NCC230582_FRO Submitted_20230321

FINANCIAL RESPONSIBILITYIOWNERSHIP 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 and/
or fax information unavailable, place NIA in the blank.)
Part A. 1. Project Name Wilmington Regional Athletic Complex 2. Location of land -disturbing activity: County New Hanover City or TownshipWilmington
ilmington
Highway/Street
205 Sutton Steam Plant Road Latitude Longitude-
34.283024 77.969531
3. Approximate date land -disturbing activity will commence: Septem her, 2021
4. Purpose of development (residential, commercial, industrial, institutional, etc.):public, athletic
5. Total acreage disturbed or uncovered (including off -site borrow and waste areas); 44.2
6. Amount of fee enclosed: $ 2,925 . The application fee of $65.00 per acre (rounded
up to the next acre) is assessed without a ceiling amount (Example: a 9-acre application fee is $585).
7. Has an erosion and sediment control plan been filed? Yes No Enclosed x
B. Person to contact should erosion and sediment control issues arise during land -disturbing activity:
NameAn ne Ballweg E-mail Address Anne,[e-mail]
Telephone [phone] cell 4 [phone] Fax # [phone]
9. Landowner(s) of Record (attach accompanied page to list additional owners):
City of Wilmington [phone] [phone]
Name Telephone Fax Number
P.O. Box 1810 305 Chestnut Street
Current Mailing Address Current Street Address
Wilmington, NC 28402 Wilmington, NC 28401
City State Zip CityState Zip
10, Deed Book No. 6269 Page No. 291 8 Provide a copy of the most current deed.
Part B.
1. Company(ies) or firm(s) who are financially responsible for the land -disturbing activity (Provide a
comprehensive list of all responsible parties on an attached sheet.) lithe company or firm is a sole proprietorship,
the name of the owner or manager may be listed as the financially responsible party.
City of Wilmington Office of the City Manager
Name
Sterling Cheatham [e-mail]
Current Mailing Address
102 N. Third Street Wilmington, NC 28401
City State Zip City State Zip
Telephone [phone] Fax Number [phone]

2. (a) If the Financially Responsible Party is not a resident of North Carolina, give name and street address
of the designated North Carolina Agent:
Name E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Telephone Fax Number
(b) If the Financially Responsible Party is a Partnership or other person engaging in business under an
assumed name, attach a copy of the Certificate of Assumed Name. If the Financially Responsible
Party is a Corporation, give name and street address of the Registered Agent:
Name of Registered Agent E-mail Address
Current Mailing Address Current Street Address
City
Telephone
State Zip City
Fax Number
State Zip
The above information is true and correct to the best of my knowledge and belief and was provided
by me under oath (This forth must be signed by the Financially Responsible Person if an individual
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 Person). I agree to provide
corrected information should there be any change in the information provided herein.
Sterling Cheatham
Type or print name
Signatur
City Manager
Title or Authority
3 - /2 -
Date
I, t , a Notary Public of the County of Ul5 j c-A-
State of North Carolina, hereby certify that !( h C4,,r— appeared
personally before me this day and being duly sworn nowledged that the above form was
executed by him. 7 It
Witness my hand and notarial seal, this �a day of --g20�
Notary .
La, �A My commission expires
F W

Landowner(s) of Record Continued:
9.1 Landowner(s) of Record (attach accompanied page to list additional owners):
Martin Marietta Material Real Estate Investments, Inc. [phone]
Name
P.O. Box 30013
Telephone Fax Number
2710 Wycliff Road
Current Mailing Address Current Street Address
Raleigh, NC 27622-0013 Raleigh, NC 27607
City State Zip City State Zip
10.1 Deed Book No. 6002 Page No. 1024 Provide a copy of the most current deed.
9.2 Landowner(s) of Record (attach accompanied page to list additional owners):
Duke Energy Progress [phone]
Name
P.Q. Box 1771
Current Mailing Address
Raleigh, NC 27602
Telephone Fax Number
411 Fayetteville Street
Current Street Address
Raleigh, NC 27601
City State Zip City State Zip
10.2 Deed Book No. 6095 Page No. 1081 Provide a copy of the most current deed.