NCC243331_FRO Submitted_20241031

Check if this project is ARPA-funded ❑
Attach a copy of the Letter of Intent to Fund
FINANCIAL RESPO BILITYIOWNERSHIP FORM
SEDIMENTATION •LLUTION CONTROL ACT
No person may initiate any land-disturbing activi • one or more acres as covered by the Act, including any
activity under a common plan of development o size as covered by the NCG01 permit, before this form
and an acceptable erosion and sedimentation c 'n o plan have been completed and approved by the Land
Quality Section, N.C. Department of Environmq(h'-1 uality. Submit the completed form to the appropriate
Regional Office. (Please type or print and, if th0 i stion is not applicable or the e-mail address or phone
number is unavailable, place N/A in the blank.)
Part A.
1. Project Name Afton Ridge
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*If this project involves American R_ c46 Plan Act(ARPA) funds, list the Project Name or Project
Number(e.g., SRP-D-ARP-0121) b-lo under which you were approved for funding through the
Division of Water Infrastructure (D I)
9umberland Hope Mills
2. Location of land-disturbing activity: Count City or Township
Afton Avenue � 34.97130 -78.92321
Highway/Street a't�de(decimal degrees) Longitude(decimal degrees)
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3. Approximate date land-disturbing activity will commence: 10/1/24
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1 residential - multifamily
4. Purpose of development(residential, comiIn rcial, industrial, institutional, etc.):
5. Total acreage disturbed or uncovered (including off-site borrow and waste areas): 12.10
6. Amount of fee enclosed: $$1 ,300.00 . The application fee of$100.00 per acre (rounded
up to the next acre) is assessed without a 'cHiling amount (Example: 8.10-acre application fee is $900).
Checks should be addressed to NCDEQ.
7. Has an erosion and sediment control planibeOn filed? Yes ❑ Enclosed El No ❑
8. Person to contact should erosion and sedimeent control issues arise during land-disturbing activity:
Name
Wade Duggins E-mail Address [e-mail]
Phone: Office# 910-850-6644 Mobile# [phone]
9. Landowner(s)of Record (attach accompaiiei page to list additional owners):
Duggins Southview Holdings, LLC. 910-221-6600 910-221-6600
Name I Phone: Office# Mobile#
2939 Breezewood Ave. - Ste. 2b1 2939 Breezewood Ave. - Ste. 201
Current Mailing Address Current Street Address
Fayetteville NC 283013 Fayetteville NC 28303
City State Zip City State Zip
10. Deed Book No. 11934 Page fro.;677 Provide a copy of the most current deed.
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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).
Duggins Southview Holdings, LLC. [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# 910-221-6600 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:
Murray O. Duggins [e-mail]
Name of Registered Agent 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# 910-221-6600 Mobile# [phone]
Murray O. Duggins
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 Manager- Duggins Southview Holdings, LLC.
Type or print n e Title or Authority
Signature Date
I, @'lrt5+(nt°. /UI. 4-ev‘rt , a Notary Public of the County of CU Kthexiavrt
State of North Carolina, hereby certify that A u,rvOuri 0. 1 acvm.1 i1` appeared personally
before me this day and being duly sworn acknowledged that the abeiVe form was executed by him/her.
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Witness my hand and notarial seal, this ae day of Y-rW3 t,LST , 20 94
•
Christine M.Henry NotaryPublic
✓✓✓ J
Q6�nd County I
North Carolina, , My commission expires Jn AA(00AA
Commission hes ,_

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#