NCC223549_FRO Submitted_20221103

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 address or phone
number is unavailable, place N/A in the blank.)
Part A.
1. Project Name LEGACY GOLF LINKS DAM #3 -REHABILITATION PLANS
2. Location of land -disturbing activity: County MOORE City or Township ABERDEEN
Highway/Street "- US-15 Latitude(decimal degrees) 35.0905 Longitude(decimai degrees)-79.4167
3. Approximate date land -disturbing activity will commence: October 2022
4. Purpose of development (residential, commercial, industrial, institutional, etc.): Dam Repair
5. Total acreage disturbed or uncovered (including off -site borrow and waste areas): 19 acres
6. Amount of fee enclosed: $ 1,900.00 . 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 0 No ❑
8. Person to contact should erosion and sediment control issues arise during land -disturbing activity:
Name BRIAN ARMSTRONG E-mail [e-mail]
Phone: Office # 910-864-3232 Mobile # [phone]
9. Landowner(s) of Record (attach accompanied page to list additional owners):
ARMSTONG TIMBER MANAGEMENT, LLC 910-864-3232 910-303-6353
Name Phone: Office # Mobile #
2709 THORNGROVE COURT SUITE 2 2709 THORNGROVE COURT SUITE 2
10.
Current Mailing Address
FAYETTEVILLE NC
City
State
28303
Zip
Deed Book No. 5118 Page No.
Current Street Address
FAYETTEVILLE NC
City
416
State
28303
Zip
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 name(s) of the owner(s) may be listed as the financially responsible party(ies).
LEGACY LAKES HOLDINGS, LLC
Company Name
2709 THORNGROVE COURT SUITE 2
Current Mailing Address
FAYETTEVILLE NC 28303
[e-mail]
E-mail Address
2709 THORNGROVE COURT SUITE 2
Current Street Address
FAYETTEVILLE NC 28303
City State Zip City State
Phone: Office # 910-864-3232 Mobile # [phone]
Zip
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:
N/A
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)
(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.
BRIAN ARMSTRONG, I
Type or 'nt name Title or Auth ity
2ignatu a Date
I, Er-n a Notary Public of the County of 14,
State of North Carolina, hereby certify that°➢ ��, appeared personally
before me this day and being duly sworn acknowledg— edit at the above forM was executed by him/her.
Witness my hand and notarial seal, this J"day of
`°0a`1ea�ao�nrno�,r
D O (1
r
�pTA/��'
�0
°ireUulu lN�s��`
Notary
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:
Legacy Golf Links Limited Ptns
Name
850 Indian Mound RD SE
Current Mailing Address
Cartersville GA
City State
3168
Deed Book No.
Landowner 3 of Record:
910-944-8825
Phone: Office # Mobile #
850 Indian Mound RD SE
Current Street Address
30120 Cartersville GA 30120
Zip City State Zip
Page No. 243 Provide a copy of the most current deed.
Huff Ronald S & Huff Charlotte
910-281-4576
Name
Phone: Office # Mobile #
457 Huff Ln
457 Huff Ln
Current Mailing Address
Current Street Address
Aberdeen NC
28315
Aberdeen NC 28315
City State
Zip
City State Zip
Deed Book No. 381
Page No.
365 Provide a copy of the most current deed.
Landowner 4 of Record:
Rotundo Arthur E & Keaton Gale T
910-554-7652
Name
Phone: Office # Mobile #
437 Solitaire Farm Rd
437 Solitaire Farm Rd
Current Mailing Address
Current Street Address
Aberdeen NC
28315
Aberdeen NC 28315
City State
Zip
City State Zip
Deed Book No. 472
Page No.
916 Provide a copy of the most current deed.
490
712
Landowner 5 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.

Continued from Item 1 in Part 8 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
Phone: Office # Mobile #
Company 3 Name E-mail Address
Current Mailing Address Current Street Address
City State Zip City State
Phone: Office # Mobile #
Company 4 Name E-mail Address
Current Mailing Address Current Street Address
City State Zip City
Phone: Office # Mobile #
Company 5 Name E-mail Address
Current Mailing Address Current Street Address
City State Zip City
Phone: Office # Mobile #
Zip
Zip
State Zip
State Zip

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.)
❑ ❑ ❑
9. Landowner(s) of Record (attach accompanied page to list additional owners):
LEGACY GOLF LINKS LIMITED PINS 910-944-8825
Name Phone: Office # Mobile #
850 INDIAN MOUND RD SE 850 INDIAN MOUND RD SE
Current Mailing Address
CARTERSVILLE GA
City State
10. Deed Book No. 31 68
Current Street Address
30120 CARTERSVILLE GA
Zip City State
243
30120
Zip
Page No. Provide a copy of the most current deed.