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HomeMy WebLinkAboutNCC232714_FRO Submitted_20230929 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 +/- 42,000-SF Warehouse Expansion for CCBCC - Monroe 2. Address where land disturbing activity will take place 4268 Capital Dr. Monroe, NC 28110 3. Approximate date disturbing activity will commence 09 / 01 / 2023 4. Purpose of development(residential,commercial,industrial,etc.) Commercial 5. Total acreage of land to be disturbed or uncovered 1.88 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.) $700 7. Agent to contact should sediment control issues arise during land disturbing activity Name Ethan Hart Phone (803) 331-2991 8. Landowner(s)of Record(use blank page to list additional owners) Name CCBCC Operations, LLC Name Mailing Address 4100 Coca-Cola Plaza Mailing Address Charlotte, NC 28211 Street Address 4100 Coca-Cola Plaza Street Address Charlotte, NC 28211 Phone (704)488-0429 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 3658 Book Page 288 Page 10. Tax Map Parcel Number where land disturbing activity will take place 09 -- 399 __ 009 07-18 Permits, Checklists, and Forms Division 07 CITY OF MONROE STANDARD SPECIFICATIONS AND DETAIL MANUAL Part II 1. Person(s)or firm(s)who are fmancially responsible for this land disturbing activity(use blank page to list additional owners) Name Fitts and Goodwin, Inc. Name Mailing Address 120 Corporate Blvd. Mailing Address West Columbia, SC 29169 Street Address 160 Mine Lake Ct. Ste 200 Street Address Raleigh, NC 27615-6417 Phone (803)796-4660 Phone Fax Fax 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 NC 27615-6417 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 Mailing Address Street address City State Zip Phone 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 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 authority to execute instruments for the financially responsible person) Type or Print Nme Thomas Fitts Title President vSignature J( � Date 08 / 22 / 2023 South I, Susan I ourigan ,a Notary Public of the County of Richland ,State of-P1e##Carolina, hereby certify thatThomas M. Fitts, Jr. - President appeared personally before me this day and being tidy sworn acknowledged that the above fonn was executed by him. Witness my hand and notarial seal,this 22nd day ofAugust, 2023 SEAL O LOUR/ 'y, C/I A ( otary);SU1oc&.n rli‘-) I My commission expires 04/14/2033 �=N'•AveIA�/T.§ 07-19 Permits, Checklists, and Forms ��' �'�'_,,,,,, �� Division 07