NCC241587_FRO Submitted_20240528

FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
SEDIMENTATION POLLUTION CONTROL ACT
EXPRESS PERMITTING OPTION
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 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 kernodlc Phax. '1
2. Location of land-disturbing activity: County A laM..sca City or Township jM' r+on
Highway/Street G[rrtnr II Qc1. Latitude(decimal degrees) 34•I53 Long itude(decimal degrees) - 79• `7f
3. Approximate date land-disturbing activity will commence: Ap ri t / 2 0 2 2
4. Purpose of development (residential, commercial, industrial, institutional, etc.): gGSiident'ta I
5. Total acreage disturbed or uncovered (including off-site borrow and waste areas): 2.$ I c2c ro S
6. Amount of fee enclosed . The Express Permitting application fee is a dual charge.
The normal fee of$100.00 per acre (rounded up to the next acre) is assessed without a ceiling amount.
In addition, the Express Permitting supplement is$250 per acre up to eight acres,after which the Express
Permitting supplemental fee is a fixed$2,000.00 (Example: 8.10-acre application fee is$2,900). Checks
should be addressed to NCDEQ.
7. Has an erosion and sediment control plan been filed? Yes ElEnclosed ❑ No I_I
8. Person to contact should erosion and sediment control issues arise during land-disturbing activity:
Name Vavid Mi0lis.(15 / or pa Atnr E-mail Address CitvliGkatiSig)1.4)inc150 CorsranrcS.uS
Phone: Office # (1336) 2$2 - 3535 Mobile# ( ) 207 - $003
9. Landowner(s) of Record (attach accompanied page to list additional owners):
VI)in1Ser InvcSt ert'S�LLG `336) Zg2-3535
Name Phone: Office# Mobile#
PO (3o)( .3147 tool Ave., S,Ai+c. 3o I
Current Mailing Address Current Street Address
Llrunsbsro _ NG 27`12cf &rccnsbo-o NC, 27yo8
City State Zip City State Zip
10. Deed Book No. Page No. 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).
Windsor Investments, LLC [e-mail]
Company Name E-mail Address
P.O. Box 9147 1007 Battleground Ave.,Suite 301
Current Mailing Address Current Street Address
Greensboro NC 27429 Greensboro NC 27408
City State Zip City State Zip
Phone: Office# [phone] Mobile# [phone]
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:
Paracorp Incoporated
Name of Registered Agent E-mail Address
2804 Gateway Oaks Dr Ste 100 176 Mine Lake Court,Ste 100
Current Mailing Address Current Street Address
Sacramenta,CA 95833-4346 Raleigh, NC 27615-6417
City State Zip City State Zip
Phone: Office# [phone] Mobile#
Barbara Geiger, Chief Financial Officer
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
(d) If order to facilitate Express Permitting, it is necessary to be able to contact the engineer or other
consultant who can assist in providing any necessary information regarding the plan and its preparation:
Engineering firm or other consultant E-mail Address
Individual contact person (type or print) Phone: Office# Mobile#
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 . .tho " to execute instruments for the Financially Responsible Party). I agree to provide
c•rrec -• P.• ou • there be any change in the information provided herein.
_.f�1i _ CAA /�li v i
Type or print name Title or Authority
I ti B. MI04/11 -i" // Zo Z�
Signature Date
I, PA4 c(i}o, A (+„l-, , a Notary Public of the County of T'at;L't VI V,--Q/1-Th
State of North Carolina, hereby certify that i U/LC& �, Mi Ci1ae--1 S appeared personally
before me this day and being duly sworn acknowledged that the above form was executed by him/her.
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Witness my hand and notarial seal, this ay of , 20 24-
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Notary
Seal My commission expires CO I (P (,;.q
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Gerringer MITI Road, LLC
4425 Sasser Farms Road
Gibsonville, NC 27249
April 6, 2024
RE: Kernodle Landing Phase 4 Subdivision
Alamance County
Existing Erosion Control Permit#ALAMA-2022-046
Existing NCGO1 Certificate of Coverage# NCC221461
Landowner Builder Agreement
North Carolina Department of Environmental Quality:
As the current landowner of the property that is being developed as Kernodle Landing Phase 4
subdivision located along Kirkland Court in Alamance County, I consent to Windsor Investments, LLC's
land disturbance activities for the Kernodle Landing Phase 4 development.
Additionally,this letter gives Windsor Investments, LLC authority to transfer the existing permits shown
above and or submit new erosion control permits for Kernodle Landing Phase 4 subdivision. We also
give permission for Windsor Investments, LLC to perform erosion control construction and maintenance
on this property.
Please contact me at [e-mail] with any questions,
Sincerely
Kevin Sasser
President/Owner
CC:Windsor Investments, LLC
1007 Battleground Ave., Suite 301
Greensboro, NC 27408
Accepted by:
dgeis,co:anyeflt
is