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HomeMy WebLinkAboutNCC222297_FRO Submitted_20220701FINANCIAL 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 address or phone number is unavailable, place N/A in the blank.) Part A. 1. Project Name Brookwood S/D Phase 2 ( Lots # 42,47,49,51,52,and Lot #42 OS1 ( septic lot) Z Location of land -disturbing activity: County Moore pC City or Township McNeil TWSp. Highway/StreetEnfield Drive Latitude(decimaldegrees) 35.291 Longitude(decimal degrees) -79.410 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): 3.93 6. Amount of fee enclosed: $ 400.00 . 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 ❑x No ❑ 8. Person to contact should erosion and sediment control issues arise during land -disturbing activity: Pamela Geddie E-mail Address Pam@cavinessandcates.com Phone: Office # 910-778-7902 Mobile # 910-709-9801 9. Landowner(s) of Record (attach accompanied page to list additional owners): caginess & Cates sanding and Development company 910-778-7902 910-709-9801 Name Phone: Office # Mobile # 639 Executive Place, Suite 400 Same Current Mailing Address Current Street Address Fayetteville N.C. 28305 Same City State Zip City State Zip 10. Deed Book No. 5809,5849 Page No. 54-57,91-94 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 or if the landowner(s) is an individual(s), the names) of the owner(s) may be listed as the financially responsible patty(ies). Caviness & Cates Building and Development Company Company Name 639 Executive Place, Suite 400 Current Mailing Address Fayetteville N.C. 28305 City State Zip Phone: Office # 910-778-7902 Pam@cavinessandcates.com E-mail Address Same Current Street Address Same City State Zip Mobile # 910-709-9801 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 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: Name of Registered Agent Current Mailing Address City State Phone: Office # E-mail Address Current Street Address City State Zip Mobile # 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 Current Mailing Address City State Zip Phone: Office # E-mail Address Current Street Address City State Zip Mobile # Name of Individual to Contact (if Registered Agent is a company) (c) If the Financially Responsible Party 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. Christopher E. Cates Type or print name Si atun Pamela M Geddie Vice President Title or Authority lact i a-� Date Notary Public of the County of Cumberland State of North Carolina, hereby certify that Christopher E. Cates appeared before me this day and being duly sworn acknowledged that the above form was executed by him/her. . Witness my hand and notarial seal, Notary public =MY Coberlono County 1, Expire, rnMission ;PXP11 /"" /),CARtG�\ My commission expires 5/22/26