NCC224073_FRO Submitted_20221213

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 N/A in the blank.)
Part A.
1. Project Name Santa Fe Apartments
2. Location of land -disturbing activity: Countv Cumberland City or Township Fayetteville
Highway/Street Santa Fe Drive Latitude 35deg06'8.59" N Longitude 78deg5739.57"W
3. Approximate date land -disturbing activity will commence: October 2021
4. Purpose of development (residential, commercial, industrial, institutional, etc.): Residential
5. Total acreage disturbed or uncovered (including off -site borrow and waste areas): 24 AC
6. Amount of fee enclosed S 1560.00 . 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 Enclosed X
8. Person to contact should erosion and sediment control issues arise during land -disturbing activity:
Name Jackson Howard E-mail Address [e-mail]
Telephone Cell # 910-483-0516 Fax #
9. Landowner(s) of Record (attach accompanied page to list additional owners):
MacPherson LLC 910-692-0276
Name Telephone Fax Number
602 Lily Place Same
Current Mailing Address Current Street Address
Southern Pines NC 28378 Same
City State Zip City State Zip
10. Deed Book No. 8479 Page No. 0670 Provide a copy of the most current deed.
4246 0492
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):
Jackson Howard / Sweetwater Capital [e-mail]
Name
1019 Hay Street
Current Mailing Address
Fayetteville NC 28305
City State Zip
Telephone [phone]
E-mail Address
Same
Current Street Address
Same
City State Zip
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
City State
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
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
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.
Jackson Howard
Type oypfint name
Managing Member
Title or Authority
u re Date
Ir s
, a Notary Public of the County of X.1',
State of North Carolina, hereby certify thatappeared
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 day of 20_L�
�s,• Keri Alpers
r M. S alNOTARY PUBLIC
Cumberland County, NC
My ommission Expires March 20, 2024
Notary
My commission expires Z