NCC242044_FRO Submitted (2)_20240705

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 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 and/
or fax information unavailable, place N/A in the blank.)
Part A. Baxter Station
1. Project Name
2. Location of land-disturbing activity: County Currituck City or Township Moyock
Highway/Street Baxter Lane Latitude 36.539 Longitude-76.182
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): 1 .02
6. Amount of fee enclosed: $ 100 . The application fee of $65.00 per acre (rounded
up to the next acre) is assessed without a ceiling amount (Example: a 9-acre application fee is$585).
7. Has an erosion and sediment control plan been filed? Yes No Enclosed X
8. Person to contact should erosion and sediment control issues arise during land-disturbing activity:
Name Jesse Myers E-mail [e-mail]
Telephone [phone] Cell# 757-404-3245 Fax# [phone]
9. Landowner(s) of Record (attach accompanied page to list additional owners):
Baxter Station LLC
Name Telephone Fax Number
417 D CARATOKE HWY 417 D CARATOKE HWY
Current Mailing Address Current Street Address
MOYOCK, NC 27958 MOYOCK, NC 27958
City State Zip City State Zip
10. Deed Book No. 1726 Page No. 919-921 (3) Provide a copy of the most current deed.
Part B.
1. Company(ies) or firm(s) who are financially responsible for the land-disturbing activity (Provide a
comprehensive list of all responsible parties on an attached sheet.) If the company or firm is a sole proprietorship,
the name of the owner or manager may be listed as the financially responsible party.
NVR Inc. dba Ryan Homes [e-mail]
Name E-mail Address
4525 South Blvd Suite 100 4525 South Blvd Suite 100
Current Mailing Address Current Street Address
Virginia Beach, VA 23452 Virginia Beach, VA 23452
City State Zip City State Zip
Telephone [phone] Fax Number 757-905-5281

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:
Corporation Service Company
Name E-mail Address
2626 Glenwood Avenue, Suite 550
Current Mailing Address Current Street Address
Raleigh NC 27608
City State Zip City State Zip
Telephone(800) 927 - 9800 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:
NVR Inc. dba Ryan Homes [e-mail]
Name of Registered Agent E-mail Address
4525 South Blvd Suite 100
Current Mailing Address Current Street Address
Virginia Beach, VA 23452
City State Zip City State Zip
Telephone(757) 905 - 5280 Fax Number(757) 905 - 5281
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.
Greg Knapp Division ManagerNice President of Ryan Homes
Type or pri e Title or Authority
‹htZLI
Signat Date
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I. CjOc E, , a Notary Public of the C of VC( • e'er-tai+7 f
s t 0 k t�� � �
State of Nert afoliaa; hereby certify that G e appeared
personally before me this day and being duly sworn acknowledged that the above form was
executed by him.
Witness my hand and notarial seal, this day of Pl a9 , 20all
• COLI:t i a 4, 0-'- -N't
Qai No ry
41
S, ie A. Hocutt
Notary Public 7969308 My commission expires [31 •
Commonwealth of Virginia
My Commission Expires May 31,2026