HomeMy WebLinkAboutNCC224193_Site Plan or Location Map_20221228FINANCIAL RESPONSIBILITYIOWNERSHIP 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 Panther's Landing
2. Location of land -disturbing activity: CountyCUrrltUck City or Township Moyock
Pun o Circle 36.5150-76.2420
HighwaylStreet `� Latlfude(decimaldegrees) Long ltilde(decimafdegrees)
3. Approximate date land -disturbing activity will commence: 12/22/22
4. Purpose of development (residential, commercial, industrial, institutional, etc.): Residential
5. Total acreage disturbed or uncovered (including off -site borrow and waste areas): 0.69
6. Amount of fee enclosed: $ 100 . 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 ❑
8. Person to contact should erosion and sediment control issues arise during land -disturbing activity:
NameAdam Beck E-mail Addressabeck@nyrinc.COm
Phone: Office # 757-905-5280 Mobile it 804-304-5938
9. Landowner(s) of Record (attach accompanied page to list additional owners):
QHOC of Panther's Landing LLC 252-585-5857
Name Phone: Office # Mobile #
417 Caratoke Hwy Unit D 417 Caratoke Hwy Unit D
Current Mailing Address
Moyock NC 27958
Current Street Address
Moyock NC 27958
City State Zip City State Zip
10. Deed Book No. R Page No. 304-307 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 owners) may be listed as the financially responsible parfy(ies).
NVR Inc, dba Ryan Homes
Company Name
4525 South Blvd Suite 100
Current Mailing Address
Virginia Beach VA 23452
City State Zip
Phone: Office # 757--905-5280
abeck@nvrinc.com
E-mail Address
4525 South Blvd Suite 100
Current Street Address
Virginia Beach VA 23452
City State Zip
Mobile # 757-905-5281
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:
Corporation Service Company
Name of Registered Agent
2626 Glenwood Ave, Suite 550
Current Mailing Address
Raleigh NC 27608
City State Zip
Phone: Office # 800-927-9800
E-mail Address
2626 Glenwood Ave, Suite 550
Current Street Address
Raleigh NC 27608
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:
Corporation Service Company
Name of Registered Agent
2626 Glenwood Ave, Suite 550
Current Mailing Address
Raleigh NC 27608
City State Zip
Phone: office # 800-927-9800
E-mail Address
2626 Glenwood Ave, Suite 550
Current Street Address
Raleigh NC 27608
City
Mobile #
Name of Individual to Contact (if Registered Agent is a company)
State Zip
(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 Dame.
Ryan Homes
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.
Greg K
Type or pry
Signature
Vice President
Title or Authority
1118122
Date
I, a Notary Public of the (5:�4 of \1' kgAl Egau.v,
her by certify that o appeared personaily
before me this day and being duly sworn acknowled4ed that the above form was executed by him/her.
Witness my hand and notarial seal, this �64", day of tJaAm Uge 20 _
Ashley Mason Notary
Commogw� ith of Virginia
NOTARY PBLIC 7905021 My commission expires 1
My Commission Fxplroo 031/202-