NCC223256_FRO Submitted_20220916

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 !Wand
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 Name Harbor Crossing Townhouse Development (Lots 1 -85)
2. Location of land -disturbing activity: County Greensboro City or Township Guilford
Air Harbor Road 36.16602491-79.81390357
Highway/Street Latitude(declmal degrees)___ _ Long ltude(declmal degrees)
3. Approximate date land -disturbing activity will commence: 0512022
4. Purpose of development (residential, commercial, industrial, institutional, etc.): Residential
5. Total acreage disturbed or uncovered (including off -site borrow and waste areas): 7.30
6. Amount of fee enclosed: $ 800.00 . 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 ® No ❑
8. Person to contact should erosion and sediment control issues arise during land -disturbing activity:
Name Eastwood Construction Partners, LLC E-mail Address [e-mail]
Phone: office # 336-587-9490 Mobile #
9. Landowner(s) of Record (attach accompanied page to list additional owners):
Air Harbor 7, LLC 336-369-2188
Name Phone: Office # Mobile #
7 Corporate Center Ct, Ste B
Current Malling Address Current Street Address
Greensboro, NC .27408-3839
City State Zip City State Zip
6336 10. Deed Book No. Page No. 29 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 orif the landowner(s) is
an individual(s), the name(s) of the owner(s) may be listed as the financially responsible party(ies).
Eastwood Construction Partners, LLC
Company Name
Suite 120
Current Mailing Address
High Point, North Carolina 27265
[e-mail]
E-mail Address
Current Street Address
City State Zip City State Zip
Phone: Office # 336-587-9490 Mobile #
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:
Eastwood Construction Partners, LLC
Name of Registered Agent
3`i6® PAem;er j,e-12p
Current Mailing Address
High Point, North Carolina 27265
City State Zip
Phone: Office # 336-587-9490
Jeff Creighton
[e-mail]
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 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 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.
Jeff Creighton
Type or.pri e
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m
Signatura-
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Vice President of Homebuilding
Title or Authority
-/ �_ Zc-zZ
Date
I, U A.a Notary Public of the County of.
State of North Carolina, hereby certify that�� CYCi G bi L) appeared personally
before me this day and being duly sworn acknowledged thatthatgibe bove form was executed by him/her.
Witness my hand and notarial seal, this VDA-hdayofmcuA 20_
NOTARY PUBLIC Notary
L ISAi A, WALL
GUILFORD COUNIV NC My commission expires