NCC230220_FRO Submitted_20230127

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 Edinborough Phases 3 - 5
2. Location of land -disturbing activity: County Guilford City or Township Rock Creek
Highway/Street Ben Nevis Avenue Latitude 36.12019692 Longitude -79.55264568
3. Approximate date land -disturbing activity will commence: June 1, 2022
4. Purpose of development (residential, commercial, industrial, institutional, etc.): 59 Lots & 32 Townhouses
5. Total acreage disturbed or uncovered (including off -site borrow and waste areas): 29.86 Acres
6. Amount of fee enclosed: $ $ 1,950.00 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 Chad Hill E-mail Address [e-mail]
Telephone [phone] Cell # 336-508-5765 Fax #
Landowner(s) of Record (attach accompanied page to list additional owners):
Edinborough 7, LLC 336-282-4127
Name Telephone
7B Corporate Center Court 7B Corporate Center Court
Current Mailing Address Current Street Address
Greensboro N.C. 27408 Greensboro N.C.
City State Zip City State
10, Deed Book No. 8381 Page No. 2712
Part B.
Fax Number
27408
Zip
Provide a copy of the most current deed.
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):
Edinborough 7, LLC
Name
7B Corporate Center Court
Current Mailing Address
Greensboro N.C. 27408
City State Zip
E-mail Address
7B Corporate Center Court
Current Street Address
Greensboro N.C. 27408
City State Zip
Telephone 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
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 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.
6 Mexnw- MUUAa v
Type or t name Title or Authority
31 �1122
Signature Date T
I, L WY�a MAMpS , a Notary Public of the County of Qol dwo
State of North Carolina, hereby certify that �Qiym QIa1(v-s appeared
personally before me this day and being duly sworn acknowledged that the above form was
executed by him.
Witness my hand and no%�«I,�pal, this day of "M u, 20 -
�PNotary Public
Davidson
Sealy County
My Comm. Exp.
y 01-05-2027 Q-
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My commission expires plI OSI1-n-1