NCC240304_FRO Submitted_20240209

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FINANCIAL RESPONSIBILITY/OWNERSHIP FORM \_ °°,,f,.
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 BOYINGTON PLACE TOWNHOMES PHASE 2
2. Location of land-disturbing activity: County ONSLOW City or Township HUBERT
Highway/Street BOYINGTON PLACE RD Latitude 34.716985 Longitude -77.299638
3. Approximate date land-disturbing activity will commence:_FEBRUARY 2023
4. Purpose of development (residential, commercial, industrial, institutional, etc.): RESIDENTIAL
5. Total acreage disturbed or uncovered (including off-site borrow and waste areas): 10.10
6. Amount of fee enclosed: $ 1,100.00 . 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).
Checks should be addressed to NCDEQ.
7. Has an erosion and sediment control plan been filed? Yes No X Enclosed X
8. Person to contact should erosion and sediment control issues arise during land-disturbing activity:
Name DWAYNE BRABBLE E-mail BUILDINGDEDEVELOPMENTS.COM
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Telephone [phone] Cell# 252-637-8813 Fax#
9. Landowner(s) of Record (attach accompanied page to list additional owners):
WEG MANCOR, LLC 508-776-9379
Name Telephone Fax Number
228 KALE RD
Current Mailing Address Current Street Address
NEW BERN NC 28562
City State Zip City State Zip
10. Deed Book No. 3917 Page No. 171 Provide a copy of the most current deed.
1-1075 (Co/reaed /S. SPe//t

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):
WEG MANCOR, LLC BUILDING(a�DEDEVELOPMENTS.COM
Name E-mail Address
228 KALE RD
Current Mailing Address Current Street Address
NEW BERN NC 28562
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:
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 State Zip City State Zip
Telephone Fax Number

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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.
WEG MANCOR, LLC 4d "!4-Q41 Fs J6- 011gA._
Type or print name Title or Authority
Signature Date
I, f<trni k"AG- , a Notary Public of the County of CP M4
State of North Carolina, hereby certify that wq``."--- 1-'-',--kl.)c&i,`- appeared
personally before me this day and being duly sworn acknowledged that the above form was
executed by him. jq DeCellABt12—
Witness my hand and notarial seal, this I. t day of , 20 r�)--
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