NCC220603_FRO Submitted_20220202

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 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 and/or fax information
unavailable, place N/A in the blank.)
Part A.
1
Project Name Walkers Grove
2. Location of land -disturbing activity: County Harnett City or Township Neill's Creek
Highway/Street Matthews Road Latitude 35d26'40"N Longitude 78d48'12"W
3. Approximate date land -disturbing activity will commence: December 2021
4. Purpose of development (residential, commercial, industrial, institutional, etc.): Residental
5. Total acreage disturbed or uncovered (including off -site borrow and waste areas): 10.2
6. Amount of fee enclosed: $ 715.00 . 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 Bobby Hilgoe
Telephone [phone] Cell #
E-mail Address [e-mail]
Fax #
9. Landowner(s) of Record (attach accompanied page to list additional owners):
True Homes, LLC
Name
900 Perimeter Drive Suite E
Current Mailing Address
Morrisville, NC 27560
C ity
[phone]
Telephone
Current Street Address
State Zip City
Fax Number
State Zip
10. Deed Book No. 4010 Page No. 0763 Provide a copy of the most current deed.
Part B.
1. Company (ies) or firm(s) who are financially responsible for the land -disturbing activity (Provide a
comprehensive list of all responsible parties on an attached sheet.) If the company or firm is a sole
proprietorship the name of the owner or manager may be listed as the financially responsible party.
True Homes, LLC [e-mail]
Name E-mail Address
900 Perimeter Drive Suite E
Current Mailing Address Current Street Address
Morrisville, NC 27560
City
State Zip City
State
Zip

Fax Number
Telephone
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 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:
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.
Bobby Hilgoe
Type or print name
Signature
Market Parnter
Title or Authority
11/23/2021
Date
I, kM0,,(Nda d� �4L , a Notary Public of the County of X-C-C
State of North Carolina, hereby certify that &ObAo appeared
personally before me this day and being duly sworn ack6owledge'd that the above form was executed
by him.
Witness my hand and notarial seal, this 2IfA day of t-1VILV CV 20 21
Seal Notsry Public
County
Notary
My commission expires l I Z�, 20'LS

Landowners) of Record (attach accompanied page to list additional owners):
KDP Development, LLC.
Name
1187 N. Raliegh Street
Current Mailing Address
Angier, NC 27501
City State Zip
[phone]
Telephone Fax Number
Current Street Address
City
State
Zip
Deed Book No. B3802 Page No. 642 Provide a copy of the most current deed.