NCC222325_FRO Submitted_20220707

JOHNSTON COUNTY 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
Johnston County Department of Public Utilities. (Please type or print and, if the question is not applicable or
the e-mail and/or fax information unavailable, place NIA in the blank.)
Part A.
1. Project Name Crosspoint Logistics Center
2. Location of land -disturbing activity: City or Township Town of Benson, Johnston County
Highway/Street Morgan Road Latitude 35.377836 Longitude-78.533352
3. Approximate date land -disturbing activity will commence: 7/1 /2022
4. Purpose of development (residential, commercial, industrial, institutional, etc.): Industrial
5. Total acreage disturbed or uncovered (including off -site borrow and waste areas): 69.50
6. Amount of fee enclosed: $ 9,900 . The application fee of $380.00 per acre (rounded
up to the next acre) is assessed for the first 10 acres and an additional $125 per acre for each
additional acre (rounded up to the next acre). Individual residential lots plans are $100 per lot.
7. Has an erosion and sediment control plan been filed? Yes W1 No ❑ Enclosed
8. Person to contact should erosion and sediment control issues arise during land -disturbing activity:
Name Brian Beaver E-mail Address [e-mail]
Telephone [phone] Cell # 336.403.7013 Fax #
9. Landowner(s) of Record (attach accompanied page to list additional owners):
EV BENSON LAND, LLC 704.770.1074
Name Telephone Fax Number
3105 Glenwood Ave Suite 105
Current Mailing Address Current Street Address
Raleigh NC 27612
City State Zip City State Zip
10. Deed Book No. 06091 Page No. 0810
Part B.
1. Person(s) or firm(s) who are financially responsible for the land -disturbing activity (Provide a
comprehensive list of all responsible parties on an attached sheet):
EV BENSON LAND, LLC [e-mail]
Name E-mail Address
3150 Glenwood Ave Suite 105
Current Mailing Address Current Street Address
Raleigh NC 27612
City State Zip
Telephone [phone]
City
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 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:
Mike Massardo [e-mail]
Name of Registered Agent E-mail Address
3105 Glenwood Ave Suite 105
Current Mailing Address Current Street Address
Raleigh NC 27612
City State Zip City State Zip
Telephone [phone] 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.
Mike Massardo
Type or print name
Signatu "e
Manager, EV BENSON LAND, LLC
Title or Authority
6/20/2022
Date
I.Anqv VL-Y-'is a Notary Public of the County of S+DIQ
State of North Carolina, hereby certify that_t�Dt..55a-'�'d.D 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 ZD4da of U 106f l 20 2,2.
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