NCC232359_FRO Submitted_20230808

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 and/
or fax information unavailable, place N/A in the blank.)
P1.art A.Project Name The Orchards at Ocean Isle
2. Location of land-disturbing activity: County BrunswickCity or Township Ocean Isle Beach
Highway/Street E 2nd Street Latitude 33°53'42.60"N Longitude 78°24'35.27"W
3. Approximate date land-disturbing activity will commence:May 2023
4. Purpose of development(residential, commercial, industrial, institutional, etc.):Residential
5. Total acreage disturbed or uncovered (including off-site borrow and waste areas):2.60
6. Amount of fee enclosed: $ 300 . The application fee of $100.00 per acre
(rounded up to the next acre) is assessed without a ceiling amount(Example: 8.10 ac= $900.00).
7. Has an erosion and sediment control plan been filed? Yes No Enclosed X
8. Person to contact should erosion and sediment control issues arise during land-disturbing activity:
Name Bret Tingey E-mail Address [e-mail]
Telephone [phone] Cell# Fax#
9. Landowner(s)of Record (attach accompanied page to list additional owners):
Build Vacations, LLC
Name Telephone Fax Number
30 N Gould St Suite R E 2nd Street
Current Mailing Address Current Street Address
Sheridan WY 82801-6317 Ocean Isle Beach NC 28469
City State Zip City State Zip
10. Deed Book No.04900 Page No.0884 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.) If the company or firm is a sole proprietorship,
the name of the owner or manager maybe listed as the financially responsible party.
Build Vacations, LLC
Name E-mail Address
30 N Gould St Suite R E 2nd Street
Current Mailing Address Current Street Address
Sheridan WY 82801-6317 Ocean Isle Beach NC 28469
City State Zip City State Zip
Telephone [phone] Fax Number

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:
Bret Tingey [e-mail]
Name E-mail Address
104 Iron Ledge Ct
Current Mailing Address Current Street Address
Holly Springs NC 27540
City State Zip City State Zip
Telephone [phone] 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 State Zip City State Zip
Telephone Fax Number
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 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.
Bret Tingey member of Build Vacations, LLC
Type or print name Title or Authority
71‘..711— // 3/2 y /2
Signature Date
I, \'S I L ►4►rn 1/Yl 56 It) , a Notary Public of the County of W.
State of North Carolina, hereby certify that T i Y) cf appeared
personally before me this day and being duly sworn acknowledged thar the `above form was
executed by him.
Witness my hand and notarial seal,this 01o1 day of VA t`t R C-k , 20
William M Mason 10
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NOT RY PUBLIC Notary
�tke County
North Carolina My commission expires y'o of
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