NCC232939_FRO Submitted_20231004

Check if this project is ARPA-funded ❑
Attach a copy of the Letter of Intent to Fund
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, including any
activity under a common plan of development of this size as covered by the NCG01 permit, 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 address or phone
number is unavailable, place N/A in the blank.)
Part A.
1. Project Name Parker & Sons LCID Landfill
'If this project involves American Rescue Plan Act(ARPA) funds, list the Project Name or Project
Number(e.g., SRP-D-ARP-0121) below under which you were approved for funding through the
Division of Water Infrastructure (DWI).
2. Location of land-disturbing activity: County Robeson City or Township Parkton
LBarlow Rd 34.9262 -79.0501
Highway/Street atltude(decimal degrees) Longltude(decimal degrees)
3. Approximate date land-disturbing activity will commence: 8/14/23
4. Purpose of development(residential, commercial, industrial, institutional, etc.): Industrial
5. Total acreage disturbed or uncovered (including off-site borrow and waste areas): 25
6. Amount of fee enclosed: $2500 . 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 0 No ❑
8. Person to contact should erosion and sediment control issues arise during land-disturbing activity:
Name Daniel Parker E-mail Address [e-mail]
Phone: Office# 91 0-858-0003 Mobile#
9. Landowner(s) of Record (attach accompanied page to list additional owners):
Dewayne B. Parker 910-858-0003
Name Phone: Office# Mobile#
PO Box 1251 Vass Dr
Current Mailing Address Current Street Address
Hope Mills, NC 28348 Parkton, NC 28371
City State Zip City State Zip
10. Deed Book No. MB 60 Page No.200 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 landowner(s)is
an individual(s), the name(s) of the owner(s)may be listed as the financially responsible party(ies).
Al Landscaping & Lot Clearing, Inc. al [e-mail]
Company Name E-mail Address
PO Box 1251 1000 Hope Mills Rd
Current Mailing Address Current Street Address
Hope Mills, NC 28348 Fayetteville, NC 28304
City State Zip City State Zip
Phone: Office# 91 0-858-0003 Mobile#
Note: If the Financially Responsible Party is not the owner of the land to be disturbed, include with this form
the landowner's 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:
Christopher D. Parker
Name of Registered Agent E-mail Address
PO Box 41035 1000 Hope Mills Rd
Current Mailing Address Current Street Address
Fayetteville, NC 28309 Fayetteville, NC 28304
City State Zip City State Zip
Phone: Office# 910-424-1981 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.
Christopher D. Parker President
Type or int name Title or A tho ity
— - y
g a ure Date
I, ASht. J. Yekit - , a Notary Public of the County of
State of North Carolina, hereby certify that Clni►s 1 rcr D. ?ci 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 8 day of P 0..54- , 20 2 3
, EJ. p
• m Notary
NCTARy
PUBLIC • f My commission expires—1 QYt 3, 2 O 2 to
:'S�'Ga'Y 3.20�O�0/
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August 1, 2023
Mr.Timothy LaBounty, P.E.
Environmental Regional Supervisor
NCDEQ-Fayetteville Regional Office
225 Green Street,Suite 714
Fayetteville, NC 28301
Re: Landowner's Consent for Land Disturbing Activity
Parker&Sons LCID Landfill
Parkton,North Carolina
Dear Mr. Labounty:
I,Dewayne Best Parker,give consent to Al Landscaping& Lot Clearing, Inc.to submit a draft erosion and
sedimentation control plan and conduct 25-acres of land disturbing activities for the Parker&Sons Land
Clearing and Inert Debris(LCID) Landfill at the following parcels that I own:
PIN Book Page Grantor Grantee
9482 4881 2521 MB 60 200 Dewayne B. Dewayne B.
Parker Parker
9482 5737 5000
9482 4772 2319 MB 60 200 Dewayne Best Dewayne Best
9482 5816 2106 Parker Parker
Please feel free to contact me with any questions or concerns at 910-858-0003.
Regards,
Dewayne Best Parker