NCC230648_FRO Submitted_20230310

coy, Pitt County
079P
� Planning Department
Development Services Building
o 1717 W. 5th Street
Greenville, North o Carolina 507834-1696 James F. Rhodes, AICP
TeleFav [phone] DPector
Financial Responsibility / Ownership Form
Soil Erosion and Sedimentation Control Ordinance
No person may initiate any land -disturbing activity on one or more contiguous acres as
covered by the Act before this form and an acceptable erosion and sedimentation control plan
have been completed and approved by the Pitt County Planning Department. (Please type or
pant `and, if question is not applicable, place N/A in the blank.)
Dart A.
1. Project Name Colonial Materials
2. Location of land -disturbing activity: County Pitt
City or Township Greenville -,and Highway/Street_ Taylors Creek Drive
3. Approximate date land -disturbing activity will be commenced: 1/1 2023 _
4. Purpose of development (residential, commercial, industrial, etc.): Gravel parking
lot.
5. Approximate acreage of land to be disturbed or uncovered: 2 ac
6. Has an erosion and sedimentation control plan been filed? Yes X No
7. Person to contact should sedimentation control issues arise during land -disturbing activity:
Name Adam Elliott Telephone [phone]
Landowner(s) of Record (Use blank page to list additional owners):
Nyquist Properties, LLC
Name(s) Name(s)
P.O. Box 642
Current mailing address Street address
Greenville, NC 27835
City State Zip City State
9t. R,corded in Deed Book No. 8 4 8 Page No. 539
Mari B.
Zip
Person(s) or firm(s) who are financially responsible for this land -disturbing activity (Use
the blank page to list additional persons or firms):
Colonial Materials Inc.
Name of person(s) or Firm(s) Name(s)
1037 Taylors Creek Drive
Current mailing address Street Address
Greenville.. NC 27834
City State Zip City State Zip
252-751-9230
Telephone
Telephone

2. (a) If the Financially Responsible Parry is a Corporation, give name and street address of
the Registered Agent.
Adam Elliott
Name(s)
1037 Tavlors Creek Drive _.
Current mailing address Street Address
Greenville, NC 27834
City State Zip City State Zip
910-443-0689
Telephone Telephone
(b) If the Financially Responsible Party is a Partnership give the name and street address
of each General Partner (Use blank page to list additional partners):
Name(s) Name(s)
Current mailing address Current mailing address
City State Zip City State Zip
Telephone Telephone
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 his/her attorney -in fact or if not an individual by an officer, director, partner, or
registered agent with authority to execute instruments for the financially responsible person). I
agree to provide corrected information should there be any change in the information provided
herein.
Adam liott Colonial Materials Area Manager
or ri n e Title or Autl on
Signature Date
I, a Notary Public of the County of P er State
of North Carolina, hereby certify t at P%Am r+n ill: —k-
appeared personally before me this day and being duly sworn acknowledged that the above form
wasexeedted by him.
Witness my hand and notarial seal this IS day of b e-c ey4m . 20_ZA
t'n L=Yzt �
HEATHER M GADDY Notary
Notary Public, North Carolina My commission expires Q--a O - AQ a1
PenderCounty
My Commission Expires

PROPERTY OWNER AUTHORIZATION
For Land Quality Permit
I, AW NId-'5 r certify that I own the property identified as Tax Parcel 4-0036.0088F, and
thus give permission to _ Colonial Materials Inc. to develop the project as currently
proposed.
Signature
Date:
SS MOW a Notary Public for the State of 2*6 County of
1` fM tlav 0v*CV _, do hereby certify that
personally appeared before me this _ - _ day of
DdC�'�1' WwY , 20 Z. and acknowledge the due execution of the authorization.
SEA4,a+++SA M�,,u,,.
� s'sioy,Q•
P� O. �G y,
My commission expires
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