NCC242787_FRO Submitted_20240923

Check if this project is ARPA-funded ❑
Attach a copy of the Letter of Intent to Fund
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, including any
activity under a common plan of development of this size as covered by the NCG01 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 is not applicable or the e-mail address or phone
number is unavailable, place N/A in the blank.)
Part A.
1. Project Name Younts Rd
*If this project involves American Rescue Plan Act(ARPA) funds, list the Project Name or Project
Number(e.g., SRP-D-ARP-0121) below under which you were approved for funding through the
Division of Water Infrastructure (DWI).
2. Location of land-disturbing activity: County Union City or Township Town of Indian Trail
2401 Younts Road 35.08391 N 80.32055 W
Highway/Street Latltude(decimai degrees) Longitude(decimai degrees)
3. Approximate date land-disturbing activity will commence: July 2024
4. Purpose of development(residential, commercial, industrial, institutional, etc.): Commerical
5. Total acreage disturbed or uncovered (including off-site borrow and waste areas):4.64ac
6. Amount of fee enclosed: $ 100.00 . 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.$400.00 was previously paid on the 1st submittal 06/06/2024
7. Has an erosion and sediment control plan been filed? Yes ❑ Enclosed 2 No ❑
8. Person to contact should erosion and sediment control issues arise during land-disturbing activity:
Name Cameron Helms E-mail Address [e-mail]
Phone: Office# 704-400-9837 Mobile#
9. Landowner(s)of Record (attach accompanied page to list additional owners):
Rainy Days, LLC 704-400-9837
Name Phone: Office# Mobile#
PO BOX 2758 4914 Indian Trail Fairview Road
Current Mailing Address Current Street Address
Indian Trail NC 28079 Indian Trail NC 28079
City State Zip City State Zip
10. Deed Book No. Page No. Provide a copy of the most current deed.
Please see attached owners page for deed book & page information for each
parcel involved for this project

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).
One-Eighty Ventures, Inc [e-mail]
Company Name E-mail Address
PO BOX 2758 4914 Indian Trail Fairview Road
Current Mailing Address Current Street Address
Indian Trail NC 28079 Indian Trail NC 28079
City State Zip City State Zip
Phone: Office# 704-400-9837 Mobile#
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:
Cameron Helms [e-mail]
Name of Registered Agent E-mail Address
PO BOX 2758 3932 Smith Farm Road
Current Mailing Address Current Street Address
Indian Trail NC 28079 Matthews NC 28104
City State Zip City State Zip
Phone: Office# 704-400-9837 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:
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 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.
Company DBA 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.
Cameron Helms Developer/Owner
Type or print name Title or Authority
C 41-►kzerLe.A /� � ^^® c3 .2—.2 vo)
Signature Date
I, k2iiII 1 z !ml r , a Notary Public of the County of U[1j I UI
State of North Carolina, hereby certify that ( 'f''i1 i4l f Ji9/1I,i 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 Zr1/ day of f-1'1/I or , 20 21
kipA,
KAYLE A, SCHMIDT otary
Notary Public, North Carolina
Union:.County Qz )�124
My commission Expires My commission expires /I J 2 2
February 15,2028

Additional Owners
PID 07084094 PID 07084034
Deed Bk7553 Pg0824 Deed Bk7603 Pg0252
Rainy Days, LLC Rainy Days, LLC
PID 07084095 PID 07084035
Deed Bk7553 Pg0824 Deed Bk7603 Pg0252
Rainy Days, LLC Rainy Days, LLC
PID 07084096 PID 07084036
Deed Bk7553 Pg0824 Deed Bk7603 Pg0252
Rainy Days, LLC Rainy Days, LLC
PID 07084030 PID 07084097
Deed Bk7603 Pg0252 Deed Bk7603 Pg0252
Rainy Days, LLC Rainy Days, LLC
PID 07084032 PID 07084092
Deed Bk7603 Pg0252 Deed Bk8712 Pg0691
Rainy Days, LLC Love Mill Farms, LLC
PID 07084033 PID 07084093
Deed Bk7603 Pg0252 Deed Bk8712 Pg0691
Rainy Days, LLC Love Mill Farms, LLC