HomeMy WebLinkAboutNCC224011_FRO Submitted_20221202FINANCIAL 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 Harding Solar, L�L-+C
2. Location of land -disturbing activity: Countyyreene City or Township Hookerton
Franklin Jones Rd 35.388706°-77.602940'
Highway/Street Latltude(decimal degrees) LOngltude(decimal degrees)
3. Approximate date land -disturbing activity will commence:06/30/22
4. Purpose of development (residential, commercial, industrial, institutional, etc.): • Industrial
5. Total acreage disturbed or uncovered (including off -site borrow and waste areas):28.83
6. Amount of fee enclosed: $25900 . 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.
Has an erosion and sediment control plan been filed? Yes ❑ Enclosed ❑x No ❑
Person to contact should erosion and sediment control issues arise during land -disturbing activity:
Name Ryan Brick E-mail Addressrbrlck@neleng.corn
Phone: Office # 303-468-3055 Mobile # 303-431-7895
Landowner(s) of Record (attach accompanied page to list additional owners):
James Harold Jones
Name Phone: Office # Mobile #
2615 Brookwood Rd
Current Mailing Address Current Street Address
Kinston, NC, 28504
City State Zip City State Zip
10. Deed Book No. 427 Page No. 592 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).
National Renewable Energy Corporation mark.caddelI@narenco.com
Company Name E-mail Address
801 Wood Ridge Center Dr. Suite A 801 Wood Ridge Center Dr. Suite A
Current Mailing Address
Charlotte, NC 28217
Current Street Address
Charlotte, NC 28217
City State Zip City State Zip
Phone: office # 704-200-2914 Mobile #
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:
R. Andrew Cox hard ingsolarllc@gmail.com
Name of Registered Agent E-mail Address
801 Wood Ridge Center Dr. Suite A 801 Wood Ridge Center Dr. Suite A
Current Mailing Address Current Street Address
Charlotte, NC 28217 Charlotte, NC 28217
City State Zip City State Zip
Phone: Office # 704-200-2915 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.
Mark Caddell
Type o print r3ame
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Signature
I Sanja C. Ryan
Executive Vice President - EPC
Title or Authority
6/27/22
Date
a Notary Public of the County of
Mecklenburg
State of North Carolina, hereby certifythat Mark Caddell appeared personally
before me this day and being duly sworn acknowledged that the above form was executed by him/her.
Witness my hand and notarial seal, this 27
\\\\\\\ P l I C.
C-1 Seal
Notary Public
Mecklenburg
County
My Comm. Exp.
Z 10-21-2023 Q-
9
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day of J u ne 2022
Notary
My commission expires l b -021 -2U23
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:
Thomas Arthur Sugg
252-205-1421
Name
Phone: Office # Mobile #
5100 Hwy 58 S
Current Mailing Address
Current Street Address
Snow Hill, NC 28580
City State
Zip City State Zip
Deed Book No. 728
Page No. 653 Provide a copy of the most current deed
Landowner 3 of Record:
Francis H. Shackelford, Jr. 252-717-8746
Name
Phone: Office # Mobile #
PO Box 207
Current Mailing Address
Current Street Address
Hookerton, NC 28539
City State
Zip City State Zip
Deed Book No. 581
Page No. 727 Provide a copy of the most current deed
Landowner 4 of Record:
Lou Ann Shackelford
252-717-8746
Name
Phone: Office # Mobile #
PO Box 207
Current Mailing Address
Current Street Address
Hookerton, NC 28539
City State
Zip City State Zip
Deed Book No. 581 Page No. 727 Provide a copy of the most current deed
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.
TBD
Company 2 Name
E-mail Address
Current Mailing Address
Current Street Address
City State
Zip
City
State
Zip
Phone: Office #
Mobile #
TBD
Company 3 Name
E-mail Address
Current Mailing Address
Current Street Address
City State
Zip
City
State
Zip
Phone: Office #
Mobile #
TBD
Company 4 Name
E-mail Address
Current Mailing Address
Current Street Address
City State
Zip
City
State
Zip
Phone: Office #
Mobile #
TBD
Company 5 Name
E-mail Address
Current Mailing Address
Current Street Address
City State
Zip
City
State
Zip
Phone: Office #
Mobile #