NCC222119_FRO Submitted_20220608

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 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 address or phone
number is unavailable, place NIA in the blank.)
Part A.
1. Project NameTuriington Acres SID Proposed Access Road
2. Location of land -disturbing activity: County Harnett City or Township Grove Township
Bennett Road (SR 2010) 35.3962-78.6721
Highway/Street LafltUde(decima� degrees) LOngltUde(decimal degrees)
3. Approximate date land -disturbing activity will commence: As Soon As Possible
4. Purpose of development (residential, commercial, industrial, institutional, etc.): Residential
5. Total acreage disturbed or uncovered (including off -site borrow and waste areas): 1.89 AC
6. Amount of fee enclosed: $ 200.00 . The application fee of $100.00 per acre (rounded
up to the next acre) is assessed without a ceiling amount (Example: 8.10-acre application fee is $900).
Checks should be addressed to NCDEQ.
7. Has an erosion and sediment control plan been filed? Yes ❑ Enclosed p No ❑
8. Person to contact should erosion and sediment control issues arise during land -disturbing activity:
Name Glenn Tew E-mail [e-mail]
Phone: Office # 910-897-3257 Ext. 105 Mobile # [phone]
9. Landowner(s) of Record (attach accompanied page to list additional owners):
Turlington Acres, LLC 910-723-6516 910-308-0804
Name
2919 Breezewood Drive, Suite 100
Current Mailing Address
Fayetteville N.C.
City State
10. deed Book No. 3763
Phone: Office # Mobile #
Same
Current Street Address
28303 Same
Zip City State Zip
Page No. 0263 Provide a copy of the most current deed.

Part B.
1. Company(ies) who are financially responsible for the land -disturbing activity (Provide a comprehensive list
of all responsible parties on accompanied page.) if the company is a sole proprietorship orirthe landowner(s) is
an individual(s), the name(s) of the owner(s) may be listed as the financially responsible party(ies).
Turlington Acres, LLC
Company Name
2919 Breezewood Drive, Suite 100
Current Mailing Address
Fayetteville N.C. 28303
City State Zip
Phone: Office # 910-723-6516
[e-mail]
E-mail Address
Same
Current Street Address
Same
City State Zip
Mobile # [phone]
Note: If the Financially Responsible Party is not the owner of the land to be disturbed, include with this form
the landowner's signed and dated written consent for the applicant to submit a draft erosion and sedimentation
control plan and to conduct the anticipated land disturbing activity.
2. (a) If the Financially Responsible Party is a domestic company registered on the NC Secretary of State
business registry, give name and street address of the Registered Agent:
D. Ralph Huff, III
[e-mail]
Name of Registered Agent
E-mail Address
2919 Breezewood Ave. Suite 100
SAME
Current Mailing Address
Current Street Address
Fayetteville N.C. 28303
SAME
City State Zip
City State Zip
Phone: office # 910-723-6516
Mobile # [phone]
Name of Individual to Contact (if Registered Agent is a company)
(b) If the Financially Responsible Party is not a
resident of North Carolina, give name and street address
of the designated North Carolina agent who is registered on the NC Secretary of State business registry:
Name of Registered Agent
E-mail Address
Current Mailing Address
Current Street Address
City State Zip
City State Zip
Phone: Office #
Mobile #
Name of Individual to Contact (if Registered Agent is a company)

(c) If the Financially Responsible Parry is engaging in business under an assumed name, give name under
which the company is Doing Business As. If the Financially Responsible Party is an individual, General
Partnership, or other company not registered and doing business under an assumed name, attach a copy
of the Certificate of Assumed Name.
Company DBA Name
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(s)
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 Party). I agree to provide
corrected information should there be any change in the information provided herein.
D. Ralph Huff, III
Manager
7e r nt n Title or Authority
A44 3 -4 22
Signature Date
a Notary Public of
State of North Carolina, hereby certify that % n Yl
before me this day and being duly sworn ac�kn �v[edged that the above
r
Witness my hand and notarial sea], this f4 \day of t' MOd-
��prpa���lnlriti,
f
meal
CUVN k
unty of
appeared personally
irm was executed by him/her.
"tVL
Notary �1
My commission expires

Continued from Items 9 & 10 in Part A of the Financial Responsibility/Ownership Form for multiple
owners. Attach copies of this page as needed to list all landowners.
Landowner 2 of Record:
Name
Phone: Office # Mobile #
Current Mailing Address
Current Street Address
City State
City State Zip
Zip
Deed Book No.
Page No.
Provide a copy of the most current deed.
Landowner 3 of Record:
Name
Phone: Office # Mobile #
Current Mailing Address
Current Street Address
City State
Zip
City State Zip
Deed Book No.
Page No.
Provide a copy of the most current deed.
Landowner 4 of Record:
Name
Phone: Office # Mobile #
Current Mailing Address
Current Street Address
City State Zip
City State
Zip
Deed Book No.
Page No.
Provide a copy of the most current deed.
Landowner 5 of Record:
Phone: Office # Mobile #
Name
Current Street Address
Current Mailing Address
City State Zip
City State
Zip
Deed Book No.
Page No.
Provide a copy of the most current deed.

Continued from Item 1 in Part B of the Financial Responsibility/Ownership Form for multiple parties.
Attach copies of this page as needed to list all financially responsible parties.
Company 2 Name E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Phone: Office # Mobile #
Company 3 Name
Current Mailing Address
City
Phone: Office #
Company 4 Name
E-mail Address
Current Street Address
State Zip City State
Mobile #
E-mail Address
Zip
Current Mailing Address Current Street Address
City State Zip City State Zip
Phone: Office # Mobile #
Company 5 Name E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Phone: Office # Mobile #