NCC231419_FRO Submitted_20230516

HoLLy
CIVIL CONSTRUCTION
SPRIGS
�m o . North Carolina DRAWING APPLICATION
Submittal Requirements
All items listed are required for a complete submittal. Incomplete submittals will be rejected and
delay the process.
Beginning the week of April 3, 2023, all applications submitted by NOON on Friday will be routed
the following week for review:
Submit the following items via the Portal (Construction & UDO Permits -> Apply for a Permit):
• Complete Application
• One complete, combined set of PDF Civil Construction Drawings
• Calculations and Reports as needed
• Action Notice from Preliminary Plan Review
• Environmental Agency Documentation (NCDEQ 401/USACE 404 Permitting Status)
• Copies of USGS and Wake County Soil Survey stream information for the project location.
Once your submittal is deemed complete and accepted, staff will send you a confirmation and
advise that submittal fees (if applicable) are available for payment in the Portal.
Visit our website for a current fee schedule:
https://www.hollyspringsnc.us/335/Forms-Review-Schedules-Fee-Sheet
For questions about your submittal, please reach out to [e-mail]
This application is 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:
0 Construction Drawing Plan Review El Erosion & Sedimentation Control Plan Review
NPDES Stormwater Review
PROJECT INFORMATION
Project Name Males Academy Holly Springs Expansion Phase N/A
Total LF Streets o
Disturbed Acres 4.99 AC
LF of Sidewalk o LF Sewer Line "
LF of Water Line LF Stormwater 1'935 LF
# SCMs < 5AC VGA # SCMs > 5AC '
Latitude Longitude
FEMA/FIRM Map # 3720073000J Panel #
Effective Date: 5220
06 PIN # 3649265028
Total Post Development Impervious Surface(FT2): 5.47S°
Approximate Date Land Disturbance will begin: "132°23
Description of Construction or Land Disturbance:
expansion of school facilities
Page 1 of 3

CIVIL CONSTRUCTION
.✓ SPRINGS DRAWING APPLICATION
N.ftwor. North Carolina
CONTACT INFORMATION (Attach additional sheets if needed)
Applicant and Financially Responsible Party will need to register for an account on the Portal
Landowner(s) of Record
Name: Robert Luddy Company:Thales Academy
Mailing Address: 3122 Heritage Trade Road
City, State, Zip:Wake Forest, NC, 27587
Mobile Phone:[phone] E-Mail:[e-mail]
Landowner(s) of Record
Name: Company:
Mailing Address:
City, State, Zip:
Mobile Phone: E-Mail:
FUTURE Landowner(s) if applicable
Name: Company:
Mailing Address:
City, State, Zip:
Mobile Phone: E-Mail:
FUTURE Landowner(s) if applicable
• If Landowner will be different at time of plan approval, provide documentation that the FRP has
permission to apply on their behalf.
Name: Company:
Mailing Address:
City, State, Zip:
Mobile Phone: E-Mail:
Book & Page where Deed or Instrument is Filed in Wake County:
Location Description:L0I RCMB THALES ACADEMY BM201402169
Parcel Identification Number (PIN):°6°92°9°2B
Tax Map, Block and Lot Number:
Book:°16692 Page:01' ; Book: Page:
Person or Firm Financially Responsible for Land-Disturbing Activity
Name:Robert Luddy Company:CaptiveAire
Mailing Address:4641 Paragon Park Road
City, State, Zip:Raleigh, NC 27616
Mobile Phone:[phone] E-Mail:[e-mail]
Registered Agent for Person or Firm Financially Responsible for Land-Disturbing Activity
Name: Company:
Mailing Address:
City, State, Zip:
Mobile Phone: E-Mail:
Plans Prepared By:
Name:Nicole Steele Company:Withers Ravenel
Mailing Address:137 S Wilmington Street, Suite 200
City, State, Zip:Raleigh, NC, 27601
Mobile Phone:[phone] E-Mail:[e-mail]
Page 2 of 3

k{i F;,' HOLLY CIVIL CONSTRUCTION
�t�1SPRINGS DRAWING APPLICATION
`' 1/ North Carolina
CERTIFICATE OF COMPLETION
The above information is true and correct to the best of my knowledge and belief and was
provided by me while under oath. (This form must be signed by the Financially Responsible
Person if an individual(s) or their 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 Party). I agree to provide corrected information should there be any change in
the information provided herein.
Signature of Financially Responsible Party: 7j-111 -el
Print Name: Robert Luddy
Title:Chairman 2023-04-17
Date:
I, / 1-i(4 AA Di ws fik- , a Notary Public of the County of ./Ugb
State of North Carolina, hereby certify that c, -4 (---, Luc
appeared personally before me this day and being duly sworn ackn led9 ed that the
above form was executed by them.
Signature of Notary Public: ("4/44/1 La...i__
Print Name: <- iv DD ,tis0--
My Commission Expires: Lt 0-S69
��vAOkk111M1 l0/%4
SEAL ,\� Al
s
o ;
- N0Tq Z=
PUBLICY _=
11111
Page 3 of 3