NCC216474_FRO Submitted_20211130

FINANCIAL RESPONSIBILITYIOWNERSHIP 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.
1. Project Name Folkstone Woods
2. Location of land -disturbing activity. County Onslow City or Township Holly Ridge
HighwaylStreet Folkstone Road Latitude 34.5227 Longitude-77.5060
3. Approximate date land -disturbing activity will commence:
4. Purpose of development (residential, commercial, Industrial, institutional, etc.): __Residential
5. Total acreage disturbed or uncovered (Including off -site borrow and waste areas): 2.7
6. Amount of fee enclosed: $ 195.00 . The application fee of $65.00 per acre (rounded
up to the next acre) is assessed without a ceiling amount (Example: a 9-acre application fee is $585).
7. Has an erosion and sediment control plan been filed? Yes _ No_ __X Enclosed X
8. Person to contact should erosion and sediment control issues arise during land -disturbing activity:
Name Mike Tutuon E-mail Address [e-mail]
Telephone [phone]--
9. Landowner(s) of Record (attach accompanied page to list additional owners):
_ Folkstone RP, LLC 910 577-1441
Name Telephone Fax Number
1000 Hunters Trail 1000 Hunters Trail
Current Mailing Address Current Street Address
Midway Park, NC 28544 Midway Park NC 28544
City State Zip City State Zip
10. Deed Book No. 4451 Page No. _. 20 _ 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 hated as the flnandally responsible party.
Folkstone RP, LLC [e-mail]
Name - E-mail Address
1000 Hunters Trail 1000 Hunters Trail
Current Mailing Address Current Street Address
Midway Park, NC 28544 Midway Park, NC 28544
-State Zip City state __.. Zip

Telephone (9") 577-1441 Fax Number
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
CRYState- �� 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. CerMcate of Assumed Name. If the Financially Responsible
Party is a Corporation, give name and street address of the Registered Agent:
Name of Registered Agent E-mail Address
Current Mailing 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 be any change in the information provided herein.
Mike Tuton__ _ _ _ President
Type or print name q Title or Authority
Signature Date
Y y- ---- , a Notary Public of the County of _ � Si 6 Q)
State of North Carolina, hereby certify that iy1 +`&Q-a L T Lk 1 u�_ 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
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day of QC . D P- Y' _, 20 a II
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My commission expires__ b `L -A