NCC223162_FRO Submitted_20220913

JOHNSTON COUNTY 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
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 Maggie Way Phase 2A ( Lots # 116,117,125,126,129,130,131,and 132)
2. Location of land -disturbing activity: City or Township Wilders Township
Highway/Street Painters Mill Pond Lane Latitude 355.73906 Longitude-78.37306
3. Approximate date land -disturbing activity will commence: As soon as possible
4. Purpose of development (residential, commercial, industrial, institutional, etc.): Residential
5. Total acreage disturbed or uncovered (including off -site borrow and waste areas): 4.29
6. Amount of fee enclosed: $ 800.00 . 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 ❑ No ❑ Enclosed
8. Berson to contact should erosion and sediment control issues arise during land -disturbing activity:
Name Pamela Geddie
E-mail Address [e-mail]
Telephone [phone] cell # 910-709-9801 Fax # [phone]
9. Landowner(s) of Record (attach accompanied page to fist additional owners):
Cates Building Inc.
910-778-7902 910-481-0585
Name
Telephone Fax Number
639 Executive Place Suite 400
Same
Current Mailing Address
Current Street Address
Fayetteville N.C. 28305
Same
City State ,Zip
City State Zip
10. Deed Book No. 6283,6283,6294 Page No. 379,387,531
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):
Cates Building Inc.
[e-mail]
Name
E-mail Address
639 Executive Place Suite 400
Same
Current Mailing Address
Current Street Address
Fayetteville N.C. 28305
Same
City State Zip
City State Zip
Telephone [phone]
Fax Number 910-481-0585

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
E-mail Address
Current Street Address
State Zip City
Telephone 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
Party is a Corporation, give name and street address of the Registered Agent:
Name of Registered Agent E-mail Address
Current Mailing Address
City State Zip
Current Street Address
Ulty
Telephone 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.
Christopher Ca es
Type or print na e
Signature
President
Title or Authority
Date
-- -------------------------------
1 Pamela M Geddie
State of North Carolina, hereby certify that _
personally before me this day and being
executed by him.
a Notary Public of the County of Cumberland
Christopher E. Cates
__... nnnanrnrJ
duly sworn acknowledged that the above form was
Witness my hand and notarial seal, this6Vday
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My commission expires May 22, 2026