Loading...
HomeMy WebLinkAboutNCC230201_FRO Submitted_20230124CITY OF GREENSBORO FINANCIAL RESPONSIBILITY/OWNERSHIP FORM SEDIMENTATION POLLUTION CONTROL ACT ;:RF FrISNc;NC: 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: Mercy Hill Church 2. Location of land -disturbing activity 1317 Pleasant Ridge Road Greensboro NC 27409 3. Approximate date land disturbing activity will be commenced August 2022 4. Development type: Commercial ✓ Industrial Institutional_ MF residential SF residential 5. Approximate acreage of land to be disturbed: 15.95 6. Has an erosion and sediment control plan been filed? Yes , No 7. Landowner(s) of Record (attach pages to list additional owners): Mercv Hill Church 336-698-4070 Name Telephone 2335.114 Presidential Drive 2335-114 Presidential Drive Current Mailing Address Durham NC 27703 City State Zip kbroderi ck @mercyhil Ich urc Email Current Physical Street Address Durham NC 27703 City State Zip 8. Deed County: Guilford Book: 8561 Page: 2631 9. Person to contact should erosion and sediment control issues arise during land -disturbing activity: Name: Keith Broderick Telephone: 336-698.4070 E-mail kbroderick(cDmercvhillchurch.com Other: Part B: 1. Company(ies) or firms) 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. Mercy Hill Church 336-698-4070 kbroderickOmercyhillchurc Name Telephone Email 2335-114 Presidential Drive 2335-114 Presidential Drive Current Mailing Address Current Physical Street Address Durham NC 27703 Durham NC 27703 City State Zip City State Zip 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: NIA NIA NIA Name Telephone Email NIA NIA Current Mailing Address Current Physical Street Address NIA NIA NIA NIA NIA NIA City State Zip City State Zip (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, give name and street address of the Registered Agent: NIA NIA NIA Name Telephone Email NIA NIA Current Mailing Address Current Physical Street Address NIA NIA NIA NIA NIA City State Zip City State Zip 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. Robert Herrinaton Type or print name ]S Signature Lead Pastor of Ministries and Operations Title or Authority Date k I, RAV AM QiG�AYASCh a Notary Public of the County of G t/11 1 �'D rof State of ���� t 1 C GAY D jam_ hereby certify that 1ag- 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 IIIday of rJ �A�t , 20 2 2 My Commission expires Al 9,0d' SARAH RICHARDSON Notary Public, North Carolina Guilford County My Commission E-pireg November 04, 2024 City of Greensboro, NC Grading Permit Application GREfN59gRD Owner Information: Company Mercy Hill Church Address P.O. Box 39209 Greensboro, NC 27438 Project Information: Project Name Mercy Hill Church Address 1317 Pleasant Ridge Road Greensboro NC 27409 Area Graded 15•45 Acres and/or sq.ft. Proposed Use of Property Religious Facility Permit #: Contact Keith Broderick Phone No, 336.402-0308 Email kbroderick@mercyhillchurch.com Latitude 36.12075 Longitude -79.96487 Tax Map 7816540716 Site Area 23.12 Acres and/or sq.ft. Zoning CU-PI Brief Description of Project Location The project is located on Pleasant Ridge Rd. approximately 600 feet east from the intersection of Brigham Rd. and Pleasant Ridge Rd. Brief Description of Development Plan This project is a proposed religious facility approximately 80,382 sf. building and associated parking lot and driveways. If this application is approved by the properly designated authorities and a grading permit issued, the undersigned does hereby agree to comply with all applicable City regulations under the Greensboro Soil Erosion and Sedimentation Control Ordinance as described in Chapter 30-12-6 of the Greensboro Land Development Ordinance. Before beginning any grading operation, call for an on -site pre -construction meeting, and when area has been protected, call for final inspection. r f� Signature of owner, developer, or agent: /Date:1( �Z i 12 2 Approved by Permit No. Tracking No. Surety Amount Surety Number Temporary Measures Approved Final Inspection Approved Date Approved FOR OFFICE USE Date Date Tracking Type: TRC Surety Type: LOC Surety Expiration Date Date Date Grading SCB HOD Check CITY OF GREENSBORO WATER RESOURCES DEPARTMENT GREENSBORo SEDIMENT AND EROSION CONTROL SECTION 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: A 61 Z -2 Z Z Owner (Print): Robert Herrington Date: June 27, 2022 Project Address: 1317 Pleasant Ridge Road Greensboro NC 27409 City of Greensboro Sediment and Erosion Control Plan and Grading Permit Submittal Checklist R'RE NWkq Project Title: Mercy Hill Chuch Disturbed Area: 15.95 AC. Plan Tracking Number: 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 __2L Soil types __2L North Arrow and scale (Maximum of 1" = 60') __X_ Legend (Provide symbols for all measures and reference them to the construction details) X 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) 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.) N/A 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.) N/A Design detail for partially installed storm sewers (City of Greensboro Standard #443) _NZA 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)