NCC241957_FRO Submitted_20240628

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 Environment and Natural Resources. (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.
1. Project Name Coastal Millwork Supply
2. Location of land-disturbing activity: County New Hanover City or Township Wilmington
Highway/Street 4100 Logistics Drive Latitude 34.319 Longitude -77.894
3. Approximate date land-disturbing activity will commence; Mid-June 2024
4. Purpose of development(residential, commercial, industrial, institutional, etc.): Industrial
5. Total acreage disturbed or uncovered(including off-site borrow and waste areas): 4.82
N/A-Permit Issued by
6. Amount of fee enclosed: $ New Hanover County . 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).
x(Filed with New
7. Has an erosion and sediment control plan been filed? Yes Hanover No Enclosed
County)
8. Person to contact should erosion and sediment control issues arise during land-disturbing activity:
Name Stephen Nunn E-mail Address [e-mail]
Telephone [phone] Cell# 910-523-0855 Fax# [phone]
9. Landowner(s)of Record(attach accompanied page to list additional owners):
Sentry Properties LLC 910-763-3300
Name Telephone Fax Number
1301 S.13th Street
1301 S.13th Street j
Current Mailing Address Current Street Address
Wilmington NC 28401 Wilmington NC 28401
City State Zip City State Zip
10. Deed Book No. 6672 _ Page No. 1561 Provide a copy of the most current deed.
Map Book 73 Page 152
Part B.
1. Person(s) or firm(s) Who are financially responsible for the land-disturbing activity (Provide a
comprehensive list of all responsible parties on an attached sheet):
Sentry Properties LLC [e-mail]
Name E-mail Address
1301 S. 13th Street 1301 S. 13th Street
Current Mailing Address Current Street Address
Wilmington NC 28401 Wilmington NC 28401 -
_City State Zip City State Zip
Telephone [phone] Fax Number 4

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: N/A
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: N/A
• 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 ,
corrected information should there be any change in the information provided herein.,
Steve Risley Manager
Type or print name Title or Authority
'
'6F June 6,2024
Signature Date
I, Aild.ei-Scv) ,(1 , a Notary Public of the County of ,V (-1-ettari
State of North Carolina, hereby certify that ve, VAj611 y appeared
personally before me this day and being duly sworn acknowledged that the above form was
executed by.:°him.
Witness my hand and notarial seal,this .'(") v day of OnC , 20 no2L
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