NCC221667_FRO Submitted_20220429

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 Soil Erosion and
Sedimentation Control Ordinance of the City of Greenville (Title 9, Chapter 8) before this form and an
acceptable erosion and sedimentation control plan have been completed and approved by the City of
Greenville, Engineering Division. (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 Joe Pecheles Hyundai
2. Location of land -disturbing activity: County Pitt City or Township Greenville
Highway/Street 203 Greenville Boulevard SE Latitude 35.57937 Longitude 77.37963
3. Approximate date land -disturbing activity will commence: 07/01/2022
4. Purpose of development (residential, commercial, industrial, institutional, etc.): Commercial
5. Total acreage disturbed or uncovered (including off -site borrow and waste areas): 3.0 acres
6. Amount of fee enclosed: $ 300.00 . The application fee of $100.00 per acre (rounded
to the tenth of acre) is assessed without a ceiling amount (Example: a 9-acre application fee is $900).
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 Pete E. West E-mail Address [e-mail]
Telephone [phone] Cell # 252-714-2157 Fax # [phone]
0
Landowner(s) of Record (attach accompanied page to list additional owners):
Joe Pecheles Volkswagen, Inc. _ _252-756-1135
Name Telephone Fax Number
203 Greenville Boulevard SE 203 Greenville Boulevard SE _
Current Mailing Address Current Street Address
Greenville NC 27858 Greenville NC
City State Zip City State Zip
10. Deed Book No. 000054 Page No. 00648 Provide a copy of the most current deed.
27858
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):
Joe Pecheles Volkswagen, Inc. bl pOpechelesauto motive. com
Name E-mail Address
203 Greenville Boulevard SE 203 Greenville Boulevard SE
Current Mailing Address Current Street Address
Greenville NC 27858 Greenville NC 27858
City State Zip City State Zip
Telephone [phone] 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
Telephone
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 by any change in the information provided herein.
Brian Pecheles
Type or pri t name
Signature
President
Title or Authority
Date
1, ?W'Ac kk. WC&CL a Notary Public of the County of
State of North Carolina, hereby certify that CwLn ACLinc. S 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 3 day of M0iCGV\ _, 20
Seal
tlPAIGE H WALLACE
NOTARY PUBLIC
PITT COUNTY, NC
MYcW19S1'Wtl
_. " 1!u
Notar
My commission expires 11� Z2