NCC222474_FRO Submitted_20220722

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-
I . Project Name Bluffs Point
2. Location of land -disturbing activity: County OnsloW City or Township SWansboro
Highway/Street Pine Bluff Rd Latitude 34.6898 Longitude -77.1539
3. Approximate date sand -disturbing activity will commence: -
4. Purpose of development (residential, commercial, Industrial, institutional, etc.): Residential_
5. Total acreage disturbed or uncovered (including off -site borrow and waste areas): 15.20
6. Amount of fee enclosed: $ 1,600.00 _. 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. X Enclosed X
8. Person to contact should erosion and sediment control issues arise during land -disturbing activity:
Name Elijah Morton E-mail Address [e-mail]
Telephone [phone] cell # Fax #
9. Landowner(s) of Record (attach accompanied page to list additional owners):
B&M Developers, LL_C _S910 548-7575
Name Telephone Fax Number
121 Garnet Lane 121 Garnet Lane
Current Mailing Address Current Street Address
Jacksonville NC 28546 Jacksonville NC 28546
City State Zip City state Zip
10. Heed Book No. 5621Page No.. 817 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 financlefly responsible party.
B&M Developers, LLC [e-mail]
Name E-m all Address
121 Garnet Lane
Current Mailing Address
Jacksonville NC 28546_
city state Zip
121 Garnet Lane
Current Street Address
Jacksonville NC 28546_
City State �lZip

Telephone [phone] Fax Number
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 - T State Zip
Telephone
E-mail Address
Current Street Address
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
Patty is a Corporation, give name and street address of the Registered Agent:
Name of Registered Agent
Current Mailing Address
City
Telephone
State
E-mall Address
Current Street Address
Zip City Fax Number
State Zip
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.
Eliiah Morton
Type or
Owner
Title or Authority
77/�/z 2,-
I, SSi Ck LtL"`3'rU)r-e a Notary Public of the County of l'lSlCl� -
State of North Carolina, hereby certify that _ � � I)ah I + Lo r'�►'1 _ appeared
personally before me this day and being duly swam acknowledged that the above form was
executed by him.
Witness my hand and notarial seal, this 3 day of . 20 aa'
C-a--
EjES.VA LAWIiEN E Notary _
jy Public
orth COT01in0 My commission expires_ t,�nt �a.b
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