortnwater-and-erosion-control-division/electronic plan submittal/electronic payments
Payment Type: Land Disturbance Plan Review Fee
Account Number: 509 Sherron Road
Enter Payment Info.
Please email me the receipt.
Plan Review Fee = $125.00/ac x 6.00 ac = $750.00
Please contact me if you have questions or require additional information.
Thanks in advance,
Chris Mehl, PE
HinEDENS
o: 1 ext. 317
m: j919)-768.2346
www.edens.inc
From: George Weller <[e-mail]>
Sent: Thursday, August 25, 2022 3:30 PM
To: Chris Mehl <chris :mehl@a edens.inc>
- - - - - ----------------
Cc: George Weller <ge9rge@greenw99dhomes_com>; Jarrod Edens <jarrod:edensedens.inc>
Subject: RE: 509 Sherron Road . .............
Hi Chris,