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HomeMy WebLinkAboutNCC240840_FRO Submitted_20240326 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 NCGO1 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: Grant's Creek *If this project involves American Rescue Plan Act(ARPA)funds, list the Project Name below under which you applied for funding through the Division of Water Infrastructure (DWI). Is Project ARPA Funded ARPA Project Name ARPA Project# No 2. Location of land-disturbing activity: County: Onslow City or Township: Jacksonville Highway/Street: Grant's Creek Road Latitude: 34.774237 Longitude:-77.300175 3. Approximate date land-disturbing activity will commence: 6/1/2024 4. Purpose of development (residential, commercial, industrial, institutional, etc.): Residential 5. Total acreage disturbed or uncovered (including off-site borrow and waste areas): 113.00 6. 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). 7. Has an erosion and sediment control plan been filed? Yes-Will be Mailed or Hand-Delivered 8. Person to contact should erosion and sediment control issues arise during land-disturbing activity: Name: Donald Aiken E-mail Address: daiken@drhorton.com Phone: Mobile: 19105080017 9. Landowner(s)of Record: Landowner(s) of Record Name Email Business Phone Mobile Phone Weyerhauser NR Company 14078085655 13534154521 Physical Address Mailing Address Street 1 City State Zip Street 1 City State Zip 13005 SW 1st Newberry Florida 32669 13005 SW 1st Newberry Florida 32669 Road, Ste. 241 Road, Ste. 241 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). Primary Financially Responsible Party Company Name Email Business Phone Mobile Phone D.R. Horton eshelton@drhorton.com 19107427946 18437372904 Physical Address Mailing Address Street 1 City State Zip Street 1 City State Zip 6752 Parker Farm Wilmington North 28405 6752 Parker Farm Wilmington North 28405 Dr. Carolina Dr. Carolina Additional Financially Responsible Parties 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: Registered Agent Information Name Email Business Phone Mobile Phone Donald Aiken daiken@drhorton.com 19105080017 Physical Address Mailing Address Street 1 City State Zip Street 1 City State Zip (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: North Carolina Agent Information Name Email Business Phone Mobile Phone Physical Address Mailing Address Street 1 City State Zip Street 1 City State Zip Engneering/Consulting Firm Information Name Email Business Phone Mobile Phone McKim & Creed TMcCormick@mckimcreed.com 17048412588 Physical Address Mailing Address Street 1 City State Zip Street 1 City State Zip 8020 Tower Charlotte North 28227 8020 Tower Charlotte North 28227 Point Drive Carolina Point Drive Carolina Additional Details 1. Stream Classification: C: Aquatic Life, Secondary Contact Recreation, Fresh water; NSW: Nutrient Sensitive Waters 2. Was Express Review Requested: No 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.