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HomeMy WebLinkAboutNCC223368_FRO Submitted_20221005FINANCIAL 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 address or phone number is unavailable, place N/A in the blank.) Part A. 1. Project NameChestnufi Greek 2. Location of land -disturbing activity: Count C City or Township Ch a pel Hill SR1 540 35.8600 -79.1629 Highway/StreetLatitude(dec,mal degrees) -Lon gl#UdE(decimal degrees) 3. Approximate date land -disturbing activity will commence. ll/l/22 4. Purpose of development (residential, commercial, industrial, institutional, etc.). residential 5. Total acreage disturbed or uncovered (including off -site borrow and waste areas): 9-65 6_ Amount of fee enclosed: $ 1000 . The applicatian fee of $100.00 per acre grounded up to the next acre) is assessed without a ceding amount (Example: 8.10-acre application fey is $900). Checks should be addressed to NCDEQ. 7. Has an erosion and sediment control plan been filed? Yes 0 Enclosed ❑ No ❑ S. Person to contact should erosion and sediment control issues arise during land -disturbing activity: NameKirk T. Mett Phone: Office # E-mail Address tuscangoupinc@g mail -com Mobile # 919.235.2077 9. Landowner(s) of Record (attach accompanied page to list additional owners): The Tuscan Group, Inc Name Phone: Office# 919.235-2077 Mobile # 661 cedar Grove Rd current Mailing Address Current Street Address Pittsboro NC 27312 City State Zip City State Zip 10. Geed Book No. 02 115 Page No. 0694 Provide a copy of the most current deed. Part B. 1. Cornpany(ies) who are financially responsible for the land -disturbing activity (Provide a comprehensive list of all responsible pasties on accompanied fags.) If the company is a sale proprietorship or if the landowner(s) is an individual(s), the name(s) of the owner(s) maybe listed as the financially responsible party(ies). The Tuscan Group, INc Company Name 661 Cedar Grove Rd current Mailing Address P'Ittsboro, NC 27312 City Stake Zip Phase: office # tuscangrou pinc@g mail com E-mail Address Current Street Address City state Zip Mobile# 919223502077 Note: If the Financially Responsible Party is not the owner of the laid 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: Kirk T. Mett Name of Registered Agent 661 cedar grove rd Current Mailing Address pittsboro NC 27312 City State Zip Phone: Office# tuscangou pi nc@g mail com E-mail Address Current Street Address City State Zip Mobile # 919w235z2077 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 an the NC Secretary of State business registry: Name of Registered Agent Current Mailing Address City State dip Phone-. office # E-mail Address Current Street Address City State Zip Mobile # Name of Individual to Contact (if Registered Agent is a company) (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 ❑BA Name The abase information is true and correct to the best of my knowledge and belief and was provided by me under oath. (This firm 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. Kirk T. Metty 10 Type or pyint President Title or Authority Signature Date iMmm iii^����A��������iii�ii��ii��ii��i����f ���E������ii ""`... iYi W - --4 � f! w��ii ��liii ��Si �iY Yi YW ���Fi-*rP4 Tr w���w�ii li �� a Notary Public of the County of (`'WY\AX\ClL- State of North Ca ro I'l n a, hereby certify that ,Y4'oL k " 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 r) k day of Commission expires o VE x NORTH CAROLIiVA GENERAL WARRAN'TY DEAD Excise Tax: ." Parcel anti fi r Nio. 1439 Mail/Box to; 'RAN This instrument vvas prepared O RAM, AV(!HFER LET) AT BOOK TAR PAS PAGE May 22f 2020 9:45:40 PM 11 4 0699 INSTRUMENT t!X Brief description f017 the .I I I d L "'I~ � '"I". � '�� �� � tip ' - �&OAD --- -----.,._. _w --...---.��._, ��....�. , .,T * � O ION N TIT AS R Q ESTED NO I S 1` E I ��PLIE"PH ., 11 � R �� O . F ` -Z IS DOCUM ENT* THIS ��� � �� �� of 2 bar and bct- �veo-n GRANTOR Douglas E. Page and.spairse, James N. Firth Robert Bruce. -Page and spouse, Linda J. Maynard MAILING ADDRESS; GREE'CNSBOR01 NIC 207265" GR.ANTEE The "F scan Group- Inc. NC c MAILFNIQ ADDRESS: 661 CE_-DAR GROVE ROAD PROPERTY ADDRESS: NEARJO ROAD R O.. } NC 27516 -P 11D, ra -Optlale, character of entity, e.g. Ei7te)- in appropriale block-fior each Gr-ar.11or cmd Grawee: naive, inailin'K 'ppy m-ppomfio).1 01--pal-Inv.-Ship, 1-he. r ipdo n Grantor and Grantee as shall l � sald parties, t 'lr he i L : Cc s r� and assigns, all include singular, plural, mascultric, feminine or neutcr as required by context. Wl"MESSETH. that tht irec'lnt r.. for a \�ahlj h l c ni tration paid by the Grantee.} the r ipt obi which 18 her(-,b)e acknoANYI edged,. has and -by these presents does 2.rant., bargaln,. sc.,11 and conVC . UnLo the Grantee in fee si l l ). H that certain lot or parcel o farad situated in CHATHAM Countv North Carolina and moi-e ar t i c u l i'l described l l o ws� - SEE ArfACHED EXHIBIT «A» The pmparty lien-inabove. dincribvd wa3 cnquired by 0r;antor bv instrument recorded 'in Deed Book 1327, P t All or a portion of the p ro perry he rL6 le e d does not in lLi the p 6nVD.1'V resi'dellC 0P Grant f-. Submitted. l e c r o n i call "(;un-"(;un-n & MesSick2 L L '" in complIance withNorth a ro 7 i na statutes gover i rag recordabld documents and the terms of the sdbmitter agreement with th'eChatham County Register of Deeds.