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HomeMy WebLinkAboutNCC230956_FRO Submitted_20230404 FINANCIAL RESPONSIBILITY/OWNERSHIP FORM SEDIMENTATION POLLUTION CONTROL ACT No person may initiate any land-disturbing activity on one nr more acres as covered by the Act. including any activity under a common plan of development of this size As covered by the NCr01 permit, 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 rs not applicable or the e-mail address or phone number is unavailable place N/A in the blank ) Part A. 1 Project Name Raeford Road Self Storage • Location of land-d*.t.l-h1-I0 activity CourvtY Cumblerand City or Township Raeford Road 35.04' -78.9` tlphwev!St ree' Let+tUdl?to a-.a y x. • : Longitude(d.KlmAt dWmPq, kr)proxtmatc_ date land-dtr:.t,1-;ing ac1tvrty will commence 5.1 .23 4 Pu,;,r. o' Oevei;rrne-r -eF.tde-alai cor rr efc:a: ;r.1:,5!7.<, atonal. etc , Commercial otom i:' ri9J: llia•1' IC+: ;r' jnccvered j r.C . r; Ou-S:",e. d,i, and waste areas) 2.5 f= Amount a' tc_.c cr•t:;tosrc 5 3007 • i:.. , - , fee of$100 00 per acre i rourded 1( .: thtr. ncic a ce .. : 3 10-acre application fee is $9001 ,:tiyc : sthoutc t,: aaa-c::se_ lc.NCDEQ ' sr erosia :s I:. let 1t"1er control plan been fied? Yes ❑x Enclosed (S3 No ❑ t Pei-sor t: :;Omy:`. a'tuut'_ r.`t>:,tc,• a-1c st.cirnent COMM? issues arise during land-disturbing activity ,skii,,,K Andrew Mericle Address d americle@voltaglobal.cc ,e,s 8042401911 IOvvV1 '6 if f1c.'_s'C at a_' y ?_r"I� ICJ. rG�yC 5I c_';''I ��I Owners) VG Fayetteville Storage LLC 305.428.6504 205.478.0234 tea+'ire c c Mi3O,le 2601 S Bayshure Dr STE 1720 2601 S Bayshore Dr STE 1720 :.JI fait•. I0allllit frj0icc.0 • c -- t✓ilarrli FL 33133 Miami FL 33133 Il _+tQ(C 16. 1`. J ib Zip L 11560 0443 _ JCCC bucii Iv_ Mbye vduJla III 111061 _aired( Jeier.l. Part B. 1 Cnmpprwf ipcl who Arp fir r loll\ rc pr r il'.1P 4(yr two IAr'd d' tii htnq artivity(F'rnvirle a Compro_hAngivp Iht of All rf.', I1hnCihlp hRrlipC t,h Qr r ll',A^'iafl (1a p } N!hp C r/7'00any r.<A.<rYi4 n''rltWliefVY•4hrC1 nr'f ffta(�I1Ifr7WYfOr(.QI i. Rn rnrlry rlimirc 1 //it nAmp(c 1 n!fhr -,r,•.c rngl•he` lic!n,H At flvP le'146r740!y r$,API'YP14111e p4yy17a4l VG Fa\vetteville Storage LLC Ihurnett@voitaglobal.com i•nmham /4PrrIP Add*ese 2601 S Bayshore Dr STE 1720 2601 S Bayshore Dr STE 1720 t.ilrreri MAihh� larlrl�ae C: -o- oc{ Addrec� - - Miami FL 33133 Miami FL 33133 hit\ State tic C � State Zip nhrinc. (')fll. c 305 428.6504 yn�¢ .o# 205.478.0234 Not 1h; r rlah:lali\ C:�:;t.1^ 1`11c ''a", `a ^,t,^,� ^f!'•€, 'arid to be disturbed. include with this form !}x. OnrInwr)r : :AI)ha: I'lr 'lalar v' 1``u r. c ' submit a draft erosion and sedirnentation ..1•Cl pi?' 'ir t: +•1:1.I:.' "Ip :4-1'1-1,-J`G- a } !tut Inan:;lln 4.pg4,rr!:.0.-,lr :1—, - - r•. - j :,n the NC Secretary of State hiso.K4: replxt•t ),vc •131^1p .to," •r.r' . .. . . . . . . .-. , IJre . i• .. ::i!\ :i die rc :/ttiUt;x I,I Iha�rc :) I,iC) v lil;.d !: :.u!Ily:" r t\Chil:iicr •• 3 -.i•1-a1 1. I. lire r li,a,r.ial , 1.1. a CAi.IC, ',,III••a )' 1!,e Ue:ly ldlei IV•.1111 ..ti,:llo.a aya 1 �.'1. c Ii ic1 a: 1 c 'J.. :c1 7i.a1 f aiiirc GI.:311•a_c .tji (I1i r•cylcic•c tL1GI1. Wir..1114 .� .. z+;.7 ..:1 a3.4 II .1;NIC /Ir I., �iiJI V'r"Ii .)111-.c 1•401.1c 1' 1�1111.LII.t1 I ::A, I ,.1�4.. . . . . . -I.... (c) If the r inencielly Responsible f'Arty is Pr'gaq,rq +n hUa ^Ads angler an a44„merl name, give name under which the cornrianv is f)oino Rucir,Pcc As if the f!rA";•a"y Fte4rnn4file Party 14 an inrlivirlual general Pertnerchip or either Cr'mpery 1r,1 'CQ,cterP(1 R"11!!",_^.(1 h:,s-^044 it-`rlor an a4411m,rl name attach a copy of the Cprtifirete of Aci!mPr1 Njwme ornrAnv 11RA hierne the above information is trip And correct to the hest of my knowledge and belief and wnwas provider] h\ rnr i inclpt oAth (Thic form must he s►gnpd by the rinancially, Responsible Person if an individual(s) `11- at1.7 nrv-in-fprt Or if nrtiAn indtveduAi by Ain officer director. partner, or registered agent with the authority tr c.ro,.tic i-,strumptYtg f(yr the FuNanicialty Respon cihle Party) I agree to prr)v1r1e corrected inforrnat,n- r_`r,',,ii.-' `hare hp 8riy oNanicte in the information provided herein _ cv print name - tie or Authority .-4. A. f .i._1!, ., \ :... . 'ne County of M.a"^n ^4-4... `•Malt: : iro..e#.- ..--.!w.1. ,,r,'r,-,, _r...n . _ ,_r'r,' t1V ` ., ;,;�.. appeared personally tvff:r: r- : ?h,: :1.2k a-i: .`rr,,-r; i.:•, .N.- .- , t,orrn was executed by him/her lrl'it'1Cij= 1`11 i:1'IC :4'1' '1:1'..,•,.. ..r, ., • V. 3 a. , .,.t . 20 �HC�. , Jf 1st! ,aiJ(1 oxprrrc-i ,w r -' ) ` - , r J M1` . /C!C S� . t+..-, !... h.wr •ads. .ad..►Ar. i