NCC220066_FRO Submitted_20220105

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
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 NIA in the blank.)
Part A.
1. Project Name Lucy Lakes, Phase 4, Sections 1-3
2. Location of land -disturbing activity: County Moore City or Township Aberdeen
Highway/Street US Hwy 15-501 Latitude 35-05'38"N Longitude 79-25'01"W
3. Approximate date land -disturbing activity will commence: Oct. 2020
4. Purpose of development (residential, commercial, industrial, institutional, etc.): Residential
5. Total acreage disturbed or uncovered (including off -site borrow and waste areas): 12.15 AC
6. Amount of fee enclosed: $845.00 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).
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 Lee Humphrey E-mail Address LeeOdoubledeng com_
Telephone [phone] Cell # Fax #
9. Landowner(s) of Record (attach accompanied page to list additional owners):
Armstrong Timber Management
Name
2709 Thorngrove Court, Suite 2
Current Mailing Address
Fayetteville NC 28303
City State Zip
[phone]
Telephone Fax Number
Same
Current Street Address
Same
City State Zip
10. Deed Book No. 5118 Page No. 395404 Provide a copy of the most current deed.
5118, 416-418 and 5118, 419-422
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):
Armstrona Timber Manaaement
Name
2709 Thorngrove court, Suite 2
Current Mailing Address
Fayetteville NC 28303
City State Zip
Telephone [phone]
BrianACD-C-sprop.com
E-mail Address
Current Street Address
City
State Zip
Fax Number NIA

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:
Name
Current Mailing Address
City
Telephone
E-mail Address
Current Street Address
State Zip City
Fax Number
State Zip
(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
Part ' a Corporation, give name and street address of the Registered Agent:
/�Gy� f/!.f'l S �rrlil
Name of Registered Agent E-mail Address
Current Mailing Address
City
Telephone
Current Street Address
State Zip City
Fax Number
State Zip
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.
Brian Armstrong
TTy�yyp%ppe�e or print name
eq_��
Signature
Title or Abfhority
/j/' /) r — a I
Date
1, L tia 1aS , a Notary Public of the County of "6he .
State of North Carolina, hereby certify that zc ',an L. RrQa"'J�_ appeared
personally before me this day and being duly sworn acknowledged ffiat the above form was
executed by him.
Witness my ha�nq�and,pgtarial seal, this 1�, "'day of Al apf , 24.')-i
D O UG`
,�\oTaR�',��
Notary.� C'
4eUR�� •'��41 My commission expires opal
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