NCC223439_FRO Submitted_20221007

co Pitt County
Planning Department
® Development Services Building
o �=�
1717 W. 5th Street
rcGreenville, NortTelephone: Carolina oolina 507834-1696 lames F. Rhodes, AICP
Fax: [phone] Director
Financial Responsibility / Ownership Form
Soil Erosion and Sedimentation Control Ordinance
No person may initiate any land -disturbing activity on one or more contiguous acres as
covered by the Act before this form and an acceptable erosion and sedimentation control plan
have been completed and approved by the Pitt County Planning Department. (Please type or
print and, if question is not applicable, place N/A in the blank.)
Part A.
1. Project Name October Glory Section 2
2. Location of land -disturbing activity: County Pitt
City or Township Grimesland , and Highway/Street NCSR 1755 and NCSR 1795
3. Approximate date land -disturbing activity will be commenced: 10/03/2022
4. Purpose of development (residential, commercial, industrial, etc.): Residential
5. Approximate acreage of land to be disturbed or uncovered: 9 Acres
6. Has an erosion and sedimentation control plan been filed? Yes X No
7. Person to contact should sedimentation control issues arise during land -disturbing activity:
Name Ken Malpass
Telephone [phone]
8. Landowner(s) of Record (Use blank page
to list additional owners):
Tucker Farms
Name(s)
Name(s)
2539 Seven Pines Road
Current mailing address
Street address
Greenville NC 27834
City State Zip
City State Zip
9. Recorded in Deed Book No. R52
Page No. 222
Part B.
1. Person(s) or firm(s) who are financially
responsible for this land -disturbing activity (Use
the blank page to list additional persons
or firms):
Tucker Farms
Name of person(s) or Firm(s)
Name(s)
2539 Seven Pines Road
Current mailing address .
Street Address
Greenville NC 27834
City State Zip
City State Zip
[phone]
Telephone
Telephone

2. (a) If the Financially Responsible Party is a Corporation, give name and street address of
the Registered Agent.
Ralph C. Tucker Jr.
Name(s)
2539 Seven Pines Road
Current mailing address Street Address
Greenville NC 27834
City State Zip City State Zip
[phone]
Telephone Telephone
(b) If the Financially Responsible Party is a Partnership give the name and street address
of each General Partner (Use blank page to list additional partners):
Name(s) Name(s)
Current mailing address Current mailing address
City State Zip City State Zip
Telephone Telephone
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/her attorney- in -fact or if not an individual by an officer, director, partner, or
registered agent with 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.
er Jr. Owner
QiVRalphC.
e-' - Title or Authority
Date V
I, i�cl��awt C. �WIHSJ' , allot ry Public of the County of �iState
of North Carolina, hereby certify that Rat C. 'Tc �a r —Jr,
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 thisTti day of u us� 20 �1.
Notary
�1v�,� z•bl My commission expires 01/17 a0rl
li Y•' `'
NOTARY
PUBLIC