NCC224007_FRO Submitted_20221202

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 BELLE OAKS - (49) LOT EROSION CONTROL SUBMITTAL
2. Location of land -disturbing activity: County CRAVEN City or Township NEW BERN
BELLE OAKS DRIVE 35.091937-77.111440
Highway/Street LatltUde(declmal degrees) LOngitude(decimal 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): 7.16 AC.
6. Amount of fee enclosed: $ 800 . 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 ❑x No ❑
Q
Person to contact should erosion and sediment control issues arise during land -disturbing activity:
Name Raymond Rinker E-mail Address [e-mail]
Phone: Office # 919.229.3238
Mobile # [phone]
Landowner(s) of Record (attach accompanied page to list additional owners):
jmik Hoffla �A 6( [1b
Name U Phone: Office #
4016 Lffvt 6w ul MG N
Current Mailing Address
W4 - W 21 W1
City I State Zip
Current Street Address
City
State
Mobile #
oil
10. Deed Book No. 310 7— Page No. 013 — 1011 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 companyis 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).
Starlight Homes North Carolina
Company Narpe
Suite 200
Current Mailing Address
Raleigh, NC _ . _ 7-
City State Zip
Phone: Office # 919.872.0048
[e-mail]
E-mail Address
Same
Current Street Address
City State Zip
Mobile # [phone]
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:
Name of Registered Agent
Current Mailing Address
City State
Phone: Office #
E-mail Address
Current Street Address
Zip 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.
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 _VZOL
Type or print name Title or Authority
Si re Date
Ia Notary Public of the County of
State of North Carolina, hereby certify that C _�I r appeared personally
before me this day and being duly sworn ackno dged that the above form was executed by him/her.
Witness my hand and notarial seal this 3 day of V, , 20
_QRRAINE IVETTE RIVERA
Notary Public
Wake County, North Carolina�kjod9amrl
My Commission Expires Notary
My commission expires_I�i

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:
84t; dad . L� 25Z-���-W��
Name Phone: Office # Mobile #
K Ult Yd
Cu ent Mailing Address Current Street Address
26 ell
City State zip City State Zip
Deed Book No. 3ul Page No. 5W -" 1D Provide a copy of the most current deed.
Landowner 3 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.
Landowner 4 of Record:
Phone: Office # Mobile #
Name
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.
Landowner 5 of Record:
Phone: Office # Mobile #
Name
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.

�y ► 5 92022
Re: Property described on the attached Exhibit A (the "Property")
To Whom It May Concern:
The undersigned,�Q- V w-%r. Aja1%s. , as Member/Manager of Belle Oaks II, LLC, which
is the landowner of record for the Property, hereby authorizes Starlight Homes North Carolina
L.L.C. to submit an erosion control and lot grading plan for the Property and to conduct the
anticipated land -disturbing activity.
BELLE OAKS II, LLC,
a North Carolina limited li.Wty company
Ja4,r, Ko"j:n PNo1i V
4ember/Manager
C,rO-v-e.r, County, Qa,­� V r,,o-
I certify that the following person personally appeared before me this day and
acknowledged to me that he or she voluntarily signed the foregoing document for the purpose
stated therein and in the capacity indicated:
Date: ► 5a
My Commission Expires:
ate{
[Affix Notary Stamp or Seal below]
BETH SIMMONS
NOTARY PUBLIC
CRAVEN COUNTY, NC
My Commission Expires 4.22-2024
Notary Public
Print Name: "a � May.
313409146.1

• f
CONROL CcAh:A ATA
4f.!Y r RWKIIUG
I I'I l! f! A -r-wPF316�58Y Y �ti?A+T9�
I ► III
It
II II It r f� Irr.�w
® ! r a
■a..�I_t,� _ wYr •.wed
a pdwwom
AN �. ;- u, Rt Yil
mse slla I .�....n I I / f i a IM®n _ y r \
WIiM ��•./: ,. •, wl w� k 1 r y� FAV L90M
SK14LM All*
*law IF
IV
OM APO A
SAD
` \ / ��p alpa•i 1 ;;i 1}j C.� Qa.l s'/. e / f�-� �
um C,
wliNww s
U / C!) I"0
^�© �j1a./f..�r !` �f�lJr lP 2n ;j! �.� \ \
Y I \T l•Jt Q �'fl aQ� I r�f 1 1 M+R
d 1.: i 4 <' �L�!Art a
ri 0LW
- 1 `f' -
1 11■dQ[ f o0 r� r — �l x
I 6 P f�IY _ r. O
I -1fi�tp'S 1 f i r �; a ufs11l YYf n amm
_ r 0. `
( 4_/ a' I i! O a
f
E 0", WAM V43
@ $ a. Iaa: •ar roV-l-lr'r
\� f � 11l HI,i 1'101� f yY1
Y.'*.l•G 1Y .C:." 1 ]) A F./6d 6Y e�'.;
-PRELRAINARa R,tiT- s+eer2c's.ovER1 90UNOARrPLAT
AVOLIS ENGINEERING. PA
1 f MUME1 u va.usY~•
401FIR w4t; IIV .051vYt, AYl;lrS AF. ?.5;{J;tl rjl�TYp.r
313409146.1