NCC222675_FRO Submitted_20220804

FU 0 UA\(-\//-\ R I Ia n
Erosion and Sedimentation Control (EC)Transmittal Form
(Required for All EC Submissions)
Project Name FV Family Entertainment Center
Project Site Address 1475 N Judd Pkwy NE + 1302 N Broad Street
EC Permit Number TBD
Disturbed Acreage 6.0 acres
Submitted By Red line Engineering c/o Gary J. McCabe, PE
p EC Plan Submission
Check ❑ if an Amendment to an Approved Plan
Submission Number: []First ❑ Second []Third +
p Fees
❑ Other
p Application Form
p Soil Erosion & Sedimentation Control Submittal Checklist
p Financial Responsibility/Ownership Form SPCA
p Construction Plans for review — 1 paper copy, 1 electronic copy
pinitial Plan Review
❑ Resubmittal
❑ Amendment
❑ Permit
❑ 1-Year Renewal
❑ 2-Year Renewal
$ 1,500 '$250/ Disturbed Acreage {rounded up)
$ "$75 starting with 3jd submittal
$
$
❑ Plans for Stamping
❑ Copies of Stamped Plans
❑ Other
'$75
"$250/ Disturbed Acreage (rounded up)
'$125/ Disturbed Acreage (rounded up)
"$250I Disturbed Acreage (rounded up)
■
■ Comments This project is part of the disturbance for Tommy's Express Car Wash (SP-2022-02 + EC-2022-02). The developer for ■
= I ommy's will install all of the Phase I Erosion Control Devices and Measures and will maintain them throughout construction of both ■
oproperties. The Phase I EC plan for Tommy's has been included in the plans for reference, which includes the LOD for our site. ■
■
■McKim & Creed has provided all calculations for erosion control under EC-2022-02. A Phase II site specific plan has been provided ■
Eby Red Line Engineering. Please feel free to call my cell if there are any questions (919) 6064560, ■

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F U Q IJ/-1`(-1//-R IN A
north c•arolina
Financial ResponsibilitylOwnership Form SPCA
See TOFV LDO, Section §9-1407 SOIL EROSION & SEDIMENTATION CONTROL and Town Standards and Specifications for
additional details.
Part A.
1. Project Name FV Family Entertainment Center
2. Location of land -disturbing activity: Highway/Street 1475 N Judd Pkwy NE + 1302 N Broad St
3. Approximate date land -disturbing activity will commence: August 1, 2022
4. Type of development (residential, commercial, industrial, institutionai,etc.): Commercial
5. Total acreage disturbed or uncovered (including off -site utilities and borrow/waste areas): 6.0 ac
(See SP--22�02?-02 & EC-2022-02)
6. Person to contact should erosion and sediment control issues arise -during land- is urbing activity:
Name Bryden McCormick E-mail Address [e-mail]
Telephone Cell # [phone]
7. Landowner(s) of Record (attach accompanied page to list additional owners):
McRolling Properties, LLC [e-mail]
Name E-mail Address
401 Attain Street 401 Attain Street
Current Mailing Address Current Street Address
Fuquay-Varina, North Carolina 27526 Fuquay-Varina, North Carolina 27526
City State Zip City State Zip
8. Deed Book No. 18837
Page No. 1195
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):
McRolling Properties, LLC [e-mail]
Name E-mail Address
401 Attain Street 401 Attain Street
Current Mailing Address Current Street Address
Fuquay-Varina, North Carolina 27526 Fuquay-Varina, North Carolina 27526
City State zip City State Zip
Telephone [phone]
Town of Fuquay-Varina r 401 Old Honeycutt Road, Fuquay-Varina, NC 27526
[phone] - fuquay-varina.org

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 Town of
Fuquay-Varina Land Development Ordinance and/or Land Disturbance Permit:
N/A
Name
Current Mailing Address
City State Zip
E-mail Address
Current Street Address
City State Zip
Telephone
(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: n
N/A ,^�eQ� �4 �w,� ek_ E 7�'V� ukGeo r,�����S�,n..:.`� . com
Name E-mail Address (j
Current Mailing Address Current Street Address
ZZ 2
City S ate Zi City 'Ctate 20p
Telephone C 3o�6 iD
The above informato 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.
Bryden McCormmick, Registered Agent
Typ r print name Title or Authority
7/
grtatu Date
1, _ ' t c� �2�t11U[PM a Notary Public of the County of, 4_A A o_"t
State of North Carolina, hereby certify that �r�C�e.t�1 Mc:liN 4Md'(. appeared personally
before me this day and being duly sworn alcknow edged that the above form was executed by him.
Witness my hand and notarial seal, this l day of
STPHANIE BURGESS
NotaryyPublic, North Carolina
Harnett County Nota
My Cor�rmi Sion Expires
Seal
My commiss on lexpires