HomeMy WebLinkAboutNCC216112_FRO Submitted_20211124FINANCIAL 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. (Please type or print and, if the
question is not applicable or the e-mail and/or fax information unavailable, place NIA in the blank.)
Part A.
1. Project Name Stella Landing
2. Location of land -disturbing activity: County Carteret City or Township Stella
Highway/Street Wetherington Landing Rd Latitude 34.774057 Longitude-77.146580
3. Approximate date land -disturbing activity will commence: September 2021
4. Purpose of development (residential, commercial, industrial, institutional, etc.): Residential
5. Total acreage disturbed or uncovered (including off -site borrow and waste areas): 20.26
6. Amount of fee enclosed: $ 1365.00 . 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:
Name Elijah Morton
E-mail Address elijahm@mortontrucking.com
Telephone 910-548-7575 Cell # Fax #
9. Landowner(s) of Record (attach accompanied page to list additional owners):
South State Development, LLC
910-548-7575
Name
Telephone Fax Number
121 Garnet Ln
121 Garnet Ln
Current Mailing Address
Current Street Address
Jacksonville, NC 28546
Jacksonville, NC 28546
City State Zip
City State Zip
10. Deed Book No, 1731 page No. 438 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):
South State Development, LLC
eiijahm@mortontrucking.com
Name
Email Address
121 Garnet Ln
121 Garnet Ln
Current Mailing Address
Current Street Address
Jacksonville, NC 28546
Jacksonville, NC 28546
City State Zip
City State Zip
Telephone 910-548-7575
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:
Name
Current Mailing Address
City
Telephone.
E-mail Address
Current Street Address
State Zip City State Zip
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.
Elijah Morton Member
Typ r int name Title or Authority j
ign ture L Date
I, S5tQtr ULJLI-'' ence , a Notary Public of the County of fly ULi
State of North Carolina, hereby certify that I:::: I i ��V Mtrr+,,-'-) 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 �� day of 20 at
JESSICA LAWAtE:EN.�Notary
'''IAlly Public
North Carolina
Onslow County My commission expires