NCC230302_FRO Submitted_20230202

FINANCIAL RESPONSIILITYIONERSIP FOR
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 NIA in the blank.)
Dart A.
1. Project Name: Manning Crossing
2. Location of land -disturbing activity: County: Alamance City or Township: Gibsonville
Highway/Street: Kutter Drive Latitude:36,1145 Longitude:79.5250
3. Approximate date land -disturbing activity will commence: 12I1122
4. Purpose of development (residential, commercial, industrial, institutional, etc.): Single Family Subdivision
5. Total acreage disturbed or uncovered (including off -site borrow and waste areas): 15.99 acres
6. Amount of fee enclosed: $ 1600.00. 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). Checks should
be addressed to NCDEQ.
7. Has an erosion and sediment control plan been filed? Yes ® Enclosed ❑ No ❑
8. Person to contact should erosion and sediment control issues arise during land -disturbing activity:
Name: David Michaels E-mail Address: dmichaeis@_windsorcompanies.us
Phone: Office #i`: 336-282-3535 Mobile ##: [phone]
9. Landowner(s) of Record (attach accompanied page to list additional owners):
Land Acquisition and Development Services, LLC
Name
PO Box 9147
Current Mailing Address
Greensboro NC
City State
336-282-3535
Phone: Office #
4327
1 0. Deed Book No.
1007 Battleground Avenue, Suite 301
Current Street Address
27429 Greensboro
Zip City
NA
Mobile #
77
Page No.
NC 27408
State Zip
Provide a copy of the most current deed.

Part B.
1. Company(ies) who are financially responsible for the land -disturbing activity (Provide a comprehensive list
of all responsible parties on accompanied page.) If the company is a sole proprietorship orif the landowner(s) is
an individual(s), the name(s) of the owner(s) may be listed as the financially responsible party0es).
Land Acquisition and Development Services, LLC [e-mail]
Name E-mail Address
PO Box 9147 1007 Battleground Avenue, Suite 301
Current Mailing Address Current Street Address
Greensboro NC 27429 Greensboro NC 27408
City State Zip City State Zip
336-894-1039 336-207--8003
Phone: Office # Mobile #
Note: If the Financially Responsible Party is not the owner of the land 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 Parry is a domestic company registered on the NC Secretary of State
business registry, give name and street address of the Registered Agent:
Name of Registered Agent
Current Mailing Address
City
Phone: Office #
E-mail Address
Current Street Address
State Zip City
Mobile ##
Name of Individual to Contact (if Registered Agent is a company)
State Zip
(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 on the NC Secretary of State business registry:
Name of Registered Agent
Current Mailing Address
City State
E-mail Address
Current Street Address
Zip City
State Zip
Phone: Office # 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 DBA Name
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(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.
David B. Michaels
Company Agent
Ty pr t nam Title or Authority
Sign ure Date
1, # n r J F i e lcls a Notary Public of the County of
State of North Carolina, hereby certify that Pid Vi r4 13 . IC�g d-e t S 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
�oTAje?�
Seal
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Notary
My commission expires S"" VT 202-

3529
0874
FILED ELECTRONICALLY
ALAMANCE COUNTY NC
HUGH WEBSTER
FILED Apr 14, 2016
AT 11:43:07 AM
BOOK 03529
START PAGE 0974
END PAGE 0875
INSTRUMENT # 05984
EXCISE TAX $0.00
Prepared by/Return to:
Isaacson Isaacson Sheridan Fountain & Leftwich, LLP
CONSENT OF THE MEMBERS AND MANAGERS
OF
LAND ACQUISITION AND DEVELOPMENT SERVICES, LLC
The undersigned, being all of the managers of Land Acquisition and Development Services, LLC,
a North Carolina limited liability company (the "Company"), after careful deliberation take the following
action and adopt the following resolutions by signing their written consent hereto.
Appointment of Company Agent
WHEREAS, pursuant to NCGS 57D-3-22, the Managers have the authority to appoint company
agents ("Company Agent or Company Agents") as additional officers of the Company to act for and on
behalf of the Company; and
WHEREAS, the Managers deem it to be in the best interest of the Company that David Michaels
be appointed as an additional Company Agent to be authorized to act for and on behalf of the Company
in certain limited situations as provided herein or otherwise specified by the Managers.
NOW, THEREFORE, BE IT RESOLVED, that the Managers hereby appoint as an additional
Company Agent of the Company, until his or her death, resignation, retirement, removal or
disqualification, or until his or her successor is appointed and qualified, the following individual(s):
David B. Michaels
submitted electronically by "Isaacson Isaacson Sheridan Fountain & Leftwich, LLP"
in compliance with North Carolina statutes governing recordable documents
and the terms of the submitter agreement with the Alamance county Register of Deeds.

3529
0875
BE IT FURTHER RESOLVED, that the Managers shall be authorized to remove any Company Agent
and to appoint replacement or additional Company Agent(s) as the Managers shall deem appropriate in
their sole discretion.
BE IT FURTHER RESOLVED, that David Michaels, as a Company Agent, be, and the same hereby
is, authorized, empowered and directed, for and on behalf of the Company, to (1) execute and deliver
any and all subcontract agreements with the subcontractors supplying materials and services in
connection with the development of tracts of real estate being developed by the Company, in the
ordinary course of the Company's business, as the David B. Michaels, as Company Agent executing the
same may deem appropriate and in the best interest of the Company, (2) execute and deliver any and all
agreements with subcontractors for the delivery of materials and performance of services in connection
with the construction of residential properties, (3) execute and deliver any and all agreements with
utility providers and (4) make application to the appropriate government entity for rezoning, site
plan/plat approval, permitting and/or annexation of any property owned or to be owned and developed
by Company.
The foregoing action is consented to and shall be effective as of the _ day of February, 2016.
MANAGER(S):
Thomas C. Hall
David R. Ho rd
Guilford County, North Carolina
certify that the following person(s) personally appeared before me this day, each acknowledging to me
that he or she voluntarily signed the foregoing document for the purpose stated therein and in the
capacity indicated; Thomas C. Hall and David R. Howard
DateA 4 04 31 2016 X
/-j-
Off,I Signature of Notary
{Official Seal)
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