NCC230495_FRO Submitted_20230224

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FINANCIAL REBPONSIBILITY1OWNERSLIIP FORM
SEDIMENTATION POLLUTION CONTROL ACT
No person may iriiLmte arty Mrid'dWUfWQ acuay em Of* or more Acres as ffivVed by the Acl, imcludiag arty-
aetivly under a camrnon plsn of daxralopnient of lhls size as Mvered by the NC0.Q1 pamult, bekwe thia corm
and an scceptable efcifm and ac4rrentalkN9 owtrid plan hsw been compWad and approved by the Land
Ouslltyr Sacbnm, N.C. Deparlrnent of EwNwmarrhel -Quelftyr. Subrnit tr* wmplated iwn W lhr$ epproprWla
Renal CA". MeEme type Dr prlry and, rf the -queukm le not appllosbis or the e-mail addreas or phama
rnrmt}eris unaxailable, plena NA in the blank.)
Pan A.
1. Rrojeel N.r,ue atehou Terrace
'if hfe prl:ped ,pvaves Arneriesa FBewue Men Aar DARPA) AMM hM the PWaf Namir beroW
u rwrYW-*YOU VFNddtlW fr,ridkrg=04h VM aViehDr3 er L+t W WMWL cry (DM).
2. Location of 19nc disturbing 9aivity: C0WWIVERT City arTown s*Winslon Salern
Hi9imar t. uI tford Dr Lail ilwd%�ff Lon]i4udew•. d.c�.; 2�39
3. Appmximis*&vr. hsixJ•disrurhing titLwHyrwill ftwWr i6neJ + 1 f 02
d. PL"ae of devekon*nl. [residerdial, commercial, irrduslriBl. insliiuAior►al. edc.,! res I d e n t I a l
S. Total acreage digWrbed or uncovared (including off -an borrow and weste areaak • 7 7
6. Anmnt Df fag enWosed: 91 101. The appllcehon toe of S100.00 per acre (rounded
up to the maxi acnal * e&seae$d wrimout a oalling amount gExan0e: 0.1"ore appllsatron ke Is SO00).
Cheeks should be addres&ed to NCDEO.
7. Hsi arc em aian and sedirnenLcafWrd plea been Red? Yes ® Enckrsad ❑ NO ❑
0. Pew+ la crntaol should erosion and asdinrent -control issues arise dunng iand-dumurbi-rg adivitY;
N,rnq B F!a n McWh Iftar E.mRil Ad ** txncwhirtarQ1nmAcirnesum.corm
Rhcxir-: arrbe4V k0bile * 7045070 95
S. Lendowneflsl or Reeorsl feltach aocampanied page La lial sddHion.&I owrwmr :
True Domes LLC 7042381229
Narne
Phor-a: Office ip WNIa Ip
2649 Brekon ridge Cen" Dr
Cun�1 Mailing 4.4dre5s � �urrgM S�eetJ�ddress
Monroe NG 28110
city :51alc. Z%> cov Sb9e Zip
10. Dead Book No. 7 4 Page Na 5- Rro'rlde a copy- of the mxnl.currentdeed.

Palm B.
40 1 Compaaylws) who are financially responsible for tnd land-dlshoblrig activity JProvido a cnmprationsive list
of all responsible parbee on accompanied page.I if rrw cnnWarry os a esteprgpft* +sew ar J the 4n�ahM�+rra1 a
an vrhlvxFwWz1, mR itww(s) d me tww wfs) may ate l4afw a+ the hAancaatly rosparr mWe Psrry(ief �
True Homes LLC
Company Name E-mail Amwess
2649 Brekonridge Center Or
Cunnnt Mailing Aitlrlrnss Cur►anf Steal Address.
Monroe NC 28110
City slate ZV C#y Slate zip
Puna: 01rce a MWIS N 7042381229
Nole tl the Frrancielly Rasponsipre Party 4, not the owner d the lard to be disturbed, ncsuda with this loom
the landowner's signed and dated rtrlhon consent lot the a ipflc$nl to subm+l a droll erosion and sedime►Halion
Contra pion and W conducl the anucipaled land dralurbng aclrvlty,
2 le) 11 the I'manciafy Reminnsihle Party ea a damask oormmny registmed on the NC SCUMMY rri Stale
business r"lry, gird narna arx! sticinl address of the Regtslmod Ayent
Nwl* of RegisWed AgorA E-mail Address
Current Mailing Adttress Currenl Street Address.
City Slate ZIP Coy
Plxx+e Office N Mobile M
Pieria or trWtvadual ro COMM {rr P%glslerad Agern n a campanyl
State Zip
lby If the Flnanelaty Respons6e Party is not a resident of Nonh Carolina give nine and elreet address
of the des+gnated Norm Carona agent wrto w regastereo on the NC Ser.retary a1 Slate buwass t"iry
Name of Regislered Agnnl
Currem Mailing Address
M
Phone Orrice N
E • mall Address
Curram Street Address,
Z4 cay
Mobile N
Name of Wivadusl to Contact IN Reglsliered AgerA is a company]
Ste. zip

The above information is true and correct to the best of my knowledge and belief and was provided
by me under oath (This form musl be signed by the Financsally Responsible Person d an individual
or his attorney-irWact. ox M oat an lndWid W. by an officer, &actor, partner, or ragbWfed agent with
the authority to execute am* ments for the Financlaky Reaporloepible Person) l ogree to provide
corrected information should lltefe be any change in ltte information provided henlrl.
Orions McWhorter
Type or grin! name
Merkel Partner F*W
Title or Authority
a 11A.IZ-7
Date
it — a NoUvy Pubbc of the County of �7 _
Slate of North Carolina, hereby cortif y that 'Bf t a 0 M( j h I f -W appeared
personalty Wore me this day and being duty sworn ackn wtedged teal ft abava fp" was
executed by him
���14t111r+1 I
Witness. my ha
-•� gyp'•.
?� p _
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N
"it,lit lW�1
tiny of . 20.11
My commission expires_!'