NCC216466_FRO Submitted_20211118

FINANCIAL RESPONSIBILITYIOWNERSHIP 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. P
1. Project Nameilchers Branch
2.
3.
4.
5,
6
Location of land -disturbing activity: County OnsloW
Highway/Street 250 Pilchers Branch Rd Latitude 34 32' 41 "
City or Township Stump Sound
Longitude -77 29132"
Approximate date land -disturbing activity will commence: 9/20/21
Purpose of development (residential, commercial, industrial, institutional, etc.): Single Source Mining
Total acreage disturbed or uncovered (including off -site borrow and waste areas): 3.7 acres
Amount of fee enclosed: $260.00 . The application fee of $65.00 per acre (rounded
up to the next acre) is assessed without a ceiling amount (Example: a 9-acre application fee is $585).
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:
NameWill Alexander E-mail Address [e-mail]
Telephone [phone] Cell # 910-264-6782 Fax #
9. Landowner(s) of Record (attach accompanied page to list additional owners):
Get Right Investments 11 LLC 910-264-6782
Name Telephone Fax Number
PO Box 296 103 Ashley King Road
Current Mailing Address Current Street Address
Holly Ridge, NC 28445 Holly Ridge, NC 28445
City State Zip City state Zip
10, Deed Book No. 5270 Page No. 402 Provide a copy of the most current deed.
Part B.
1. Company(ies) or firm(s) who are financially responsible for the land -disturbing activity (Provide a
comprehensive list of all responsible parties on an attached sheet.) if the company orfirm is a sole proprietorship,
the name of the owner or manager may be listed as the financially responsible party.
Get Right Investments II LLC [e-mail]
Name E-mail Address
PO Box 296 103 Ashley King Road
Current Mailing Address Current Street Address
Holly Ridge, NC 28445 Holly Ridge, NC 28445
City State Zip City State Zip
Telephone [phone] Fax Number

I/
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:
Name
Current Mailing Address
City
E-mail Address
Current Street Address
state Zip City
Telephone Fax Number
State zip
(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
Current Mailing Address
City
State zip
E-mail Address
Current Street Address
c:1ry
Telephone Fax Number
State zip
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.
Will Alexander Owner
Type or a m e Title or Authority
9116121
Signature Date
Jordan Alexa Gonzalez
a Notary Public of the County of Craven
State of North Carolina, hereby certify that William Alexander
personally before me this day and being duly sworn acknowledged that the above forrmearewas
executed by him.
Witness my hand and notarial seal this 16th day of September 12021
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