NCC240792_FRO Submitted_20240319

60
CAPITAL GROWTH
BUCHALTER
March 12, 2024
Mr. Bill Denton
Engineering Supervisor II
Division of Energy,Mineral,and I.and Resources
Raleigh Regional Office
3800 Barrett Drive
Raleigh, NC 27609
RE: Wawa#5902 Benvenue Road &Jeffreys Road,Rocky Mount,NC
Mr.Denton,
Please accept this letter as written authorization from Rocky Mount ARD CGP,LLC,
owner of the above referenced property that Wawa North Carolina,LI.0 and their
contractor A.R. Chesson Construction have our permission and authorization to
submit an FRO and/or eN01 and take responsibility for the sites Soils Erosion and
Control coverage for all future construction activities at the property.
Please don't hesitate to contact inc if you have any questions.
Sincerely,
Rocky Mount ARD CGP, LLC
By:Danielle E.Ya Ice--
Its:Authorized Agent
3G1 Summit Blvd . Suite 110 . Birminrthnm Al 3S243 cpbuckatter.ewn
205,i) 8A220 ph 205.96d.9229 Lix

FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
SEDIMENTATION POLLUTION CONTROL ACT
No person may initiate any land-disturbing activity on one or more acres as covered by the Act before this
form and an acceptable erosion and sedimentation control plan have been completed and approved by
the Land Quality Section, N.C. Department of Environmental Quality. Submit the completed form to the
appropriate Regional Office. (Please type or print and, if the question is not applicable or the e-mail and/
or fax information unavailable, place N/A in the blank.)
Part A. General Plan Level II for WaWa-#5902 Benvenue Rd&Jeffreys Rd, Rocky Mount, NC 27804
1. Project Name
2. Location of land-disturbing activity: County Nash City or Township Rocky Mount
Highway/Street Benvenue Road Latitude Longitude
3. Approximate date land-disturbing activity will commence:
4. Purpose of development(residential, commercial, industrial, institutional, etc.).Commercial
5. Total acreage disturbed or uncovered (including off-site borrow and waste areas): 2.54
6. Amount of fee enclosed: $ 150 (previously paid) The application fee of $100.00 per acre
(rounded up to the next acre) is assessed without a ceiling amount(Example: 8.10 ac= $900.00).
7. Has an erosion and sediment control plan been filed? Yes X No Enclosed
8. Person to contact should erosion and sediment control issues arise during land-disturbing activity.
Name Will Gautier E-mail [e-mail]
Telephone [phone] Cell# 252-217-5512 Fax#
9 Landowner(s) of Record (attach accompanied page to list additional owners):
Rocky Mount ARD CGP LLC
Name Telephone Fax Number
361 Summit Blvd, Suite 110 361 Summit Blvd, Suite 110
Current Mailing Address Current Street Address
Birmingham, NC 35243 Birmingham, NC 35243
City State Zip City State Zip
10. Deed Book No 3189 Page Na 642 Provide a copy of the most current deed.
Part B.
1. Company(ies) or firm(s) 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.
A.R. Chesson Construction Company, Inc. [e-mail]
Name E-mail Address
P.O. Box 1147 315 W. Main St.
Current Mailing Address Current Street Address
Williamston, NC 27892 Williamston, NC 27892
City State Zip City State Zip
Telephone [phone] Fax Number N/A

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:
Name E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Telephone 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:
Al. R. Chesson, Jr. al [e-mail]
Name of Registered Agent E-mail Address
315 W. Main St. 315 W. Main St.
Current Mailing Address Current Street Address
Williamston, NC 27892 Williamston, NC 27892
City State Zip City State Zip
Telephone [phone] Fax Number N/A
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.
Al R. Chesson, Jr. President
Type or print name ( Title or Authority
. 3/14/24
Signature Date
I, i\1 . 2. ; (SO( , a Notary Public of the County of M ar-Hc
State of North Carolina, hereby certify that Pr R. Che SSoc), f. appeared
personally before me this day and being duly sworn acknowledged that the above form was
executed by him.
Witness my hand and notarial seal;this y day of luc_rci,-) , 20 a y
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