NCC223253_FRO Submitted_20220920

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 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 and/
or fax information unavailable, place N/A in the blank.)
Part A. Caliber Collision Morrisville
1. Project Name
2. Location of land -disturbing activity: County Wake City or Township Morrisville
Highway/Street Airtech Drive Latitude 35050'24"N Longitude 78049'48"W
3. Approximate date land -disturbing activity will commence: 9/21 /2022
4. Purpose of development (residential, commercial, industrial, institutional, etc.): Commercial
5. Total acreage disturbed or uncovered (including off -site borrow and waste areas): 2.20
6. Amount of fee enclosed: $143.00 . The application fee of $65.00 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 X No Enclosed
8. Person to contact should erosion and sediment control issues arise during land -disturbing activity:
Name Alex Horner, PE E-mail Address [e-mail]
Telephone [phone] Cell # 828-989-2672 Fax #
9. Landowner(s) of Record (attach accompanied page to list additional owners):
Eminent Properties, LLC
Name Telephone Fax Number
400 Pinner Weald Way Suite 201 400 Pinner Weald Way Suite 201
Current Mailing Address Current Street Address
Cary, NC 27513-2794 Cary, NC 27513-2794
City State Zip City State Zip
10. Deed Book No.164663 Page No. 20 Provide a copy of the most current deed.
Part B.
1. Company(ies) or firm(s) who are financially responsible for the land -disturbing activity (Provide a
comprehensive list of all responsible parties on an attached sheet.) If the company or firm is a sole proprietorship,
the name of the owner or manager may be listed as the financially responsible party.
McNeel Properties, LLC [e-mail]
Name
160 Mike Lake Ct. Suite 200
Current Mailing Address
Raleigh NC 27615-6417
City State Zip
Telephone [phone]
E-mail Address
160 Mike Lake Ct. Suite 200
Current Street Address
Raleigh NC 27615-6417
City State Zip
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
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
Current Mailing Address
City
Telephone
E-mail Address
Current Street Address
State Zip City
Fax Number
State Zip
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.
Walter M. Keenan Jr. Owner
Title or Authority
a Notary Public of the County of
State of Ne#h Carolina, hereby certify that 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 dayof S� n z�,�'� t' , 20 ) 72
I 1 �
RACHAEL L. DAVIS Nota \
Notary Public
State of SARg6rolina
My Commission Expires Dec 7, 2030 My commission expires��