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HomeMy WebLinkAboutNCC243381_FRO Submitted_20241031 (ATTACHMENT A) 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 Environment and Natural Resources. (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. 1. Project Name: Project Frontier - Parcel Services 2. Location of land-disturbing activity: Onslow County City or Township: City of Jacksonville Highway/Street: New Frontier Way Latitude: 34° 4745'9" Longitude: 77° 25'48.0" 3. Approximate date land-disturbing activity will commence: November 2024 4. Purpose of development(residential, commercial, industrial, institutional, etc.): Industrial 5. Total acreage disturbed or uncovered (including off-site borrow and waste areas): 12.50 6. Amount of fee enclosed: $ 1,725 The application fee of$225.00 for the first acre plus $125 for every additional acre (rounded up to the next acre) is assessed without a ceiling amount. (Example: 6.4-acre application fee is $975). 7. Has an erosion and sediment control plan been filed? Yes ❑ No ❑ Enclosed 0 8. Person to contact should erosion and sediment control issues arise during land-disturbing activity Name: Ryan Harris E-mail Address: rharris@suncappg.com Telephone #: 704-945-8013 Cell #: 980-307-9515 Fax #: 9 6101 Carnegie Blvd, Suite 180 6101 Carnegie Blvd, Suite 180 Current Mailing Address Current Street Address Charlotte NC 28209 Charlotte NC 28209 City State Zip City State Zip 10. Deed Book: DB 1415 Page Number: PG 1001 (Provide a copy of the most current deed) Part B. 1. Person(s) or firm(s) who are financially responsible for the land-disturbing activity (Provide a comprehensive list of all responsible parties on an attached sheet): SunCap Property Group rharris@suncappg.com Name E-mail Address 6101 Carnegie Blvd, Suite 180 6101 Carnegie Blvd, Suite 180 Current Mailing Address Current Street Address Charlotte NC 28209 Charlotte NC 28209 City State Zip City State Zip Telephone #: 704-945-8013 Cell #: 980-307-9515 Fax #: 2. (a) If the Financially Responsible Party is not a resident of North Carolina, give name and street address the designated North Carolina Agent: Name E-mail Address Current Mailing Address Current Street Address City State Zip City State Zip Telephone #: Cell #: Fax #: (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 E-mail Address Current Mailing Address Current Street Address City State Zip City State Zip Telephone #: Cell #: Fax #: 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. eel Sri C ' l� fn ✓crl lu P ro / Yin u )x� Type or name Title or Authori• ,e-e to//c I Signature Date I, C`1Ir r-Ym v,v-‘ ,a Notary Public of the County of , C State of North Carolina, hereby certify that fct-.-v appeared personally before me this day and being duly sworn acknowledged that the above form was executed by him. Witness my hand and notarial seal, this L1 day of ,CVt. , 20 2- - - Nota RACSHUNN FARRINGWA Notary Public,Norlh C rolina ' My commission expires MacklenbuittCaq My Commission Bliss ' , 02/0612029