NCC240621_FRO Submitted_20240307

FINANCIAL RESPONSIBILITY/OWNERSHIP FO M
SEDIMENTATION POLLUTION CONTROL AC
No person may initiate any land-disturbing activity on one or more acres as coverd by the Act before this form
and an acceptable erosion and sedimentation control plan have been complete and approved by the Land
Quality Section, N.C. Department of Environmental Quality. Submit the compl ted form to the appropriate
Regional Office. (Please type or print and, if the question is not applicable or he e-mail address or phone
number is unavailable, place N/A in the blank.)
Part A.
1. Project Name Evilfs Place
2. Location of land-disturbing activity: County Harnett City or Township Grove
Highway/Street SR 1547 Latltude(decimal degrees)35.4581 Longitude(decimai degrees)-78.6748
3. Approximate date land-disturbing activity will commence: 05-01-2022
4. Purpose of development (residential, commercial, industrial, institutional, etc.): residential
5. Total acreage disturbed or uncovered (including off-site borrow and waste reas): 1 .8
6. Amount of fee enclosed: $200.00 . The application fee f$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 0 Enclosed ❑ No 0
8. Person to contact should erosion and sediment control issues arise during land-disturbing activity:
Name Dess Langdon E-mail Address dglSon @gmail.com
Phone: Office# Mobile# [phone]
9. Landowner(s) of Record (attach accompanied page to list additional owne ):
DANNY FRED DENNING &ALICE B DENNING
Name Phone: Office # Mobile#
967 DENNING ROAD 967 DENNING I*OAD
Current Mailing Address Current Street Address
ANGIER, NC 27501 ANGIER, NC 2701
City State Zip City tate Zip
10. Deed Book No. 2752 Page No. 123 Provide a ca py 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 or if the landowner(s)is
an individual(s), the name(s)of the owner(s)may be listed as the financially responsible party(ies).
RL Properties, LLC [e-mail]
Company Name E-mail Address
130 Pope Lake Road 130 Pope Lake Road
Current Mailing Address Current Street Address
Angier, NC. 27501 Angier, NC. 27501
City State Zip City State Zip
Phone: Office# Mobile# [phone]
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:
levAuL ass LMCDot dgisoM 09 mei 1 ,e4:=./v1
Name of Registered Agent E-mail Address
13 D Pope_ 1--e-tLe Pd . 130 PE Lei 'Ro_.
Current M iling Address Current St-eet Address
not cr ►3- 7sol A nc-jy r NC- 7saj
City State Zip City State Zip
Phone: Office# cl i g 1) O �"�, Mobile# cl i -4 Z 7- 32g1
tx_ss (1_00N IC) - `-+27- 3-2,k1
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 ass med 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 a-sumed 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 a d belief and was provided
by me under oath. (This form must be signed by the Financially Responsib e Person if an individual(s)
or his attorney-in-fact, or if not an individual, by an officer, director, partn r, or registered agent with
the authority to execute instruments for the Financially Responsible arty). I agree to provide
corrected information should there be any change in the information provil ed herein.
Devaul Dess Langdon Registered Agent
Type or print name Title or Authority
f
Signature Date
I, 3u t 5. OQ,Yy1 j j-h , a Notary Public of the Cou ty of Wa.
State of North Carolina, hereby certify that i Lan Y1 appeared personally
before me this day and being duly sworn acknowledged that the above or was executed by him/her.
Witness my hand and notarial seal, this a3r�1 day of YY)Q rCi) , 20 as
flAce,, , /6/4/ y-A-4,46r,g-K_
Notary
My commission expires 5, ,1-aei d
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