NCC221435_FRO Submitted_20220411

WAKE COUNTY FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
SEDIMENTATION POLLUTION CONTROL ACT
7WA No person may initiate any land -disturbing activity on one or more acres as covered by the Wake
County Unified Development Ordinance before this form and an acceptable erosion and
COUNTY sedimentation control plan have been completed and approved by Wake County Department of
_1 cARM, Environmental Services, Water Quality Division. (Please type or print and, if the question is not
- applicable, place N/A in the blank.)
Part A.
1. Project Name The Franklin - Lot EC Plan
2. Location of land -disturbing activity: Jurisdiction
3.
4.
5.
6.
II
Wake
(Wake Co. or Municipality)
Highway/Street SR1383 Latitude 35d44'09" Longitude 78d44'09"
Approximate date land -disturbing activity will commence: 01-03-2022
Type of development (residential, commercial, industrial, institutional, etc.). residential
Total acreage disturbed or uncovered (including off -site utilities and borrow/waste
areas):_4.4
Person to contact should erosion and sediment control issues arise during land -disturbing activity:
Name
Rudy Upton E-mail Address [e-mail]
919-427-5571
Telephone Cell # Fax #
Landowner(s) of Record (attach accompanied page to list additional owners):
RCU, LLC 919-427-5571
Name(s) Telephone
1409 Hathaway Rd
Uurrent Mailing Address Current Street Address
Raleigh NC 27608
City State
8. Deed Book No.
018255
Zip City
Page No. 01962
State
[e-mail]
Fax or E-mail address
Zip
Provide a copy of the most current deed.
Part B.
1. Person(s) or firm(s) who are financially responsible for the land -disturbing activity (Provide a
comprehensive list of all responsible parties on an attached sheet. Include requested information):
RCU, LLC [e-mail]
Name
1409 Hathaway Rd
(;urrent Mailing Address
Raleigh NC 27608
City State Zip
Telephone
E-mail Address
Current Street Address
City State Zip
Fax Number

2. (a) If the Financially Responsible Party is not a resident of Wake County, identify a designated agent in
Wake County to receive any notice, process, pleading in any action or legal proceeding arising out of any
matter relating to the Wake County Erosion and Sedimentation Control Ordinance and/or Land
Disturbance Permit:
N/A
Name
Current Mailing Address
City
Telephone
E-mail Address
Current Street Address
State Zip City State Zip
Fax Number
(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:
Name of Registered Agent
Current Mailing Address
City
Telephone
E-mail Address
Current Street Address
State Zip City State Zip
Fax Number
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.
Juay C - UP -TAM owNca 1 M GR
Type or print name Title or Authority
2
Signature Date
-------- _L — ----------------------------------------------------------------
I, ' r�. r per"f ►L� 1'� fTA a Notary Public of the County of
State of North Carolina, hereby certify that RIAALt appeared
personally before me this day and being duly sworn acknowledged (Hat the above form was executed by him.
Witness my hand and notarial seal, this c2oday of 20 �-�
C1r �tp�t 'c..c r
tary
eal KATHERINE ALLGOOD Nb
' 3 : Nctary Public, North Carolina My commission expires _��
F Wake County
MY ❑mrnissc rr EX -res

