NCC243128_FRO Submitted_20241010

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 Soil Erosion and
Sedimentation Control Ordinance of the City of Greenville(Title 9,Chapter 8)before this form and an acceptable.
erosion and sedimentation control plan have been completed and approved by the City of Greenville,
Engineering Department. (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 North State Steel - Office Addition
2. Location of land-disturbing activity: County Pitt City or Township Greenville
Highway/Street Gum Rd. (NCSR 1421) Latltude(deamal degrees) 35.644 LOngitUde(decimal degrees) '77.388
3. Approximate date land-disturbing activity will commence: August 2024
4. Purpose of development(residential, commercial, industrial, institutional, etc.): industrial
5. Total acreage disturbed or uncovered (including off-site borrow and waste areas): 15.00
6. Amount of fee enclosed: $ 1,500 . The application fee of$100.00 per acre or portion
thereof (rounded up to the next acre) is assessed ,without a ceiling amount (Example: 8.10-acre
application fee is $900).
7. Has an erosion and sediment control plan been filed? Yes ❑ Enclosed NI No El
8. Person to contact should erosion and sediment control issues arise during land-disturbing activity:
Name Bryan Fagundus E-mail Address [e-mail]
Phone: Office# 252-565-1024 Mobile# [phone]
9. Landowner(s)of Record (attach accompanied_page to list additional owners):
North State Steel, Inc. 252-830-8884
Name Phone: Office# Mobile#
PO Box 5003 1010 Gum Rd
Current Mailing Address Current Street Address
Greenville NC 27835 Greenville NC 27834
City State Zip City State Zip
10. Deed Book No. 4347 Page No. 453 Provide a copy of the most current deed.
4385 84
4347 502
4370 690
4347 446
4352 260
3243 ' 219

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)maybe listed as the financially responsible party(ies).
North State Steel, Inc. CathyPNorthStateSteel.com
Company Name E-mail Address
PO Box.5003 1010 Gum Rd
Current Mailing Address Current Street Address
Greenville NC 27835 Greenville NC 27834
City State Zip City State Zip
Phone: Office# 252-830-8884 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:
Cathy Allsbrook [e-mail]
Name of Registered Agent E-mail Address
PO Box 5003 1010 Gum'Rd
Current Mailing Address Current Street Address
Greenville NC 27835 Greenville NC 27834
City State Zip City State Zip
Phone: Office# 252-830-8884 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.
Cathy Alisbrook Chief Financial Officer
Type or print name Title or Authority
ag,„
t 4ethcrei (.a6
Signature Date
I, D(awn m b-s • , a Notary Public of the County of 19U
State of North Carolina, hereby certify that( } AlE)prot appeared personally
before me this day and being duly sworn acknowledggd that the above form was executed by him/her.
035
Witness my hand and notarial seal, this c2day of. CJLin , 20 a-
l!"
aAa- GB/
gt
Q 4 aM�`'�,,,N s
"'OORF,,,'••• My commission expires 1J� r
"��lon Fk4 • ••, X
(1
•
‘4p1l►RY ° s I
PUIO i 0 i
/r.COU ,,`� •
''<<tIIII nolo

•
Continued from Items 9.& 10 in Part A of the Financial Responsibility/Ownership Form for multiple
owners. Attach copies of this page as needed to list all landowners.
Landowner 2 of Record:
Trevathan Family, LLC 252-830-8884
Name Phone: Office# Mobile#
PO Box 5003 1001 College Court
Current.Mailing Address Current Street Address
Greenville NC 27835 New Bern NC 28562
City State Zip City State Zip
Deed Book No. 620 Page No. 808 Provide a copy of the most current deed.
3243 219
Landowner 3 of Record:
Name Phone: Office# Mobile#
Current Mailing Address Current Street Address
•
City State Zip City State Zip
Deed Book No. • Page No. Provide a copy of the most current deed.
Landowner 4 of Record:
Name Phone: Office# Mobile#
Current Mailing Address Current Street Address
City State Zip City State Zip
Deed Book No. - Page No. Provide a copy of the most current deed.
Landowner 5 of Record:
Name Phone: Office# Mobile#
Current Mailing Address Current Street Address
City State Zip City State Zip
Deed Book No. Page No. Provide a copy of the most current deed.

Continued from !tern 1 in Part B of the Financial Responsibility/Ownership Form for multiple parties.
Attach copies of this page as needed to list all financially responsible parties.
Company 2 Name E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Phone: Office# Mobile#
Company 3 Name E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Phone: Office# Mobile#
Company 4 Name E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Phone: Office# Mobile#
Company 5 Name E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Phone: Office# Mobile#