NCC230480_FRO Submitted_20230228

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 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 Name Rhodestown Volunteer Fire Dept.
2. Location of land -disturbing activity: County Onslow City or Township Jacksonville
Highway/Street US 258 Latitude�decimal degrees) 34.8167 Longitude�decimal degrees) 77.5167
3. Approximate date land -disturbing activity will commence: January 2023
4. Purpose of development (residential, commercial, industrial, institutional, etc.): Institutional
5. Total acreage disturbed or uncovered (including off -site borrow and waste areas): 2.0
6. Amount of fee enclosed: $ 200.00 . 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:
NameJ.R. Marks E-mail [e-mail]
Phone: Office # 910-330-6472 Mobile # same
9. Landowner(s) of Record (attach accompanied page to list additional owners):
Rhodestown Volunteer Fire Dept., Inc. 910-330-6472
Name
5169 Richlands Highway
Current Mailing Address
Jacksonville NC, 28540
City State
same
Phone: Office # Mobile #
5169 Richlands Highway
Current Street Address
Jacksonville NC, 28540
Zip City
State
Zip
4434
10. Deed Book No. Page No. 956 Provide a copy of the most current deed.

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 or if the landowner(s) is
an individual(s), the name(s) of the owner(s) may be listed as the financially responsible party(ies).
Rhodestown Volunteer Fire Dept., Inc.
Company Name
5169 Richlands Highway
Current Mailing Address
Jacksonville NC, 28540
City State Zip
Phone: Office # 910-330-6472
[e-mail]
E-mail Address
5169 Richlands Highway
Current Street Address
Jacksonville NC, 28540
City State Zip
Mobile # same
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 Party 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 E-mail Address
Current Mailing Address Current. -Street Address
City State Zip City State Zip
Phone: Office # Mobile #
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 on the NC Secretary of State business registry:
Name of Registered Agent E-mail Address
Current Mailing Address Current Street Address
City State 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.
J.R. Marks
Type or print name
sidnature
Chief/President
Title or Authority
Date
I, rV, , a Notary Public of the County of on5low
State of North Carolina, hereby certify that G,��C`J' 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 5day of `1 , 20 r-W-
.�`��� PING, �00io
Ws0,
Notary
Seal wiARr `din v
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u My commission expires__JQ ,HLa�—
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Continued from Items 9 & 90 in Part A of the Financial Responsibility/Ownership Form for multiple
owners. Attach copies of this page as needed to list all landowners.
1.
Landowner 2 of Record:
Name Phone: Office # Mobile #
Current Mailing Address Current Street Address
City State Zip City State Zip
Deed Book No. Page No. Provide a copy of the most current deed.
Landowner 3 of Record:
Name Phone: Office # Mobile #
Current Mailing Address Current Street Address
4
City State Zip City State Zip
Deed Book No. Page No. Provide a copy of the most current deed.
Landowner 4 of Record:
Name
Current Mailing Address
Phone: Office # Mobile #
Current Street Address
City State Zip City State Zip
Deed Book No. Page No. Provide a copy of the most current deed.
Landowner 5 of Record:
Name
Current Mailing Address
City
Deed Book No.
Phone: Office # Mobile #
Current Street Address
State Zip City State Zip
Page No. Provide a copy of the most current deed.

Continued from Item 9 in Part 8 of the
Financial Responsibility/Ownership Form for multiple parties.
Attach copies of this page as needed
to list all financially responsible parties.
Company 2 Name
E-mail Address
Current Mailing Address
Current Street Address
City State
Zip City State
Zip
Phone: Office #
Mobile #
Company 3 Name
E-mail Address
Current Mailing Address
Current Street Address
City State
Zip City State
Zip
Phone: Office #
Mobile #
Company 4 Name
E-mail Address
Current Mailing Address
Current Street Address
City State
Zip City State
LZip
Phone: Office #
Mobile #
Company 5 Name
E-mail Address
Current Mailing Address
Current Street Address
City State
Zip City State
Zip
Phone: Office #
Mobile #

Rhodestown Volunteer Fire Department
The Rhodestown Volunteer Fire Department proposes to develop a 2.0 acre tract located on
Richlands Hwy (US Hwy 258 & NC 24) near its intersection with NC 111 in Onslow County.
(The tract spans the distance between Richlands Hwy and NC 111, and the proposed
development will have an entrance at each highway.) The proposed development includes a
13,681 sf building with associated parking, an outside equipment area & dumpster pad.
The site is currently vacant. Site topography is generally flat to gently sloping (0 - 2%). The
site generally drains towards the west and southwest. Two (2) existing ditches drain
westward through the adjoining property towards Richlands highway. Two small areas of
wetlands are located on site, at the end of these ditches. (Total wetlands area = 252. , 65 sf)
The project site is located in the White Oak River basin and drains to an Unnamed Tributary
of New River (C;NSW). The proposed development activities are high density (percent
impervious > 24 %); therefore, stormwater treatment facilities are required. The attached
Stormwater Plan includes a Constructed Stormwater Wetland (designed to meet both the
current BMP Manual specifications. Stormwater runoff from the site will be diverted (via
swales and inlet structures) into a system of pipes discharging into the forebay of the
Constructed Wetland.
There is an amount of offsite runoff draining towards the site. Offsite runoff draining
westward across the front corner of the site towards Richlands Hwy will be diverted to the
existing piped system along the highway. Offsite runoff draining towards the south will be
diverted towards the existing ditch along NC 111.
Water and sewer service to be provided by ONWASA. Sewer Service will require
installation of a Wastewater Pumping Station and 1.5 "forcemain (service) connecting to an
existing 12" forcemain along US 258 which pumps to the Northwest Wastewater
Reclamation Facility, also operated by ONWASA.

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SCALE 1:24000
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