TEL [phone]
FAX [phone]
WAKEEnvironmental 336 Fayetteville St. P.O. Box 550
COUNTY Services Raleigh, NC 27602
NORM [AR01 Ii A
Construction Plan Application for Stormwater, Floodplain Management,
Sedimentation & Erosion Control
I. PROPERTY INFORMATION
1. Project Name: The Franklin - Lot EC Plan
2. Address:. 3101 Campbell Rd
3. Wake County Pin #: 0772826775
R-40
5. Zoning District
7. County Watershed: Swift Creek
4. Jurisdictional Area: Wake County
(List municipality if applicable for S&EC)
6. River Basin: Neuse
(Neuse/Cape Fear)
(Falls Lake, Smith Creek, Little River, Swift Creek, Jordan)
8. Total area in acres: 8.468 acres 9. Total property area to be disturbed in acres: 4.4 acres
10. Present Land Use (Check):_ Non-residential Subdivision Agricultural Forest X Vacant
11. Proposed Land Use/Project Type (Check): Non-residential X Subdivision _Lot Redevelopment
12. Recorded: Book of Maps No. 018255 page No. 01962 13. Property W/ln FEMA Flood Zone: FEMA/Flood Soils (circle)
14. Zone: N/A 15. FIRM Panel No.: 3720077200J 16. FIRM Effective Date: 5/2/20007Exiting Impervious (sq.ft) 5,115
(A, AE, X)
18. New or Proposed Impervious (sq.ft) 59,515 19. Impervious Surface of Well Lot and Access Road N/A (sq.ft)
II. DOCUMENTS SUBMITTED TO PORTAL:
Copy of this application X Construction Plans X Fees — invoiced upon application (See fee schedule on web site)
*MINIMUM FEE IS $250 (based on 1 acre)
A. Stormwater Review:
Subdivision Preliminary Approval Document /# X Wake County Hybrid Stormwater Tool(.xls) X
Stormwater Narrative N/AStormwater Checklist: N/A SW Calculations N/A Nitrogen Export Load Galeulations
Deed Restrictions and Protective Covenants Application Form N/A Operations, Maintenance, Inspection and Budget Manuel' /A
Soil Scientist Soils Evaluation Stream Determination Letter
B. Flood Study Review:
Floodstudy Narrative N/A Flood Study Checklist HEC RAS Checklist Flood Study Calculations
C. For Sedimentation & Erosion Control Review:
Erosion Control Narrative X Sedimentation & Erosion Checklist X Financial Responsibility/Ownership Form: X
S&E Calculations X DWQ, 404 and/or 401 approval document NC DOT Driveway Encroachment Agreement: X
D. Land Disturbance - Individual I mt(s): Wake Counly Standard Plan or Custom Plan circle one FRP formplot plan &
application

III. GENERAL INFORMATION
Name:
l . Property Owner (s) (specify the name of the corporation, individual, etc., who owns the property):
RCU, LLC;
Street Address: 1409 Hathaway Rd, Raleigh NC 27608
Mailing Address:
E-Mail Address: rUery_ u 6nari co.corn
Phone# -'12 1 427-5571 Cell#:(__) Fax#: (�
2. Applicant* (Person to whom all correspondence will be sent):
Name: Rudy Upton
Firm/other: RCU. LLC
Street Address: 1409 HathawayHathamLay Rd, Raleigb, NC 27608
Mailing Address:
E-Mail Address: rli u tonan coxor n
Phone#: [phone] Cell#: �(_ ) Fax#:
Relationship to Owner:
*If not a resident of North Carolina, a North Carolina agent must be designated for the purpose of receiving correspondences.
IV. APPLUCANT'S CERTIFICATION:
PRINT NAME Rudy Upton
SIGNATURE
OWNER/PURSON F1'h ANCIALLY RESPONSIBLE
V. Residential Construction Plan Review Fees:
DATE l z- Z L 'Z 1
S&E 4.4 x $250.00 = $2,200
Disturbed acres (to tenth of acre) round to nearest dollar
NO CAP / minimum fee based on 1 acre
*SW N/A x $250.00 =
Disturbed acres (to tenth of acre) round to nearest dollar
(I O-Acre Cap or minimum of $250.00)
*Minor Flood Study please add $500.00/ each crossing x 500.00 = N/A
*Major Flood Stud lease add $1,000.00/ each crossing N/A
y p g x 1,000.00 =
Total Fees Due $2,200
VI. Non -Residential Construction Plan Review Fees:
S&E x $250.00
Disturbed acres (to tenth of acre) round to nearest dollar
NO CAP / minimum fee based on 1 acre
$250 (0-9 acres)
$375 (10-19 acres)
*SW x $435 (20-29 acres) _
Disturbed acres (to tenth of acre) $470 (30-39 acres) round to nearest dollar
(50 Acre Cap) $485 (40-50 acres)
*Minor Flood Study please add $500.00/ each crossing x 500.00
*Major Flood Study please add $1,000.00/ each crossing x 1,000.00 =
Total Fees Due
*Annlies only to Waite County, Jurisdictional Proiects (form updated April 2019)
PERMIT FEES FOR STORMWATER AND EROSION CONTROL, DUE UPON PERMIT ISSUANCE