NCC215363_FRO Submitted_20210930

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 Environment and Natural Resources. (Please type or print and, if
the question is not applicable or the e-mail and/or fax information unavailable, place NIA in the blank.)
Part A.
1. Project Name Carolina Club Subdivision
2. Location of land -disturbing activity: County Craven City or Township New Bern
Highway/Street US HIGHWAY 70 EAST Latitude 35.034883 N Longitude-77.004928 W
3. Approximate date land -disturbing activity will commence: Fall 2021
4. Purpose of development (residential, commercial, industrial, institutional, etc.): Residential
5. Total acreage disturbed or uncovered (including off -site borrow and waste areas): 50 acres
6. Amount of fee enclosed: $ $3,260.00 The application fee of $65.00 per acre (rounded up to the next
acre) is assessed without a ceiling amount
7. Has an erosion and sediment control plan been filed? Yes No Enclosed_X
Person to contact should erosion and sediment control issues arise during land -disturbing activity:
Name Bobby Billingsley E-mail Address_ BobbyBillinaslevOThomasEn4ineeringPA.com
Telephone [phone] Cell # 252.671.2408 Fax # [phone]
Landowner(s) of Record (attach accompanied page to list additional owners):
The Turf Club LLC 262.638.1701 n1a
Name Telephone Fax Number
310 Craven Street 310 Craven Street _
Current Mailing Address Current Street Address
New Bern, NC 28563-1664 New Bern NC 28563-1654
City State Zip City State Zip
10. Deed Book No. 2327 Page No. 688 & Deed Book No. 2327 Page No. 692
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):
Nolan Commercial Contractors. Inc. accountsftc-mi.com
Name E-mail Address
PO Box 7227 754 Ramsey Road Suite F
Current Mailing Address Current Street Address
Jacksonville, NC 28540 Jacksonville NC 28546
City State Zip City State Zip
Telephone [phone] Fax Number 910.939.2805

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
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
E-mail Address
Current Street Address
City State Zip City State Zip
Telephone 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 by any change in the information provided herein.
Nolan W. S des President — Nolan Commercial Contractors, Inc.
Type or print name Title or Authority
Signatur Date
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I, _1 2OhXj ljV1Y1,C&_I a Notary Public of the County of L DW
State of North Carolina, hereby certify that appeared
personally before me this day and being duly sworn acknowledged that the above form was
executed by him.
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