NCC242518_FRO Submitted_20240820

•1L�'
WILSON
Financial Responsibility-Ownership Form
No person may partake in any land disturbing activity within the confines of the City of Wilson Sedimentation and Erosion Control Ordinance
before completing and filing this form with the City of Wilson Erosion Control Division. (*Indicate N/A if a question is not applicable)
Field Name Description Comments
PROJECT Tracking
number
Complete Application Received date
Application/N01
Commercial(30001)=1542,Highway(30005)=1611,Industrial(30002)
=1541,Residential,Single Family Houses(SFE)=1521,Residential,
SIC Code(Primary) 30001 other than SFE(30000)=1522,others=blank
Project or Site name Delta Heating Cooling&Plumbing
Site Street Address 2826 Wooten Blvd.
Site City Wilson
Site County Wilson
Site State NC
Site Zip Code 27893
Non-Government=POF(default)
Government-County =CNG
Government-Federal=FDF
Site/Facility Type of Government-Municipal=MWD
Ownership POF Organization Government-State=STF
Approximate Activity
Start Date July 1,2024
Total Acres of
Disturbance 1.30 ACRES
FRO-First Name Michael **MUST be Financially Responsible Owner Person**
FRO-Last Name Gaier **MUST be Financially Responsible Owner Person**
FRO- Organization
Formal Name DHCP PROPERTIES,LLC **MUST belong to Financially Responsible Owner**
FRO-eMail Address [e-mail] **MUST belong to Financially Responsible Owner**
FRO-Mailing Street
Address 2021 Raleigh Blvd. **MUST belong to Financially Responsible Owner**
FRO-Mailing
Supplemental Location
Text 2021 Raleigh Blvd. **MUST belong to Financially Responsible Owner**
FRO-Mailing City Raleigh **MUST belong to Financially Responsible Owner**
FRO-Mailing State NC **MUST belong to Financially Responsible Owner**
FRO-Mailing Zip Code 27604 **MUST belong to Financially Responsible Owner**
Latitude:Decimal
Degrees 35.7176
Longitude:Decimal
Degrees
-77.9569

.
WILSON
NOR.
(#)ACRES TO BE DISTURBED 1.30 AC X$150.00/ACRE=$195.00
Person(s)or Firm(s)financially responsible for this land disturbing activity: (If out of state,a registered agent in North Carolina
must be used.)
In case of a violation please list the preferred contact(either the Financially Responsible Person or Registered Agent on the line
below:
Micheal Gaier, Managing Member Ronnie L.Sutton,PE
Financially Responsible Person Registered Agent
The above information is true and correct to the best of my knowledge and belief and as provided by me while under oath.(This
form must be signed by the Financially Responsible Person if an individual or by an officer,director, partner,and attorney-in-fact,
or other person with authority to execute instruments for the financially responsible person if not an individual.)
March 25,2024
Date
Title or Authority
Managing Member, DHCP Properties, C
Signature
Michael Gaier
Type or Print Name
Managing Member 3-25-2024
Title Date
p I C,,,�_� J C ,"3.Z—�-7 ,a Notary Public of the County of `}t; OCc ,State of North Carolina
hereby certifies
N\ c) c,__( L
r. .,0 " rL personally appeared before me this day and under oath acknowledged that the
above form was executed by him.
Witness my hand and notary se ,.#I.is-_ /5 rn day of � H L' 1 .
(Notary Public) --,
__ MICHAEL J CASEY
My commission expires �''r L ZZ• e-oL Notary Public
r: � Wake Co., North Carolina
My Commission Expires April 22,2024