NCC220816_FRO Submitted_20220221

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. Flats at Hanover Center
1. Project Name
2. Location of land -disturbing activity: Count New Hanover City or Township Wilmington
Highway/Street 3500 Park Ave Latitude34 13' 05.42" N Longitude77 54' 06.85" W
3. Approximate date land -disturbing activity will commence:02-25-22
4. Purpose of development (residential, commercial, industrial, institutional, etc.): Residential / Commercial
5. Total acreage disturbed or uncovered (including off -site borrow and waste areas): 9.05
6. Amount of fee enclosed: $ . 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? YesX No Enclosed
8. Person to contact should erosion and sediment control issues arise during land -disturbing activity:
NameT. Jason Clark, P.E. E-mail [e-mail]
Telephone [phone] cell # N/A Fax # [phone]
9. Landowner(s) of Record (attach accompanied page to list additional owners):
New Market - Hanover, L.P.
770-635-3390 N/A
Name
Telephone Fax Number
3284 Northside Parkway, NW, Suite 150
3284 Northside Parkway, NW, Suite 150
Current Mailing Address
Current Street Address
Atlanta GA 30327
Atlanta GA 30327
City State Zip
City State Zip
10. Deed Book No. 6273 Page No.391-392 Provide a copy of the most current deed.
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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 or firm is a sole proprietorship,
the name of the owner or manager may be listed as the financially responsible party.
New Market - Hanover, L.P.
[e-mail]
Name
E-mail Address
3284 Northside Parkway, NW, Suite 150
3284 Northside Parkway, NW, Suite 150
Current Mailing Address
Current Street Address
Atlanta GA 30327
Atlanta GA 30327
City State Zip
City State Zip
Telephone[phone]
Fax Number N/A

(a) If the Financially Responsible Party is not a resident of North Carolina, give name and street address
of the designated North Carolina Agent:
Vcorp Services, LLC [e-mail]
Name
160 Mine Lake Court, Suite 200
Current Mailing Address
Raleigh NC 27615
City
State Zip
Telephone [phone]
E-mail Address
160 Mine Lake Court, Suite 200
Current Street Address
Raleigh NC 27615
City State Zip
Fax Number N/A
(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
Telephone
E-mail Address
Current Street Address
State Zip City State Zip
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.
Market Hanover GP, LLC, General Partner, Jeffrey Sprain Authorized Agent
Sign
Title or Authority
Date
a Notary Public of the County of ��t�'-c�c�
State of l" ��, hereby certify tha— 1� ��/�t (V
appeared
personally before me this day and being duly sworn acknowledged that the above form was
executed by him.
Witness my hai�d nd�r�o ii risgpI, this �N day of 20 -
� � � `�•� U`� • <., LPL-�'�
FIRES Notary
9eaIGEORG'A
\UGUST 27>2023�_ My commission expired`.
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