NCC215243_FRO Submitted_20210927

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JOHNSTON COUNTY FINANCIAL RESPONSIBILITYIOWNERSHIP 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
Johnston County Department of Public Utilities. (Please type or print and, if the question is not applicable or
the e-mail and/or fax information unavailable, place NIA in the blank_)
Part A.
1. Project Name Mule Farm Solar, LLC
2. Location of land -disturbing activity: City or Township Benson
Highway/Street 855 IN Johnson Street Latitude 35.38611 Longitude-78.53949
3. Approximate date land -disturbing activity will commence: 8/23/2021
4. Purpose of development (residential, commercial, Industrial, institutional, etc.): Commercial Solar
5. Total acreage disturbed or uncovered (including off -site borrow and waste areas): 13.40
6. Amount of fee enclosed: $3,740 . The application fee of S330.00 per acre (rounded up
to the next acre) is assessed for the first 10 acres and an additional $110 per acre for each
additional acre (rounded up to the next acre).
7. Has an erosion and sediment control plan been filed? Yes No Enclosed X
8. Person to contact should erosion and sediment control issues arise during land -disturbing activity
Name Sean Chastain E-mail Address sea n.chastain a@ purepowercontractors.com
Telephone Cell # 828-421-9364 Fax #
9. Landowner(s) of Record (attach accompanied page to list additional owners):
Name Telephone Fax Number
Current Mailing Address Current Street Address
City State Zip City State Zip
19_ Deed Book No Page No
Part B.
1. Person(s) or firms) who are financially responsible for the land -disturbing activity (Provide a
comprehensive list of all responsible parties on an attached sheet):
Pure Power Contractors, LLC [e-mail]
Name E-mail Address
2812 Gray Fox Rd. 2812 Gray Fox Rd.
Current Mailing Address Current Street Address
Monroe NC 28110 Monroe NC 28110
City State Zip City State Zip
Telephone Fax Number
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