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Home My WebLink AboutNCC221370_FRO Submitted_20220407FINANCIAL 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 address or phone number is unavailable, place NIA in the blank.) Part A. Project NameOakmont, Phase Two, Section Two -Lots 62, 69-72, 82-84, 89, 129, 130, 316-321 & 324 2 Location of land -disturbing activity: County Harnett City or Township_ Barbecue Township Countryside Drive, Kingwood Court Highway/Street & Bunting Drive Latitude(decimaldegrees) N 35.3228' Longitude(deama1degrees) W-78.9833° 3. Approximate date land -disturbing activity will commence: Aril 2022 4 Purpose of development (residential, commercial, industrial, institutional, etc.): Residential 5. Total acreage disturbed or uncovered (including off -site borrow and waste areas) 11.65 Acres 6. Amount of fee enclosed: $ 1.200.00 . 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. 7. Has an erosion and sediment control plan been filed? Yes ❑ Enclosed C No ❑ 8. Person to contact should erosion and sediment control issues arise during land -disturbing activity: Name Leslie Groves E-mail Address_ lesl ieg rovesCcDhhhomes.com Phone; Office # 910-486-4864 Mobile # 9. Landowner(s) of Record (attach accompanied page to list additional owners): Oakmont Development Partners, LLC 910-485-8463 Name Phone: Office # Mobile # 109 Hay Street Suite 301 Same Current Mailing Address Current Street Address Fayetteville_ NC _ 28301 Same City State Zip City State Zip Lots72,82, 83,129,130, 316-321 &324 10. Deed Book No. 3662 Page No. 762 Provide a copy of the most current deed. 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 landownerfs) is an individual(s), the name(s) of the owner(s) may be listed as the financially responsible party(ies). H&H Constructors of Fayetteville, LLC Company Name 3709 Raeford Road. Suite 200 Current Mailing Address leslie roves hhhomes.com E-mail Address Same Current Street Address Fayetteville NC 28304 San City State Zip City Phone: Office # 910-486-4864 Mobile # State Zip 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: Name of Registered Agent Current Mailing Address City State Phone: Office # E-mail Address Current Street Address Zip City Mobile # Name of Individual to Contact (if Registered Agent is a company) State Zip (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). agree to provide corrected information should there be any change in the information provided herein. Leslie Groves VP of Sales Type or print name h.F ignature -------------------------------------------------------------- Title or Authority Date I, �9, 'a 1, . a Qzts., , a Notary Public of the County of Lmoeff'l dy-�4 State of North Carolina, hereby certify that L'OA f C, appeared personally before me this day and being duly sworn acknowledged that the above form was executed by him/her. A A Witness my hand and notarial seal, this �i� day of c /V ay. 20 ^ 0111 L J C otar j My commission expires J rj,f 4, Continued from Items 9 & 90 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: _ H&H Constructors of Fayetteville. LLC 910-486-4864 Name Phone: Office # 3709 Raeford Road Suite 200 Current Mailing Address Fayetteville NC 28304 City State Zip Lots 62, 69, 70, 84 Lots 62, 69, ❑eed Book No. 4119 Page No. 688 Landowner 3 of Record: H&H Constructors of Fayetteville, LLC Name 3709 Raeford Road, Suite 200 Current Mailing Address Same Current Street Address Mobile # Same City State .Zip 70,84 Provide a copy of the most current deed. 910-486-4864 Phone: Office # Same Current Street Address Mobile # Fayetteville NC T 28304 Same City State Zip City State Zip Lot 72 Lot 72 Deed Book No. 4127 Page No. 936 Provide a copy of the most current deed. Landowner 4 of Record: McKee Homes, LLC Name 109 Hay Street, Suite 301 Current Mailing Address Fayetteville NC 28301 City State Zip 910-486-4864 Phone: Office # Mobile # Same Current Street Address Same City State Zip Lot 89 Lot89 Deed Book No. 3980 Page No. 095 Landowner 5 of Record: Name Current Mailing Address City State Deed Book No Provide a copy of the most current deed. Phone: Office # Mobile # Current Street Address Zip City State Zip Page No. Provide a copy of the most current deed.