NCC222229_FRO Submitted_20220701

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 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. Shops on Main
1. Project Name
2. Location of land -disturbing activity: County Cumberland City or Township Hope Mills
Highway/Street Main Street Latitude 34.981556 Longitude 78.962206
3. Approximate date land -disturbing activity will commence: May 2021
4. Purpose of development (residential, commercial, indust.i ial, institutional, etc.:,: Commercial
5. Total acreage disturbed or uncovered (including off -site borrow and waste areas): 2.12 acres
6. Amount of fee enclosed: $195.00 . 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 EnclosedXX
8. Person to contact should erosion and sediment control issues arise during land -disturbing activity:
Name Joe Riddle E-mail Address [e-mail]
Telephone[phone] cell # Fax #
9. Landowner(s) of Record (attach accompanied page to list additional owners):
Joseph P. Riddle, III and wife Trina T. Riddle 910-864-3135
Name Telephone Fax Number
4200 Morganton Rd., Suite 150 4200 Morganton Rd., Suite 150
Current Mailing Address Current Street Address
Fayetteville NC 28314 Fayetteville NC 28314
City State Zip City State Zip
10. Deed Book No.10644 Page No.0665 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.
Riddle Commercial Properties, Inc. [e-mail]
Name
4200 Morganton Rd., Suite 150
Current Mailing Address
Fayetteville NC
City
E-mail Address
4200 Morganton Rd., Suite 150
Current Street Address
28314 Fayetteville NC 28314
State Zip City
Telephone[phone] Fax Number
State
Zip

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 State Zip
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
Current Mailing Address
City
Telephone
E-mail Address
Current Street Address
State Zip City State Zip
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.
Joseph P. Riddle, III
Type or print name
Signature
President
Title or Authority
Date
, a Notary Public of the County of _L.�,ti•� �, i'�,�
State of North Carolina, hereby certify that 56�\ ?- appeared
personally before me this day and being duly orn acknowledged that the above form was
executed by him.
1
Witness my hand and notarial seal, this
a s
NOTARY N
Seal
PUBLIC
day of IV\,O,\rC 20 oZ
Notary
My commission expires +(t J N a.p1