NCC241278_FRO Submitted_20240506

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FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
SEDIMENTATION POLLUTION CONTROL ACT
No person may initiate any land-disturbing activity VD one or more acres as covered by the Act before this
form and on acceptable erosion and sedimentation control plan have been completed and approved by the
Land Quality Secion, 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 Orchard Creek Subdivision
2. Location of land-disturbing activity: County [}ns|mw City or Township Richlands
Highway/Street Hall Branch Road Latitude 34" 32'28^ N Longitude 77"38'28^VV
3. Approximate date land-disturbing activity will commence: October, 2022
4. Purpose of development(residential,commercial,industrial,institutional,etc.): Residential Subdivision
5. Total acreage disturbed or uncovered (including off-site borrow and waste anyam): 34.0
G. Amount of fee enclosed: $ 3.400.00 . The application fee ofo85.00 per acre (rounded
upto the next acre) ia assessed without a ceiling amount (Euemp|e: a9'acns application fee in$58G).
7. Has en erosion and sediment control plan been filed? Yes No Enclosed X
B. Person to contact should erosion and sediment control issues arise during land-disturbing activity:
Name John Pierce E-mail Address bettvb6o-)i}pnccom
Telephone [phone] Cell# 910-389-0015 Fox#
&. Landmwner(a) of Record (attach accompanied page to list additional mwneny)�
BmmvorCmaehinvaotom. |no. 910-346-9800 810-348-1210
Name Telephone Fax Number
P.O. Box 1G85
Current Mailing Address Current Street Address
Jacksonville NO 28451
Cdx State Zip Chv State Zip
10. Deed Book No. 5561 Page No. 218 Provide a copy of the most current deed.
PartB.
1. Person(s) or firm(y) who are financially responsible for the land-disturbing activity (Provide a
comprehensive list of all responsible parties nnen attached mheet):
Beaver Creek Investors, Inc. bettvb(�_i|pno.com
Nome E-mail Address
P.{>. Box 1685 4O5 Johnson Blvd
Current Mailing Address Current Street Address
Jacksonville, NC 28451 Jacksonville NC 28450
c/tr State Zip city State Zip
Telephone 910'346'9800 Fax Number 810-346-1210

2. (a) If the Financially Responsible Party is not o resident of North CaroUna, give name and street address
of the designated NorthCano|inaAoent:
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 u copy of the Certificate mfAssumed Name. !f 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 3]p 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 aft¢rnmy-in-foct, or if not an individuo!, by on officer, director, partner, or registered agent with
the authority to execute instruments for the Financially Responsible Person). | mQnaa to provide
corrected information should there be any change in the information provided herein.
BettyBuU0ck President Of Beaver Creek Investors, Inc.
Type or print no Title orAuthority
Gi8notDhs � ' Date
|, /oA v~0A, . a Notary Public of the County of /\vl� |(}i ' l
" ���State of North Cann|ina, hereby oe�|fvthat " IVLk appeared
personally before me this day and being acknowledged
that the above form was
executed byhim.
Witness rny hand and notarial seal, this 3154dayof \Px-) . 30 Q2
w'�y� ^~~
Notary U

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Low Density Residential Subdivisions ,, , . . .
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Deed Restrictions & Protective Covenances ...,?:, , • .. ,
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In accordance with Title 15 NCAC 2H.1000 and S.L. 2006-246, the Stormwater Management
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Regulations, deed restrictions and protective covenants are required for Low Density Residential 4.s.t,,/
Subdivisions where lots will be subdivided and sold. Deed restrictions and protective covenants are
necessary to ensure that the development maintains a "built-upon"area consistent with the applicable
regulation governing the density level.
I, Betty Bullock acknowledge and affirm by my signature below, that I will cause the following
deed restrictions and protective covenants to be recorded for Orchard Creek Subdivision prior to
the sale of any lot:
1. The following covenants are intended to ensure ongoing compliance with State Stormwater
Management Permit Number..S10109;20(003 , as issued by the Division of Energy, Mineral and
Land Resources under the Stormwater Management Regulations.
2. The State of North Carolina is made a beneficiary of these covenants to the extent necessary to
maintain compliance with the stormwater management permit.
3. These covenants are to run with the land and be binding on all persons and parties claiming
under them.
4. The covenants pertaining to stormwater may not be altered or rescinded without the express
written consent of the State of North Carolina, Division of Energy, Mineral and Land Resources.
5. Alteration of the drainage as shown on the approved plan may not take place without the
concurrence of the Division of Energy, Mineral and Land Resources.
6. The maximum allowable built-upon area per lot is 7,000 square feet. This allotted amount
includes any built-upon area constructed within the lot property boundaries, and that portion of the
right-of-way between the front lot line and the edge of the pavement. Built upon area includes, but
is not limited to, structures, asphalt, concrete, gravel, brick, stone, slate, and coquina, but does
not include raised, open wood decking, or the water surface of swimming pools.
7. In the case of a lot within CAMA's regulated AEC, where the Division of Coastal Management
calculates a different maximum allowable built-upon area for that lot than is shown herein, the
governing maximum built-upon area for that lot shall be the most restrictive of the two.
8. Filling in or piping of any vegetative conveyances(ditches, swales, etc.) associated with the
development except for average driveway crossings is strictly prohibited by any persons.
9. Each lot will maintain a 30*foot wide vegetated buffer between all impervious areas and surface
waters.
10. All roof drains shall terminate at least 30*foot from the mean high water mark of surface waters.
*50 foot for pro ts locat din the 20 coastal counties.
Signature: tail? Date:
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I, '-ne,c;f QS___ C2, . p, krvA,r0 0 , a Notary Public in the
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State of ocit-V\ Cxxx-OkkYNCA.., County of
do hereby certify that \ )08A- , ci)o...\\(i)( personally appeared
before me this the ?)\S\-- day of nr\0,-K , 20 D, .., and acknowledge
the due execution of the foregoing instrument. Witness my hand and official seal,
tottlittiii,
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Signature
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My Commission expires k0 1 2-LA i 120'210 7:1 0 It "1.1(30°.
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1. (SY\10-24-00"..k•;.'''
Form DRPC-5 Rev.2 05Nov2009 Page 1 of 1 ,/ No•..........• ..s ,,:.•
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