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HomeMy WebLinkAboutNCC241512_FRO Submitted_20240517 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 address or phone number is unavailable. place N/A in the blank.) Part A. 1 . Project Name GET RIGHT BORROW PIT 2. Location of land-disturbing activity: County Onslow City or Township Maple Hill — Stump Sound Highway/Street 185 Hardy Graham Road (SR 1530) Latr decimal degrees) 34.683°N Longldecimaidegreesl_77.622 3 Approximate date land-disturbing activity will commence: September 10. 2023 4. Purpose of development (residential, commercial, industrial, institutional, etc.): Residential 5. Total acreage disturbed or uncovered (including off-site borrow and waste areas): 3.4 ac 6. Amount of fee enclosed: $ 400.00 The application fee of $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 Enclosed No = 8. Person to contact should erosion and sediment control issues arise during land-disturbing activity Name Will Alexander E-mail Address getrightenterprisesllcgmail.corn Phone: Office # 910 264 6782 Mobile # 9. Landowner(s) of Record (attach accompanied page to list additional owners): Get Right Investments. LLC 910-264-6782 Name Phone: Office # Mobile # PO Box 296 103 Ashley King Road Current Mailing Address Current Street Address Holly Ridge NC 28445 Holly Ridge NC 28445 City State Zip City State Zip 10. Deed Book No. 6004 Page No. 767 Provide a copy 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). Get Right Investments LLC 910-264-6782 Name Phone: Office # Mobile # PO Box 296 same Current Mailing Address Current Street Address Holly Ridge NC 28445 same City State Zip City State Zip Note: If the Financially Responsible Party is not the owner of the land to be disturbed. include with this form the landowners 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 registerea on the NC Secretary of State business registry. give name and street address of the Registered Agent: Will Alexander getrightenterprisesllc(c�gmail.com Name of Registered Agent E-mail Address same as above 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) (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' n/a 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) (ci If the Financially Responsible Party is engaging in business under an assumed 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 assumed name. attach a copy of the Certificate of Assumed Name. C k4 — Yk4 FS CL-c. Company DBp Name 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(s) 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 Party). I agree to provide corrected information should there be any change in the information provided herein. William S. Alexander Ire Sf VL "� Type or •rint name Title or Authority Signature Date \11. � . a Notary Public ry ubI c of the County of y104)-.1/_ State of North Carolina. hereby certify that \ )d1 t Q W' 7g/1---XQ-VI V appeared personally before me this day and being duly sworn acknowledged that the above form was executed by him/her. Witness my hand and notarial seal, this fay of 1\taj . 20 02/4 it) I� Melita G. Becker Notary Notary Public Pender County, NC My commission expires ©�/fiete My Commission f ron Expires 05/26/2027