NCC242172_FRO Submitted_20240718

(-risonville City of Jacksonville
�``gQC �M,unsy°� Erosion and Sedimentation Control Application
1. Applicant(s): Educate Onslow, LLC for Milestones Academy
Address: 3605 Henderson Drive, Jacksonville, NC 28546
Phone Number: 910-455-3136
Interest in property: Owner/Developer
(Owner, developer, registered agent, manager, etc.)
2. ePlan Applicant Info: (Information of the person who will be uploading documents to eplan)
First Name: Larry Last Name: LaVecchia
Email Address: [e-mail]
3. Owner of Property: Educate Onslow, LLC
(If not the applicant)
Address: 3505 Henderson Drive, Jacksonville, NC 28546
Fax Number: 910-455-3136 Email:
4. Description of property:
a. Location of Property/Address: 7105 Western Blvd
b. Onslow County Deed Book: 6116 Page Number: 0868
c. Onslow County Map Book: 83 Page Number: 177
d. Total Acreage in Tract: 15.96 Ac
e. Acreage to be Disturbed: 7.27 Ac
5. Submit the following documentation to Planning and Permitting:
a. One original fully executed Financial Responsibility/Ownership Form. (Attachment A)
b. One copy of a completed checklist along with all required information and documentation.
(Attachment B)
c. Check made out to the CITY OF JACKSONVILLE for the total amount due.
($225 for first acre plus $125 for every additional acre or portion thereof based on the
total disturbed acreage in the tract.)
d. Upload to eplan - Erosion control plan(s) along with all related details, calculations, and
documents as required on the checklist.
ep 71)
ig tt re of Property Owner or Applicant Date

(ATTACHMENT A)
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 Environment and Natural Resources. j(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: Milestones Academy
2. Location of land-disturbing activity: Onslow County City or Township: City of Jacksonville
Highway/Street: 7105 Western Blvd Latitude: 34°47'43.5" Longitude: 77°26'45.4"
3. Approximate date land-disturbing activity will commence: July 2024
4. Purpose of development(residential, commercial, industrial, institutional, etc.): Commercial
5. Total acreage disturbed or uncovered (including off-site borrow and waste areas): 7.27
6. Amount of fee enclosed: $1,100.00
The application fee of$225.00 for the first acre plus $125 for every additional acre (rounded up to the
next acre) is assessed without a ceiling amount. (Example: 6.4-acre application fee is $975).
7. Has an erosion and sediment control plan been filed? Yes y No Enclosed y
8. Person to contact should erosion and sediment control issues arise during land-disturbing activity
Name: Michael Elks E-mail Address: [e-mail]
Telephone #: [phone] Cell #: [phone] Fax #: n/a
9. 3605 Henderson Drive same
Current Mailing Address Current Street Address
Jacksonville NC 28546 same
City State Zip City State Zip
10. Deed Book: 6116 Page Number: 0868 (Provide a copy of the most current deed)
Part B.
1. Person(s) or firm(s) who are financially responsible for the land-disturbing activity
(Provide a comprehensive list of all responsible parties on an attached sheet):
Educate Onslow, LLC [e-mail]
Name E-mail Address
3605 Henderson Drive same
Current Mailing Address Current Street Address]
Jacksonville NC 28546 same
city state Zip City State Zip
Telephone #: [phone] Cell #: [phone] Fax #:

2. (a) If the Financially Responsible Party is not a resident of North Carolina, give name and street address
the designated North Carolina Agent:
Name E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Telephone #: Cell #: Fax #:
i
(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:
Name E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Telephone #: Cell #: Fax #:
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.
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SigLatur Date
I, �`'r ily PO/i0r,IC ,a Notary Public of the County of OA6/0t'.L
State of North Carolina, hereby certify that •,/J/7.Cj her-!� / .S appeared personally
before me this day and being duly sworn acknowledged that the above form was executed by him.
Witness my ha;d�w ��tarial seal, this .J day of May' , 20
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