NCC221421_FRO Submitted_20220413

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 Qualify. 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. Jasmine South
1. Project Namo
2. Location of land -disturbing activity: County NeW Hanover City or Township Wilmington
Highway/Street 6009 8,6015 [NORTH BEND RD Latitude 34.157 Longitude-77.894
3. Approximate date land -disturbing activity will commence: 4/11 /2022
4. Purpose of development (residential, commercial, industrial, institutional, etc.): Residential
5. Total acreage disturbed or uncovered (including off -site borrow and waste areas): 4.8
6. Amount of fee enclosed: $ N/A . 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 X No Enclosed
8. Person to contact should erosion and sediment control issues arise during land -disturbing activity:
Name Craig Johnson E-mail Address [e-mail]
Telephone [phone] cell # 910-399-5688 Fax # NIA
9. Landowner(s) of Record (attach accompanied page to list additional owners):
River Birch Investments, LLC
910-399-5688 NIA
Name
Telephone Fax Number
PO Box 538
2005 Deer Island Ln.
Current Mailing Address
Current Street Address
Wrightsville Beach, NC 28480
Wilmington NC, 28405
City State Zip
City State Zip
10. Deed Book No. 6544 Page No 0258
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.
River Birch Investments, LLC
[e-mail]
Name
E-mail Address
PO Box 538
2005 Deer Island Ln.
Current Mailing Address
Current Street Address
Wrightsville Beach, NC 28480
Wilmington NC, 28405
City State Zip
City State Zip
Telephone [phone]
Fax Number N/A

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:
Mary Johnson [e-mail]
Name of Registered Agent E-mail Address
PO Box 538 2005 Deer Island Ln.
Current Mailing Address Current Street Address
Wrightsville Beach, NC 28480 Wilmington NC, 28405
City State zip City State zip
Telephone [phone]
Fax Number N/A
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). 1 agree to provide
corrected information should there be any change in the information provided herein.
Mary Johnson
Type or print name
Signa re
LIJ-1 ------------------------------------
Managing Member
Title or Authority
414y2022
Date
, a Notary Public of the County of w0i l61yy
State of North Carolina, hereby certify that 641r\- appeared
personally before me this day and being duly sw rn acknowledged that the above form was
executed by him.
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Witness my h�! fQ, oj�c r��tOeal, this day of rl� ( i J
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NEW HANOVER COUNTY
ENGINEERING
230 Government Center Drive, Suite 160, Wilmington, NC 28403
P: [phone] ! F: [phone] 1 NHCgov.corn
Jim lannucci, PE, CFM, County Engineer
March 30, 2022
River Birch Investments, LLC
P.O. Box 538,
Wrightsville Beach, North Carolina 28480
RE, Grading Permit #42-21, Jasmine South
Dear Mrs. Mary Johnson:
This office has reviewed the erosion and sedimentation control plan. We find the plan to be
acceptable and hereby Issue this land -disturbing permit with modifications. Please read the permlt
conAlony„&r your records. A
copy of the enclosed land -disturbing permit must be pasted at the job site. This letter gives the notice
required by GS 113A-61.1(a) and the New Hanover County Erosion and Sedimentation Control Ordinance
Article VIII Section 8.21 of our right of periodic inspection to ensure compliance with the approved plan.
As of April 1, 2019, all new construction activities are required to complete and submit an
electronic Notice of Intent (eNOI) form requesting a Certificate of Coverage (COC) under the NCG010000
Construction General Permit, The COC must be obtained prior to the commencement of any land -
disturbing activity on the above -named project, according to State Stormwater requirements. The NO]
form may be accessed at deq.nc,gov/NCG01.. Please direct questions about the NOI form to Paul Clark at
Paul.clark@.ncdenr.sov. After you submit a complete and correct NOI Form, you will receive a link with
payment instructions for the $100 annual permit fee. After the fee is received, you will receive the COC
via email. The $100 fee will be charged annually until the project receives a final land -disturbance
inspection. Once the project is stabilized and receives the final land -disturbance inspection, you should
file a Notice of Termination (NOT) with the State to final out the project.
A copy of the enclosed land -disturbing permit, a copy of the approved erosion and sedimentation
control plan as well as any approved deviations, records of inspections made during the previous 12
months with the States Certificate of Compliance (COC) number on the reports, and a rain gauge must be
posted at the job site as required by 15A NCAC 4B .0118(a), the NCGO1 permit, and the New Hanover
County Erosion and Sedimentation Control Ordinance Article V1I1 Section 8.19(o).
The land disturbing fee of 1440 is due to be paid to Beth Wetherill`s attention in Engineering,
prior to Plat Recordation

Page 2 of 2
A preconstruction meeting Is optional prior to land -disturbing activity on this project. Please
contact me at [phone] if you would like to schedule this meeting in our office. If you choose not to
have a preconstruction meeting, you must contact us with the date the land -disturbing activity will take
place onsite and again once the initial erosion control measures are Installed.
New Hanover County's Erosion and Sedimentation Control Program is performance -oriented,
requiring protection of existing natural resources and adjoining properties. If, following the
commencement of this project, it is determined that the erosion and sedimentation control plan is
inadequate to meet the requirements of the Sedimentation Pollution Control Act of 1973 (North Carolina
General Statutes 113A-51 through 66), and the New Hanover County Erosion and Sedimentation Control
Ordinance Article Vlll Section 8.19 (f), this office may require revisions to the plan and its implementation
of the revisions to ensure compliance with the Act and Ordinance.
This land -disturbing permit will expire within I year following the date of approval, if no land -
disturbing activity has been undertaken, as required by the New Hanover County Erosion and
Sedimentation Control Ordinance Article Vlll Section 8.18 (d). If no activity takes place within one year
after work has begun onsite, the permit will expire. Please contact this office to reactivate a permit that
has expired,
Acceptance and approval of this erosion control plan is conditioned upon your compliance with
Federal and State water quality laws, regulations and rules and local city or county ordinances or rules.
This land -disturbing permit approval does not supersede any other permits or approvals, It is the owner's
responsibility to have all the permits and approvals that are required, prior to beginning construction.
Please note this approval is based in part on the accuracy of the information provided in the
Financially Responsibility Form, which you provided. You are required to file an amended form if there is
any change in the information included on the form.
Your cooperation is appreciated,
f -
Beth E. Wetherill C.P.E.S.C.
Erosion Control Specialist
Enclosures: Land -disturbing Permit
NPbES NCGO1 Fact Sheet and Monitoring Form
cc: Charles Cazier PE Intracoastal Engineering, PLLC
Amy [doss Current Planner, New Hanover County