HomeMy WebLinkAboutNCC230177_FRO Submitted_20230123FINANCIAL 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 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 N/A in the blank.)
Part A.
1. Project Name Lynn Ridge Lots 1, 34-55, 77
2. Location of land -disturbing activity: County Harnett City or Township Angier
Highway/Street Meadow Vista Lane Latltude(decimai degrees) 35.51273 Longltude(decimai degrees)-78,71644
3. Approximate date land -disturbing activity will commence: January 2023
4. Purpose of development (residential, commercial, industrial, institutional, etc.): Residential
5. Total acreage disturbed or uncovered (including off -site borrow and waste areas): 5.180
6. Amount of fee enclosed: $ 600.00 . 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.
7. Has an erosion and sediment control plan been filed? Yes ❑ Enclosed p No ❑
8. Person to contact should erosion and sediment control issues arise during land -disturbing activity:
Name Raymond Rinker E-mail Address raymond.rinker@ashtonwoods.com
Phone: Office # 919-872-0048 Mobile # 919-229-3238
9. Landowner(s) of Record (attach accompanied page to list additional owners):
Starlight Homes North Carolina LLC 919-872-0048
Name Phone: Office # Mobile #
4025 Lake Boone Trail, Suite 200 4025 Lake Boone Trail, Suite 200
Current Mailing Address
Raleigh NC
City State
10. Deed Book No. 3744
Current Street Address
27607 Raleigh NC 27607
Zip City State Zip
Page No. 570-573 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 orif the landowner(s) is
an individual(s), the name(s) of the owner(s) may be listed as the financially responsible party(ies).
Starlight Homes North Carolina LLC raymond.rinker@ashtonwoods.com
Company Name
4025 Lake Boone Trail, Suite 200
Current Mailing Address
Raleigh NC 27607
City State Zip
Phone: Office # 919-872-0048
E-mail Address
4025 Lake Boone Trail, Suite 200
Current Street Address
Raleigh NC 27607
City State Zip
Mobile # 919-229-3238
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:
Name of Registered Agent E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Phone: Office # Mobile #
Name of Individual to Contact (if Registered Agent is a company)
(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 Current Street Address
City State Zip City State Zip
Phone: Office # Mobile #
Name of Individual to Contact (if Registered Agent is a company)
(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.
Raymond Rinker
VP of Land Development
Type or print nam Title or Authority
Signature7 Date
a Notary Public of the County of W(Ao)
State of North Carolina, hereby certify that
before me this day and being duly sworn ackno dgec
Witness my hand and notarial seal, this day of
appeared personally
that the above form was executed by him/her.
20 2 t-
MARY HILL HEROLD Notary j
NOTARV PUBLIC C/I ,,UI
WAKE COUNTY, NC My commission expires 6 v 4
My Commission Expires 9-24-2026