NCC223304_FRO Submitted_20220921

FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
SEDIMENTATION POLLUTION CONTROL ACT
No person may inrtiatP 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. Submd the completed form to the
appropriate Regional Office . (Please type or pent and, if the question is not applicable or the e-mail and/
or fax information unavailable, place N/A in the blank )
Part A. Greenville Auto Auction - Vehicle Storage Expansion
1 Project Name
2 Location of land -disturbing activity:
Highway/Street NC
13
County Pitt
City or Township Greenv
Latitude 35-5781 longitude-77.4384
ille
3 Approximate date land -disturbing activity will commence: February 2022
4 Purpose of development (residential, commercial, industrial, institutional, etc.) Commercial
5. Total acreage disturbed or uncovered (including off -site borrow and waste areas)' 5,34
6. Amount of fee enclosed- $ 390 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 Enclosed X
!J
9.
Person to contact should erosion and sediment control issues arise during land -disturbing activity:
Name Billy Willis E-mail Address billy@ greenvill A4 utoauction.com
Telephone [phone]
111
Cell #
Fax #
Landowner(s) of Record (attach accompanied page to list additional owners):
Greenville Auto Auction Site, LLC
Name
1645 E. Arlington Blvd, Suite E
Current Mailing Address
Greenville NC 27858
City State Zip
252-355-4111
Telephone
Fax Number
1645 E. Arlington Blvd, Suite E
Current Street Address
Greenville NC 27858
City Slate Zip
10. Deed Book No. 2767 page No 39 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.) It the company or firm is a sole propnetorshrp,
the name of the owner or manager maybe listed as the financially responsible party
Clark Stallings Ir a. < <�� �`L� Vi.ce,
Name E-mail Addres4J L
1645 E. Arlington Blvd, Suite E
Current Mailing Address
Greenville
NC
27858
City State Zip
Telephone [phone]
1645 E. Arlington Blvd, Suite E
Current Street Address
Greenville NC 27858
City State Zip
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 State Zip
Telephone
E-mail Address
Current Street Address
Cray State Zip
Fax Number 0�
(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:
Clark Stallings
Name of Registered Agent
1645 E. Arlington Blvd, Suite E
Current Mailing Address
Greenville NC 27858
City State Zip
Telephone [phone]
E-mail Address
1645 E. Arlington Blvd, Suite E
Current Street Address
Greenville NC 27858
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 i formation should ere JDe any change in t informatio provi ed herein.
CV-1
Typ
Signature
Title or AuthPdty
C) _00z�_) I 2.4e
Date
1� �.oE.. Y� a NotaryPublic of the Countyof
P� 4V—
State of North Carolina, hereby certify that _
personally before me this day and being
executed by him..
Witness -G<d notarial seal,
SET T 01rAj?,, �s
CAu e
C
So
COUNT11
to
LLhq S appeared
duly sworn acknowledged thak the above form was
this 2eO day of ()CVa , 20 Z 1
My commission expires
1,1 �v • ?000, %
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