NCC242353_FRO Submitted_20240822

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 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 Eutaw Landing
*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 Cumberland City or Township Fayetteville
925 Elm St. 35.07699 -78.92474
Highway/Street Latltude�decimai degrees) Longitude(decimal degrees)
3. Approximate date land-disturbing activity will commence: 3/4/24
4. Purpose of development(residential, commercial, industrial, institutional, etc.): residential multifamily
5. Total acreage disturbed or uncovered (including off-site borrow and waste areas): 4.00
6. Amount of fee enclosed: $$400 (paid previously) 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 1 Enclosed ❑ No ❑
8. Person to contact should erosion and sediment control issues arise during land-disturbing activity:
Name
Sky ler George E-mail Address [e-mail]
Phone: Office# 1-336-454-6134 Mobile# [phone]
9. Landowner(s)of Record (attach accompanied page to list additional owners):
Eutaw Landing Associates Limited Partnership 910-764-6600 910-591-6078
Name Phone: Office# Mobile#
2939 Breezewood Ave - Ste 201 2939 Breezewood Ave - Ste 201
Current Mailing Address Current Street Address
Fayetteville NC 28303 Fayetteville NC 28303
City State Zip City State Zip
10. Deed Book No. 1 1745 Page No.261 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).
Eutaw Landing Associates Limited Partnership [e-mail]
Company Name E-mail Address
2939 Breezewood Ave - Ste 201 2939 Breezewood Ave - Ste 201
Current Mailing Address Current Street Address
Fayetteville NC 28303 Fayetteville NC 28303
City State Zip City State Zip
Phone: Office# 910-764-6600 Mobile# [phone]
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:
Michael Wenig [e-mail]
Name of Registered Agent E-mail Address
400 Bellemeade Street - ste 800 400 Bellemeade Street - ste 800
Current Mailing Address Current Street Address
Greensboro NC 27401 Greensboro NC 27401
City State Zip City State Zip
Phone: Office# 910-764-6600 Mobile# [phone]
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.
Murray O. Duggins, Jr. Partner in Eutaw Landing Associates LP
Type or ri na Title or Authority
/Z- /K.- ZO2-3
Signature Date
I, Nrc54-in e_ ) . -e.11 tr1 , a Notary Public of the County of (.t ether(Oii
State of North Carolina, hereby certify that A trrn L.1 0. i. uolli n5,. Sr. appeared personally
before me this day and being duly sworn acknowledged that the abeeNk form was executed by him/her.
Witness my hand and notarial seal, this N FL day of (e m r). r , 20 a,J
ei/11-Wtujit. -P/lh C
Christine M.Henry
NotaryI U
311otary Public
Curth Carolina
nd County
No My commission expires 1 D A POP
My Commission Expires 4, -0-4
North

Continued from Items 9 & 10 in Part A of the Financial Responsibility/Ownership Form for multiple
owners. Attach copies of this page as needed to list all landowners.
Landowner 2 of Record:
Name Phone: Office# Mobile#
Current Mailing Address Current Street Address
City State Zip City State Zip
Deed Book No. Page No. Provide a copy of the most current deed.
Landowner 3 of Record:
Name Phone: Office# Mobile#
Current Mailing Address Current Street Address
City State Zip City State Zip
Deed Book No. Page No. Provide a copy of the most current deed.
Landowner 4 of Record:
Name Phone: Office# Mobile#
Current Mailing Address Current Street Address
City State Zip City State Zip
Deed Book No. Page No. Provide a copy of the most current deed.
Landowner 5 of Record:
Name Phone: Office# Mobile#
Current Mailing Address Current Street Address
City State Zip City State Zip
Deed Book No. Page No. Provide a copy of the most current deed.

Continued from Item 1 in Part B of the Financial Responsibility/Ownership Form for multiple parties.
Attach copies of this page as needed to list all financially responsible parties.
Company 2 Name E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Phone: Office# Mobile#
Company 3 Name E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Phone: Office# Mobile#
Company 4 Name E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Phone: Office# Mobile#
Company 5 Name E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Phone: Office# Mobile#