Loading...
HomeMy WebLinkAboutNCC242568_FRO Submitted_20240822 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. Perdue ECOP Upgrades Site Design 1. Project Name p9 2. Location of land-disturbing activity: County Hyde City or Township CUrrItuck Highway/Street NC-45 HWY N Latitude 35.644885 Longitude-76.587573 3. Approximate date land-disturbing activity will commence:May 2024 4. Purpose of development(residential, commercial, industrial, institutional, etc.):Commercial 5. Total acreage disturbed or uncovered (including off-site borrow and waste areas): 1 .42 6. Amount of fee enclosed: $ 200 . The application fee of$100.00 per acre (rounded up to the next acre) is assessed without a ceiling amount (Example: 8.10 ac=$900.00). 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 Scott Peterson E-mail Address scott.peterson@perdue.com Telephone(757) 494-5594 Cell# Fax# 9. Landowner(s) of Record (attach accompanied page to list additional owners): East Carolina Oilseed & Processors, LLC (877) 858-3855 Name Telephone Fax Number 31149 Old Ocean City Rd 31149 Old Ocean City Rd Current Mailing Address Current Street Address Salisbury MD 21804 Salisbury MD 21804 City State Zip City State Zip 10. Deed Book No.000246 Page No.00184 Provide a copy of the most current deed. Part B. 1. Company(ies) or firms) 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. East Carolina Oilseed & Processors, LLC Name E-mail Address 31149 Old Ocean City Rd 31149 Old Ocean City Rd Current Mailing Address Current Street Address Salisbury MD 21804 Salisbury MD 21804 City State Zip City State Zip Telephone(877) 858-3855 Fax Number 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: CT Corporation System Name E-mail Address 160 Mine Lake Ct Ste 200 160 Mine Lake Ct Ste 200 Current Mailing Address Current Street Address Raleigh NC 27615 Raleigh NC 27615 City State Zip City State Zip Telephone(877) 858-3855 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: Name of Registered Agent E-mail Address Current Mailing Address Current Street Address City State Zip City State Zip Telephone Fax Number 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. K,,.a fr-Oka A Type print name Title Authority /4/C-ft— 0 2-AS--/,,2- Signature Date I, Li Ndw m )UNes , a Notary Public of the County of H ea..i--PoiLl State of North Carolina, hereby certify that ii 'O ReNo mL(.S c appeared personally before me this day and being duly sworn acknowled ed that the above form was executed by him. Witness my hand and notarial seal, this /S day of reb240421 , 20 g(i (7, 6,°_,,h; A /' I Notary Seal / My commission expires q a.Z a 5-