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HomeMy WebLinkAboutNCC242330_FRO Submitted_20240802 n Official Check 5303176391 Customer Copy Non-Negotiable STIER SUPPLY COMPANY May 13, 2024 TWO THOUSAND DOLLARS and 00 CENTS $2000.00 NC DEQ FRO-LEE-2023-017 r� 68-236/514 TRUIST; Official Check 5303°163 1 Purchaser STIER SUPPLY COMPANY Date May 13, 2024 Cost Center 8043916 Pay TWO THOUSAND DOLLARS and 00 CENTS $2000.00 To the Order of NC DEQ Truist Bank is an Authorized Agent Truist Bank Memo FRO-LEE-2023-017 Payable at Truist Bank Authorized Signature ll' S30317639111' Check if this project is ARPA-funded ❑ Attach a copy of the Letter of Intent to Fund 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 NCG01 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 Stier Sanford Industrial Development *If this project involves American Rescue Plan Act(ARPA) funds, list the Project Name or Project Number(e.g., SRP-D-ARP-0121) below under which you were approved for funding through the Division of Water Infrastructure (DWI). 2. Location of land-disturbing activity: County Lee City or Township Sanford Rod Sullivan Road 35.5797 -79.110289 Highway/Street Latltude(decimal degrees) Longitude(decimal degrees) 3. Approximate date land-disturbing activity will commence: 6/3/24 4. Purpose of development(residential, commercial, industrial, institutional, etc.): Industrial 5. Total acreage disturbed or uncovered (including off-site borrow and waste areas): 20 6. Amount of fee enclosed: $2,000 . 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). Checks should be addressed to NCDEQ. 7. Has an erosion and sediment control plan been filed? Yes ❑ Enclosed 0 No ❑ 8. Person to contact should erosion and sediment control issues arise during land-disturbing activity: Name Tim Wipperman E-mail Addresstwipperman@arcodb.com Phone: Office# Mobile# (919) 339-2371 9. Landowner(s)of Record (attach accompanied page to list additional owners): Stephens Enterprises, LLC (919) 779-8649 Name Phone: Office# Mobile# 319 Chapanoke Road 319 Chapanoke Road Current Mailing Address Current Street Address Raleigh, NC 27603 Raleigh, NC 27603 City State Zip City State Zip 10. Deed Book No.1667 Page No.1003 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). Stier Supply Company ryanstier@stiersupply.com Company Name E-mail Address PO Box 1059 303 Bellinger Lane Current Mailing Address Current Street Address Gaston, SC 29053 Gaston, SC 29053 City State Zip City State Zip Phone: Office# Mobile#(843) 247-0718 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: Jonathan Ryan Stier ryanstier@stiersupply.com Name of Registered Agent E-mail Address 119 Green Meadows Ln 119 Green Meadows Ln Current Mailing Address Current Street Address Columbus, NC 28722 Columbus, NC 28722 City State Zip City State Zip Phone: Office# Mobile# (843) 247-0718 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 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. Jonathan Ryan Stier CEO/President Type or prin Title or Authority 5/13/2f Signat Date I, Me( issQ. Ann PnrJcV , a Notary Public of the County of bcr Ve I State of Ne+4h Carolina, hereby certify that �yar1 Sfif.r appeared personally before me this day and being duly sworn acknowledged that the above form was executed by him/her. Witness my hand and notarial seal, this 13 day of May , 20 a .�`,00,pNNpi,��''�� Notary�1��C�IJ w` "L�— • c,StA PO ''�. / 3g ;r�'��.2°�'�.'P�B���r�, My commission expires v�'" 8 O % rP '•.......= y : ' *f`"nusna0 0.