NCC222846_FRO Submitted_20220810

FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
SEDIMENTATION POLLUTION CONTROL ACT
EXPRESS PERMITTING OPTION
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 address or phone
number is unavailable, place N/A in the blank.)
Part A.
1. Project Name H I BS
2. Location of land -disturbing activity: county -Chatham City or Township Siler City ETJ (unincorporated)
Highway/Street US 64 W Latltude(decimai degrees) 35.74239 Longltude(decimai degrees)-79.53566
3. Approximate date land -disturbing activity will commence:. August, 2022
4. Purpose of development (residential, commercial, industrial, institutional, etc.): Industrial
5. Total acreage disturbed or uncovered (including off -site borrow and waste areas): 187 acres
6. Amount of fee enclosed $20,700.00 . The Express Permitting application fee is a dual charge.
The normal fee of $100.00 per acre (rounded up to the next acre) is assessed without a ceiling amount.
In addition, the Express Permitting supplement is $250 per acre up to eight acres, afterwhich the Express
Permitting supplemental fee is a fixed $2,000.00 (Example: 8.10-acre application fee is $2,900). Checks
should be addressed to NCDEQ.
7. Has an erosion and sediment control plan been filed? Yes ❑ Enclosed x❑ No ❑
8. Person to contact should erosion and sediment control issues arise during land -disturbing activity:
Name Wes Feinman E-mail Address [e-mail]
Phone: Office # 919-256-6460 Mobile # [phone]
9. Landowner(s) of Record (attach accompanied page to list additional owners):
TIMS FARM & FORESTRY LLC 336-362-2026 336-362-2026
Name Phone: Office # Mobile #
7157 BOBBY JEAN RD OFF US 64 W
Current Mailing Address Current Street Address
JULIAN NC 27283 CHATHAM CO. NC 27344
City State Zip City State Zip
Parcei ID: 67263
10. Deed Book No. 1547 Page No. 0865 Provide a copy of the most current deed.

Part B.
1. Company(ies) who are financially responsible for the land -disturbing activity (Provide a comprehensive list
of all responsible parties on accompanied page.) If the company is a sole proprietorship or if the landowner(s) is
an individual(s), the name(s) of the owner(s) may be listed as the financially responsible party(ies).
The Whiting -Turner Contracting Company
Company Name
8529 Six Forks Road Forum IV, Suite 150
Current Mailing Address
Raleigh North Carolina 27615
City State Zip
Phone: Office # 919-256-6471
[e-mail]
E-mail Address
8529 Six Forks Road Forum IV, Suite 150
Current Street Address
Raleigh North Carolina 27615
City State Zip
Mobile # [phone]
Note: If the Financially Responsible Party is not the owner of the land to be disturbed, include with this form
the landowner's signed and dated written consent for the applicant to submit a draft erosion and sedimentation
control plan and to conduct the anticipated land disturbing activity.
2. (a) If the Financially Responsible Party is a domestic company registered on the NC Secretary of State
business registry, give name and street address of the Registered Agent:
Name of Registered Agent
Current Mailing Address
City State Zip
Phone: Office #
E-mail Address
Current Street Address
City State Zip
Mobile #
Name of Individual to Contact (if Registered Agent is a company)
(b) If the Financially Responsible Party is not a resident of North Carolina, give name and street address
of the designated North Carolina agent who is registered on the NC Secretary of State business registry:
Name of Registered Agent
Current Mailing Address
E-mail Address
Current Street Address
City State Zip City
Phone: Office # Mobile #
Name of Individual to Contact (if Registered Agent is a company)
State Zip
(c) If the Financially Responsible Party is engaging in business under an assumed name, give name under
which the company is Doing Business As. If the Financially Responsible Party is an individual, General

Partnership, or other company not registered and doing business under an assumed name, attach a copy
of the Certificate of Assumed Name.
Company DBA Name
(d) If order to facilitate Express Permitting, it is necessary to be able to contact the engineer or other
consultant who can assist in providing any necessary information regarding the plan and its preparation:
Civil -Consultants
Engineering firm or other consultant
Tony Whitaker
Individual contact person (type or print)
[e-mail]
E-mail Address
919-490-1645 919-943-8418
Phone: Office #
Mobile #
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(s)
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 Party). I agree to provide
corrected information should there be any change in the information provided herein.
Wes Feinman
Type or print name
Signature
I
Ll ameT/a�
Sr. Project Manager
Title or Authority
7/13/22
Date
, a Notary Public of the County of .lJ GL, L -e,
State of North Carolina, hereby certify that Wes Felnman appeared personally
before me this day and being duly sworn acknowledged that the above form was executed by him/her.
Witness my hand and notarial seal, this
Arlene villanm
IJOTARY PUBLIC
: W County, NC
My oommlasim Expires December 06, 2=
13th day of Jul
20 22
My commission expires

