NCC221506_FRO Submitted_20220421

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 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 The Villages on Canterbury
2. Location of land -disturbing activity: County Craven City or Township Trent Woods
Highway/Street Canterbury Road Latitude 35.086892 N Longitude-77.081367 W
3. Approximate date land -disturbing activity will commence: spring 2021/2022
4. Purpose of development (residential, commercial, industrial, institutional, etc.): Residential
5. Total acreage disturbed or uncovered (including off -site borrow and waste areas): 11 acres
$100.00 / acre
6. Amount of fee enclosed: $ 1,100.00 The application fee of $66 90-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 Bobby Billingsley E-mail Address [e-mail]
or'D Fite 252.671.2408 252.636.2448
Telephone " " ' ` ` Cell #
Fax #
9. Landowner(s) of Record (attach accompanied page to list additional owners):
Trent Utilities, Inc. 252.349.8146
Name Telephone
905 Hampton Way 905 Hampton Way
Current Mailing Address
Current Street Address
n/a
Fax Number
New Bern NC 28562 New Bern NC 28562
City State Zip City State Zip
10. Deed Book No. 1259 Page No. 026 Provide a copy of the most current deed.
Deed Bk 826, Pg 800 & Deed Book 791, Pg 230
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):
Trent Utilities, Inc. [e-mail]
Name
905 Hampton Way
E-mail Address
905 Hampton Way
Current Mailing Address Current Street Address
New Bern NC 28562 New Bern NC 28562
City State Zip City State Zip
Telephone 252.34 9.814 6 Fax Number.
n/a

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
city
State Zip
Current Street Address
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.
Paul W. Crayton, Jr. President - Trent Utilities, Inc.
TO grin name
Signature
Title or Authority
- dt-' Z'az_R _
Date
1, C,^t ':s�w�t,►.er 1...t. 14'0.. , a Notary Public of the County of Cc`a L- ./V
State of North Carolina, hereby certify that "? Ate► ( W • gt, IFS--- ,,Ta. , 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 9 day of M gr cJ% , 20-l-
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