NCC224132_FRO Submitted_20230105

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 The Sentinels — Lots 14, 15, 20, 36 and 48
2. Location of land -disturbing activity: County Cumberland City or Township Grays Creek Township
Highway/Street Mountain Run Dr Latitude(decimal degrees) 34.904952 Longitude(dec;mai degrees)-78.8642
3. Approximate date land -disturbing activity will commence: April 06, 2022
4. Purpose of development (residential, commercial, industrial, institutional, etc.): residential
5. Total acreage disturbed or uncovered (including off -site borrow and waste areas): 1.92 acres
6. Amount of fee enclosed: $ 200.00 . 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 of Enclosed Ll No Ll
8. Person to contact should erosion and sediment control issues arise during land -disturbing activity:
Name Chris Roberts E-mail Address marketplacebuilders(a)gmail.com
Phone: Office# 910-987-2900 Mobile # [phone]
9. Landowner(s) of Record (attach accompanied page to list additional owners):
Marketplace Builders, LLC
Name
3102 North Main St
Current Mailing Address
Hope Mills NC 28348
City State Zip
910-987-2900 910-987-2900
Phone: Office # Mobile #
3102 north Main St
Current Street Address
Fayetteville NC 28348
City State Zip
10. Deed Book No. 11420 Page No. 774 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).
Marketplace Builders. LLC marketplacebuilders(cD-gmail.com
Company Name E-mail Address
3102 North Main St 3102 North Main St
Current Mailing Address Current Street Address
Hope Mills NC 28348 Fayetteville NC 28348
City State Zip City State Zip
Phone: Office # 910-987-2900 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
Mobile #
Name of Individual to Contact (if Registered Agent is a company)
State Zip
(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)

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:
Skyward Developers, LLC 910-483-9715 910-483-9715
Name Phone: Office # Mobile #
581 Executive Place Suite 700 581 Executive Place Suite 700
Current Mailing Address Current Street Address
Fayetteville NC 28305 Fayetteville NC 28305
City State Zip City State Zip
Deed Book No. 10154 Page No. 716 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
Deed Book No. Page No.
Landowner 4 of Record:
Name
Current Mailing Address
City
State Zip
Provide a copy of the most current deed.
Phone: Office #
Current Street Address
Mobile #
City State Zip City State Zip
Deed Book No. Page No. Provide a copy of the most current deed.
Landowner 5 of Record:
Current Mailing Address
Phone: Office #
Current Street Address
Mobile #
City State Zip City State Zip
Deed Book No. Page No. Provide a copy of the most current deed.

(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.
Chris Roberts Owner/Manager
Type or print nam Title or Authority
S' nature Date
I, "VeJ SlmPSC»,S r� , a Notary Public of the County of C U YYL►30KL-'h7 J40
State of North Carolina, hereby certify that �iLf2/S 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 -2-37-1"day of %nC/-! , 20 -.2— ---�Z-
pNotary Public Notary
Lori �7
Cumber�n �CunEp Er My commission expires
North Carolina