HomeMy WebLinkAboutNCC223937_FRO Submitted_20221201FINANCIAL 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 SETTLERS POINTE (47) LOT EROSION CONTROL SUBMITTAL
2. Location of land -disturbing activity: County WAYNE Cityor Township PIKEVILLE
SETTLERS POINTE DRIVE 35.479874-77.870395
Highway/Street Latltude(dedmal degrees) Longitude(aedmai degrees)
3. Approximate date land -disturbing activity will commence: SUMMER 2023
4. Purpose of development (residential, commercial, industrial, institutional, etc.): RESIDENTIAL
5. Total acreage disturbed or uncovered (Including off -site borrow and waste areas). 25 AC.
6. Amount of fee enclosed: $ 2,500.00 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 Raymond Rinker E-mail Address raymond.rinker@ashtonwoods.com
Phone: Office # Mobile # 919.229.3238
9. Landowner(s) of Record (attach accompanied page to list additional owners):
Zebulon Mini -Storage Group, LLC 919.437.0290
Name
701 Patetown Road
Current Mailing Address
Goldsboro, NC 27530
Phone: Office # Mobile #
701 Patetown Road
Current Street Address
Goldsboro, NC 27530
City State Zip City State Zip
10. Deed Book No. 3311 Page No. 559-561 Provide a copy of the most current deed.
Part B.
1, Company(les) 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(les),
Starlight Homes North Carolina LLC. raymond.rinker@ashtonwoods.com
Company Name E-mail Address
4025 Lake Boone Trail, ste 200 4025 Lake boone Trail, STE 200
Current Mailing Address
Raleigh, NC 27607
City State Zip
Phone: Office #
Current Street Address
Raleigh, NC 27607
City State Zip
Mobile # 919.229.3238
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:
Starlight Homes North Carolina LLC
Name of Registered Agent
4025 Lake Boone Trail, ste 200
Current Mailing Address
Raleigh, NC 27607
City State Zip
Phone: Office #
Raymond Rinker
raymond.rinker@ashtonwoods.com
E-mail Address
4025 Lake Boone Trail, STE 200
Current Street Address
Raleigh, NC 27607
City State Zip
Mobile # 919.229.3238
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.
N/A
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.
Raymond Rinker VP of Land Development
Type or print nam Title or Authority
11 /1 /22
Sign r Date
,, Mary Herold
a Notary Public of the County of Wake
State of North Carolina, hereby certify that Raymond Rinker appeared personally
before me this day and being duly sworn acknowledged that the above form was executed by him/her.
i hand and notarial seal, this
MARY HILL HEROLD
NOTARY PUBLIC
WAKE COUNTY, N.C.
My Cop
,Mlpsion Expires 9.24-2026.
day of NoAmber , 2022
Notary--,/- 1 \ I
My commission expires