HomeMy WebLinkAboutNCC240060_FRO Submitted_20240109 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 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 and/or fax information
unavailable, place N/A in the blank.)
Part A.
Ridgecrest Farms
1. Project Name
Stanly Millingport
2. Location of land-disturbing activity: County City or Township
Millingport
Highway/Street R c-a d Latitude 35 . 1900 Longitude—8 0 .2 214
March 2022
3. Approximate date land-disturbing activity will commence:
4. Purpose of development(residential, commercial, industrial, institutional, etc.): residential
5. Total acreage disturbed or uncovered (including off-site borrow and waste areas): 5 . 6 acres
6. Amount of fee enclosed: $ 390 . 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 Bonnie Droze E-mail Address bdroze@gmail. com
Telephone 704 798 1135 Cell# Fax#
9. Landowner(s)of Record (attach accompanied page to list additional owners):
Bonnie Droze 704 798 1135
Name Telephone Fax Number
12515 Barrier Store Road
Current Mailing Address Current Street Address
Locust NC 28097
City State Zip City State Zip
10. Deed Book No. 1701 Page No. 852 Provide a copy of the most current deed.
Part B.
1. Company (ies) or firm(s) who are financially responsible for the land-disturbing activity (Provide a
comprehensive list of all responsible parties on an attached sheet.) If the company or firm is a sole
proprietorship the name of the owner or manager may be listed as the financially responsible party.
WR Contracting & Design, LLC bdroze@gmail .com
Name E-mail Address
12515 Barrier Store Road
Current Mailing Address Current Street Address
Locust NC 28097
City State Zip 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 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
correc d information should there be any change in the information provided herein.
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personally before me this day and being duly sworn acknowledged that the above form was executed
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Bonnie Droze
12515 Barrier Store Road
Locust, NC 28097
June 27, 2022
WR Contracting& Design, LLC
12515 Barrier Store Road
Locust, NC 28097
RE: Ridgecrest Farms
Stanly County
To whom it may concern:
I Bonnie Droze, landowner allow WR Contracting& Design, LLC to perform the work on my land.
Please contact me with any questions.
Sincerely,
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