HomeMy WebLinkAboutNCC230129_FRO Submitted_20230127FINANCIAL RESPONSIBILITY/OWNERSHIP STATEMENT
As per 15A NCAC 04B .0118 — The draft Erosion and Sediment Control Plans will not be approved until
an authorized statement of financial responsibility and ownership is submitted.
As per GS 113A-54.1(a) - If the applicant is not the owner of the land to be disturbed, the owner's written
consent for the applicant to submit a draft Erosion and Sediment Control Plan and to conduct the
anticipated land -disturbing activity must be submitted with this document.
PART A.
1. Project Name:
High Point Plant
2. Physical Address/Location:
street Address: 1812 Alleghany St
3. Latitude:35.946918
11
city: Randleman
Longitude:-79.964489
state: NC zip. 27317
Approximate date land -disturbing activity will commence: August 1, 2022
5. Purpose of development (residential, commercial, industrial, etc.)
Industrial
31
7
Approximate acreage of land to be disturbed or uncovered: 9.14 Acres
Landowner(s) of Record (use blank page to list additional owners):
Blue Sky Holdings, LLC
Name
P.O Box 834
Current Mailing Address
Randleman, NC 27317
City, State, Zip
Telephone Number
Name
Current Mailing Address
City, State, Zip
Telephone Number
8. Indicate book and page where deed or instrument is filed (use blank page to list additional deeds
or instruments). Provide copies of Deeds with this submittal.
Book 8385 Page
Book 429
Page
FinResFm. Page 4 1
PART B.
Person(s) or firm(s) who are financially responsible for this land -disturbing activity:
Boggs Contracting, Inc.
Name
Name
1613 W. Roosevelt Blvd
Current Mailing Address
Current Mailing Address
Monroe, NC 28110
City, State, Zip
City, State, Zip
704-289-8482
Telephone Number
Telephone Number
2. Registered agent, if any, for
the person or firm who is financially responsible:
Signature
Mailing Address
Printed Name
Telephone Number
3. 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 if not an individual,
by an officer, director, partner or attorney -in -fact, or registered
agent with 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.
Drew Boggs
Manager -Member
T Print N e
Title of Authority
March 7, 2022
Signature
Date
13 Hannah L RUs'` nq
allotary Public of the County of ht�� , State of North
Carolina, do hereby certify that Dam
In appeared personally before me
this day and being duly sworn acknowledged that the above form was executed by him.
Witness my hand and notarial seal, this Ah day of MaV6 , 2022
Notary Publicyy,
HANNAH L RUSHING M commission expires: / Z
NOTARY PUBLIC Y p [o ` Z O - Z_ O2 4
Union county
North Carolina
My Conuftslon Expires June 20, 2024
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