NCC223080_FRO Submitted_20220906

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.
1. Project Name Heartsease at Calabash
2
9
Location of land -disturbing activity: County Brunswick
Highway/StreetPersimmon Rd (SR 1167) Latitude 33.905551
Approximate date land -disturbing activity will commence:_
City or Township Calabash
Longitude-78.572921
4. Purpose of development (residential, commercial, industrial, institutional, etc.): Residential
5. Total acreage disturbed or uncovered (including off -site borrow and waste areas): 40.1 (41) acres
6. Amount of fee enclosed: $ 4,100 . The application fee of $100.00 per acre (rounded
up to the next acre) is assessed without a ceiling amount (Example: 8.10-acre application fee is $900).
7. Has an erosion and sediment control plan been filed? Yes No Enclosed X
8. Person to contact should erosion and sediment control issues arise during land -disturbing activity:
Name Andy Smith E-mail Address [e-mail]
Telephone 843.588,5021 Cell # Fax #
9. Landowner(s) of Record (attach accompanied page to list additional owners):
Willis Alvin Bryan, III [phone]
Name Telephone Fax Number
PO Box 2020 1324 Hewett Farms Rd SW
Current Mailing Address Current Street Address
Shallotte NC 28459 Shallotte NC 28470
City State Zip City State Zip
10. Deed Book No. 03353 Page No. 0706 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.
EYC Companies, LLC [e-mail]
Name E-mail Address
1005 St. Andrews Blvd, Unit C 1005 St. Andrews Blvd, Unit C
Current Mailing Address Current Street Address
Charleston SC 29407 Charleston NC 29407
City State Zip City State Zip

Telephone 919,256.3370 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
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
State
E-mail Address
Current Street Address
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.
Manager
Title or Authority
Date
I, AQJ S a Notary Public of the County of C
`- appeared
State of-k�Fleretma, hereby certify that
personally before me this day and being duly sworn acknowledged that the above form was executed
by him. fc
Witness my hand and notarial seal, this P day of 114-C P 20
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SARAH NIENHAUS Nota -
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