NCC223287_FRO Submitted_20220922

FINANCIAL RESPONSIBILITY/OWNERSHIP FORM i
SEDIMENTATION POLLUTION CONTROL ACT
5 a -
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 address or phone
number is unavailable, place NIA in the blank.)
Part A.
1. Project Name The Estates at Morgan Farms
Harnett Hectors Creek Twsp.
2. Location of land -disturbing activity: County City or Township
Grass Meadow Road 35.4366-78.8320
Highway/Street y Latitude(decimai degrees) Long(tude(decimai degrees)
3. Approximate date land -disturbing activity will commence:
As soon as possible
4. Purpose of development (residential, commercial, industrial, institutional, etc.):
Residential
5. Total acreage disturbed or uncovered (including off -site borrow and waste areas):
6.64
6, Amount of fee enclosed: $ 700.00 . The application fee of $100.00 per acre (rounded
up to the next acre) is assessed without a ceiling amount (Example: 8.10-acre application fee is $900).
Checks should be addressed to NCDEQ.
Has an erosion and sediment control plan been filed? Yes ❑ Enclosed ❑x No ❑
Porsnn to contact should erosion and sediment control issues arise during land -disturbing activity:
Name David Allgood
Phone: Office #
-mail Address [e-mail]
Mobile # [phone]
9. Landowner(s) of Record (attach accompanied page to list additional owners):
KD Property Development, LLC
Name
5501 Erinvale Court
Current Mailing Address
Holly Springs N.C. 27540
City
State zip
919-422-5941
Phone: Office # Mobile #
Same
Current Street Address
Same
City State zip
10. Deed Book No. 9
3429 Page No. 459 Provide a copy of the most current deed.

Part B.
1. Company(ies) who are financially responsible for the land -disturbing activity (Provide a comprehensive list
of all responsible parties on accompanied page.) if the company is a sole proprietorship or if the landowners) is
an individual(s), the name(s) of the owner(s) may be listed as the financially responsible party(ies).
KID Property Development, LLC
Company Name
5501 Erinvale Court
Current Mailing Address
Holly Springs N.C. 27540-7261
City State Zip
Phone: Office #
[e-mail]
E-mail Address
Same
Current Street Address
Same
City State Zip
Mobile # [phone]
Note: If the Financially Responsible Party is not the owner of the land to be disturbed, include with this form
the landowner's signed and dated written consent for the applicant to submit a draft erosion and sedimentation
control plan and to conduct the anticipated land disturbing activity.
2. {a) If the Financially Responsible Party is a domestic company registered on the NC Secretary of State
business registry, give name and street address of the Registered Agent:
David W. Allgood
Name of Registered Agent
5501-Erinvale Court
Current Mailing Address
Holly Springs N.C. 27540-7261
City State Zip
Phone: Office #
[e-mail]
E-mail Address
Same
Current Street Address
Same
City
Mobile # [phone]
!Name of Individual to Contact (i€ Registered Agent is a company)
State Zip
(b) If the Financially Responsible Party is not a resident of North Carolina, give name and street address
of the designated North Carolina agent who is registered on the NC Secretary of State business registry:
Name of Registered Agent E-mail Address
Current Mailing Address
City State
Phone: Office #
Current Street Address
Zip City
Mobile #
Name of Individual to Contact (if Registered Agent is a company)
State Zip

(c) if the Financially Responsible Party is engaging in business under an assumed name, give name under
which the company is Doing Business As. If the Financially Responsible Party is an individual, General
Partnership, or other company not registered and doing business under an assumed name, attach a copy
of the Certificate of Assumed Name.
Company DBA Name
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(s)
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 Party). I agree to provide
corrected information should there be any change in the information provided herein.
W. avid Allgood . Managing Member
.rwType or p ' t name, Title or Authority
Signa ©ate
a Notary Public of the County of 61 rr)t-'�t
State of North Carolina, hereby certify that Vi appeared personally
before me this day and being duly sworn acknowledged that the abo form was executed by him/her.
Witness my hand and notarial seal, this day of , 20
OU LaMffl &ZINLA
;;ea:aarerrEoa,
Notary
My commission expires U 202'5
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