NCC231629_FRO Submitted_20230607

CITY OF MONROE STANDARD SPECIFICATIONS AND DETAIL MANUAL
07.06 EROSION CONTROL FORMS AND CHECKLISTS
07.06.01 EROSION CONTROL FINANCIAL RESPONSIBILITY FORM
No person may initiate any land-disturbing activity as defined in Chapter 158 of the Monroe City Code prior to
completion of this form,and an applicable and acceptable erosion and sedimentation control plan has been approved by
the City of Monroe Engineering Department. (Please type or print)
Part I
1. Name of Project Rocky River Crossing
2. Address where land disturbing activity will take place 3622 Lacee Paige Rd Monroe, NC 28110
3. Approximate date disturbing activity will commence 06 / 20 / 2023
4. Purpose of development(residential,commercial,industrial,etc.) Residential and Commercial
5. Total acreage of land to be disturbed or uncovered 25.30
6. Amount of fee enclosed(fee will be the amount of current policies per acre multiplied by the total number
of acres or any part of an acre from number 5. i.e.7.28 acres equals 8 acres.) $3,000
7. Agent to contact should sediment control issues arise during land disturbing activity
Name Signature Property Group (Phillip Arrington) Phone [phone]
8. Landowner(s)of Record(use blank page to list additional owners)
Name Liquid Management, LLC Name
Mailing Address 231 Post Office Dr, Suite 8 Mailing Address
Indian Trail, NC 28079
Street Address 231 Post Office Dr, Suite 8 Street Address
Indian Trail, NC 28079
Phone [phone] Phone
Fax Fax
9. Indicate Book and Page where deed of the property where land disturbing activity will take place is recorded
(use blank page to list additional owners)
Book 7918, 8187, 8360, 8537 Book
Page 0098, 0810, 248, 0717 Page
10. Tax Map Parcel Number where land disturbing activity will take place -- -- 08303006
08303005A
-- -- 08303005B
08303005
07-18 Permits, Checklists, and Forms
Division 07

CITY OF MONROE stANDAtu)SPECIFICATIONS AND DETAIL MANUAL
Part II
i. Person(s)or firm(s)who are financially responsible for this land disturbing activity(use blank page to list
additional Qvners)
Name Signature Rocky River, LLC Name
Mailing Address 230 North Elm Street,Suite 1000' Mailing Address
Greensboro,NC 27401-2499
Street Address 230 North Elm Street,Suite 1000 Street Address
Greensboro,NC 27401-2499
Phone [phone] Phone
Fax 'Tax
2. A)If the Financially Responsible Party is not a resident of North Carolina,give name and address of a North
Carolina Agent
Name of Registered Agent
Mailing Address
Street address City State Zip
Phone Email Fax
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 the name and street address of the Registered Agent:
Name of Registered Agent Schell Bray PLLC
Mailing Address230 North Elm Street, Suite 1500, Greensboro, NC 27401-2499
Street address City State /i p
Phone^336-294-9199 Email Fax
3. The above information is true and correct to the best of my knowledge and belief and was provided by me
under oath. I agree to provide corrected information should there be any change in the information provided
herein.(This form •ust be signed by the financially responsible person if an individual or his attorney in fact,
or if not an indivi, .1,by an officer,director,partner,or registered agent with authority to execute instruments
for the financial, ,ponsible person)
Type or Prin =•• Taylor Title Vice President, Development
Signature - Date I ( / ; 2I
t, t-Q8 1 .A-._i4_LgQ.ge/_t.a Notary Public of the County of /ar...‘„"_cespn State of North Carolina,
hereby certify that___esCitQA Gi lC2 i/as appeared personally before me this day and being ly sworn acknowledged
that the above form was executed by him. 7
Witness my hand and notarial seal,this f 3 day of A../ f
TM)b..w , 1e.11
SEAL Erika K.Larson —
NOTARY PUBLIC (N ary) —
Davidson County,NC My commission expires Y— p,Ge
My Commission Expires April 08,2028 07-19 Permits, Checklists,and Forms
Division 07