NCC221555_FRO Submitted_20220421

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. Monday Solar Electric Power Plant
1. Project Name
2. Location of land -disturbing activity: County Franklin City or Township Louisburg
Highway/Street NC 56 Latitude 36.088628 Longitude-78.325071
3. Approximate date land -disturbing activity will commence: February 2022
4. Purpose of development (residential, commercial, industrial, institutional, etc.): Solar
5. Total acreage disturbed or uncovered (including off -site borrow and waste areas): 35.0
6. Amount of fee enclosed: $ $3,500.00 . The application fee of $100.00 per acre
(rounded up to the next acre) is assessed without a ceiling amount (Example: 8.10 ac = $900.00).
7. Has an erosion and sediment control plan been filed? Yes No X Enclosed X
8. Person to contact should erosion and sediment control issues arise during land -disturbing activity:
Name Clay Holliday E-mail Address [e-mail]
Telephone [phone] x733 cell # 910-527-5119 Fax #
9. Landowner(s) of Record (attach accompanied page to list additional owners)
Eleanor K Baker
N/A N/A
Name
Telephone Fax Number
4075 NC 98 HWY
4075 NC 98 HWY
Current Mailing Address
Current Street Address
Youngsville NC 2759
Youngsville NC 27596
City State Zip
City State Zip
10. Deed Book No. 324 Page No. 18
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.
Strata Solar Development, LLC
[e-mail]
Name
E-mail Address
800 Taylor Street, Suite 200
800 Taylor Street, Suite 200
Current Mailing Address
Current Street Address
Durham NC 27701
Durham NC 27701
City State Zip
City State Zip
919-960-6015
Telephone
Fax Number919-724-4146

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 State
Telephone
E-mail Address
Current Street Address
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
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.
Markus Wilhelm Manager
Wia
r print name Title or Authority
I 1 EO
a Date
a Notary Public of the County of _CJL1R__
State of North Carolina, hereby certify that �A v-) appeared
personally before me this day and being duly sworn acknowledged that the above form was
executed by him.
Witness my hand and notarial seal, this day of r , 20 �1
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N ota
My commission expires �i,