Continued from Items 9 & 10 in Part A of the Financial Responsibility/Ownership Form for multiple
owners. Attach copies of this page as needed to list all landowners.
Landowner 2 of Record:
TIMS FARM &FORESTRY LLC
Name
7157 BOBBY JEAN RD
Current Mailing Address
JULIAN NC
Deed Book No. 1729
Landowner 3 of Record:
336-362-2026
Phone: Office #
OFF US 64 W
336-362-2026
Current Street Address
27283 CHATHAM CO. NC 27344
Zip City State Zip
1027 Parcel ID: 72513
Page No. , Provide a copy of the most current deed.
TIMS FARM &FORESTRY LLC 336-362-2026 336-362-2026
Name Phone: Office # Mobile #
7157 BOBBY JEAN RD OFF US 64 W
Current Mailing Address Current Street Address
JULIAN NC 27283 CHATHAM CO. NC 27344
City State Zip City State Zip
Parcel ID: 61119
Deed Book No. 1659 Page No. 0443 Provide a copy of the most current deed.
Landowner 4 of Record:
TIMS FARM &FORESTRY LLC 336-362-2026 336-362-2026
Name
7157 BOBBY JEAN RD
Current Mailing Address
JULIAN NC,
City State
Deed Book•No. 1729
n wi iC. vinL;e +F IVIUMM ff
OFF US 64 W
Current Street Address
27283 CHATHA .00--=- -..,,27J44 F
Zip City -State Zip
1027 ; Parcel 1[]: 158fl 9
Page No. —Provide Ti copy,of,the g1ost current deed,
Landowner 5 of Record
TIMS FARM &FORESTRY LLC
Name
7157 BOBBY JEAN RD
Current Mailing Address Current Street Address
JULIAN NC 27283 CHATHAM CO. NC 27344
City State Zip City State Zip
0515 Parcel ID: 12547
Deed Book No. 1664 Page No.-- Provide a copy of the most current deed.
336-362-2026 336-362-2026
Phone: Office # Mobile #
OFF BENJIE WILLIAMS RD

Continued from Items 9 & 10 in Part A of the Financial Responsibility/Ownership Form for multiple
owners. Attach copies of this page as needed to list all landowners.
Landowner 6 of Record:
TIMS FARM &FORESTRY LLC 336-362-2026 336-362-2026
Name Phone: Office # Mobile #
7157 BOBBY JEAN RD OFF US 64 W
Current Mailing Address Current Street Address
JULIAN NC 27283 CHATHAM CO. NC 27344
City State Zip City State Zip
Parcel ID: 82157
Deed Book No. 1547 Page No. 0865 Provide a copy of the most current deed.
Landowner 7 of Record:
TIMS FARM &FORESTRY II LLC 336-362-2026
7157 BOBBY JEAN RD
Current Mailing Address
JULIAN NC
City State
Deed Book No. 1704
Landowner 4 of Record
Name
Current Mailing Address
City
Deed Book No.
Landowner 9 of Record:
Name
Current Mailing Address
336-362-2026
Phone: Office # Mobile #
STOCKYARD RD
Current Street Address
27283 CHATHAM CO. NC 27344
Zip City Slate Zip
0053 Parcel ID: 76879
Page No. Provide a copy of the most current deed.
Phone: Office #
Current Street Address
State Zip City
Page No.
Mobile #
State Zip
Provide a copy of the most current deed.
Phone: Office #
Current Street Address
Mobile #
City State Zip City State Zip
Deed Book No. Page No. Provide a copy of the most current deed.

Continued from Item 1 in Part B of the Financial Responsibility/Ownership Form for multiple parties.
Attach copies of this page as needed to list all financially responsible parties.
Company 2 Name E-mail Address
Current Mailina Address Current Street AHriracc
State Zip
rnone: urrice iF Mobile #
Company 3 Name E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Phone: Office # Mobile #
Company 4 Name E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Phone: Office # Mobile #
Companv 5 Name E-mail Addrecc
Current Mailing Address Current Street Address
City State Zip City State Zip
Phone: Office # Mobile #