NCC230502_FRO Submitted_20230307

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Quality
FINANCIAL RESPONSIBILITYIOWNERSHIP FORM DEC a
SEDIMENTATION POLLUTION CONTROL ACT 2
No person may initiate any land -disturbing activity on one or more acres as covered by the-N& his form
and an acceptable erosion and sedimentation control plan have been completed and approved by &moo f fJ.
ee
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.)
Part A.
1. Project Name TOWNES AT CENTRAL SQUARE
2. Location of land -disturbing activity: County. LEE City or Township SAN FORD
Highway/Street GOLDSBORO AVE Latitude(dwmW degm-) 35.476 Longitude(d,InrW degrees)-79.158
3. Approximate date land -disturbing activity will commence: MARCH 2023
4. Purpose of development (residential, commercial, industrial, institutional, etc.): RESIDENTIAL
S. Total acreage disturbed or uncovered (including off -site borrow and waste areas): 3.8 AC
6. Amount of fee enclosed: $ 400 . 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
BRANDON HARRINGTON E-mail Address [e-mail]
Phone: Office # Mobile # [phone]
9. Landowner(s) of Record (attach accompanied page to list additional owners):
HARRINGTON PROPERTIES OF NC, LLC 919-770-5969
Name Phone: Office # Mobile #
2659 SAN LEE DRIVE SAME AS MAILING
Current Mailing Address Current Street Address
SANFORD NC 27330
City State Zip City State Zip
10. Deed Book No. 1700 / 1703 page No. 907 / 268 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 or if the landowners) is
an individual(s), the name(s) of the owners) may be listed as the financially responsible party(les).
HARRINGTON PROPERTIES OF NC, LLC [e-mail]
Company Name
2659 SAN LEE DRIVE
Current Mailing Address
SANFORD NC 27330
E-mail Address
SAME AS MAILING
Current Street Address
City State Zip City State
Phone: Office # Mobile # [phone]
Zip
Note: If the Financially Responsible Party is not the owner of the land to be disturbed, include with this form
the landowners 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.
BRANDON HARRINGTON MANAGING MEMBER
Type Tint name
All
Signature
Title or Authority
/.2- .? /--Z 02 2-
Date
I, �S'0��- ��.1�n e , a Notary Public of the County of Le -
State of North Carolina, hereby certify that 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 a) day ofce�b� , 20c_a •—
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Nota
My commission expires,