NCC232393_FRO Submitted_20230809

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 Environment and Natural Resources. (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.)
Part A.
1. Project Name Meares Bluff Plantation - Phase 4, lot development
2. Location of land-disturbing activity: County Wayne City or Township Stoney Creek Township
Highway/Street NC Hwy. 111 N. River Basin: Neuse
Latitude N 35.4319 Longitude W -77.9511
(Lat and Long given to 4 decimal places it)0 .xxxx N, -YY.yyyy W. not XX xx'xx" N, -YY yy' yy"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): 31.5
6. Amount of fee enclosed: $ 3,200 The application fee of $100.00 per acre (rounded up to the
next acre) is assessed without a ceiling amount (Example: a 9-acre application fee is $900).
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 Blain Crocker E-mail Address blaincrocker(u(7gmail.com
Telephone Cell# [phone] Fax#
9. Landowner(s) of Record (attach accompanied page to list additional owners):
CE2, LLC [phone]
Name Telephone Fax Number
809 Mill Road 809 Mill Road
Current Mailing Address Current Street Address
Goldsboro NC 27534 Goldsboro NC 27534
City State Zip City State Zip
10. Deed Book No. 3223 Page No. 413 Provide a copy of the most current deed.
Part B.
1. Person(s) or firm(s) who are financially responsible for the land-disturbing activity (Provide a
comprehensive list of all responsible parties on an attached sheet):
CE2, LLC iack(a�mbest.orq
Name E-mail Address
809 Mill Road 809 Mill Road
Current Mailing Address Current Street Address
Goldsboro NC 27534 Goldsboro NC 27534
City State Zip City State Zip
Telephone [phone] _ Fax#

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#
(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#
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 by any change in the information provided herein.
C. Munroe Best, Jr, Member
Type or print name Title or Authority
C iKi)„\Arz_ /Irk& 6-/-/7- 2>
Signature C Date
Doris S. McFatter a-Notary Public of the County of Wayne
State of North Carolina, hereby certify that C. Munroe Best, Jr. appeared personally before
• me this day and being duly sworn acknowledged that the above form was executed by him.
Witness my hand and notarial seal, this l 7rh day of April , 20 23 .
Notary D is S. McFatter
N&FAIRY _ My commission expires 01/13/2026
PUBLIC
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