NCC241775_FRO Submitted_20240610

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: Mountain Meadows Subdivision
*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: Polk City or Township: Tryon
Highway/Street: Peniel Road Latitude: 35.238936 Longitude:-82.150933
3. Approximate date land-disturbing activity will commence: 4/1/2024
4. Purpose of development (residential, commercial, industrial, institutional, etc.): Residential
5. Total acreage disturbed or uncovered (including off-site borrow and waste areas): 18.00
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: Chris Waters E-mail Address: [e-mail]
Phone: [phone] Mobile: [phone]
9. Landowner(s)of Record:
Landowner(s) of Record
Name Email Business Phone Mobile Phone
SECOA Investors, LLC [e-mail]
Physical Address Mailing Address
Street 1 City State Zip Street 1 City State Zip
130 Gardeners Johns Island SC 29455 130 Gardeners Johns Island SC 29455
Circle, PMB 601 Circle, PMB 601
Name Email Business Phone Mobile Phone
Mark Zitterich
Physical Address Mailing Address
Street 1 City State Zip Street 1 City State Zip
1249 Melvin Hill Campobello SC 29322 1249 Melvin Hill Rd Campobello SC 29322
Rd
Name Email Business Phone Mobile Phone
Rebecca Zitterich
Physical Address Mailing Address

Street 1 City State Zip Street 1 City State Zip
1249 Melvin Hill Campobello SC 29322 1249 Melvin Hill Rd Campobello SC 29322
Rd
Name Email Business Phone Mobile Phone _
William Berens _
Physical Address Mailing Address
Street 1 City State Zip Street 1 City State Zip
45 East Mallard Lake Forest IL 60045 45 East Mallard Lake Forest IL 60045
Lane Lane
Name Email Business Phone Mobile Phone
Maureen Kelly
Physical Address Mailing Address
Street 1 City State Zip Street 1 City State Zip _
45 East Mallard Lake Forest IL 60045 45 East Mallard Lake Forest IL 60045
Lane Lane
Name Email Business Phone Mobile Phone
William High
Physical Address Mailing Address
Street 1 City State Zip Street 1 City State Zip
398 Mapleton Columbus NC 28722 398 Mapleton Lane Columbus NC 28722
Lane
Name Email Business Phone Mobile Phone _
Linda High
Physical Address Mailing Address
Street 1 City State Zip Street 1 City State Zip
398 Mapleton Columbus NC 28722 398 Mapleton Lane Columbus NC 28722
Lane

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
SECOA Investors, LLC [e-mail]
Physical Address Mailing Address
Street 1 City State Zip Street 1 City State Zip
130 Gardeners Johns SC 29455 130 Gardeners Johns SC 29455
Circle, PMB 601 Island Circle, PMB 601 Island
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
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
Brian Carroll [e-mail]
Physical Address Mailing Address
Street 1 City State Zip Street 1 City State Zip
331 Prospect Tryon NC 28782 331 Prospect Tryon NC 28782
Point Drive Point Drive
En ineering/Consulting Firm Information
Name Email Business Phone Mobile Phone
Odom Engineering PLLC [e-mail]
Physical Address Mailing Address
Street 1 City State Zip Street 1 City State Zip
169 Oak Street Forest City NC 28043 169 Oak Street Forest City NC 28043

Additional Details
1. Stream Classification: C: Aquatic Life, Secondary Contact Recreation, Fresh water
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.