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HomeMy WebLinkAboutNCC220968_FRO Submitted_20220307FINANCIAL 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 NIA in the blank.) Part A. The Hills at Stone Gate 1. Project Name Cumberland FayettevNe - Manchester 2. Location of land -disturbing activity: County City or Township Highway/Street Edwinstowe Ave. Latitude 35.159101 Longitude-78.879866 3. Approximate date land -disturbing activity will commence: September 2021 4. Purpose of development (residential, commercial, industrial, institutional, etc.): F-IteSidentlal 5. Total acreage disturbed or uncovered (including off -site borrow and waste areas): 33.85 6. Amount of fee enclosed: $ 2,210.00 . The application fee of $65.40 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 George Armstrong E-mail Address r Telephone 910-864-3232 cell # Fax # 9. Landowner(s) of Record (attach accompanied page to list additional owners): CRA Home Builders LLC. 910-864-3232 Name Telephone Fax Number 2709 Thorngrove Court - Suite 2 2709 Thorngrove Court - Suite 2 Current Mailing Address Current Street Address Fayetteville NC 28303 Fayetteville NC 28303 City State Zip City State Zip 10. Deed Book No. Page No. 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 or firm is a sole proprietorship, the name of the owner or manager may be listed as the financially responsible party. CRA Home Builders LLC, Name E-mail Address 2709 Thorngrove Court - Suite 2 2709 Thorngrove Court - Suite 2 Current Mailing Address Current Street Address Fayetteville NC 28303 Fayetteville NC 28303 City State Telephone 910-864-3232 Zip City State f-tp 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 E-mail Address Current Mailing Address Current Street Address City State Zip City State Zip Telephone 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 Current Mailing Address E-mail 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. George H. Armstrong Type or 'nt name Signature President Title or Authority Date 1, Cc, rl �c�lGi�G� _ _ , a Notary Public of the County of State of North Carolina, hereby certify that 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 ```,t`,5`111111111111111/f!1!!•'•,I �OTARy Notary ' I Seal �'°U1300 ,/V R= My commission expires y�,+ COLIC !%l/11111111111 0