NCC230055_FRO Submitted_20230109

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 H I BS Wolfspeed _
2. Location of land -disturbing activity: CountyChatham _ City or Township slier City ETJ (Unincorporated)
U S 64 W 35.74239-79.53566
Highway/Street Latltude(decimal degrees)Longltude(decimal degrees)
3. Approximate date land -disturbing activity will commence:. January 2023
4. Purpose of development (residential, commercial, industrial, institutional, etc.): Industrial
5. Total acreage disturbed or uncovered (including off -site borrow and waste areas): 236.E 6
6. Amount of fee enclosed: $1 1 800 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 ❑
L"
Person to contact should erosion and sediment control issues arise during land -disturbing activity:
Name Wes Feinman E-mail [e-mail]
Phone: Office # 919-256-6460 Mobile # [phone]
Landowner(s) of Record (attach accompanied page to list additional owners):
TIMS FARM & FORESTRY LLC 336-362-2026
Name
7157 BOBBY JEAN RD
Current Mailing Address
JULIAN NC 27283
Phone: Office #
OFF US 64 W
Current Street Address
CHATHAM CO.
City State Zip City
10. Deed Book No. 1 547 Page No. 0865
336-362-2026
Mobile #
NC
State
27344
Zip
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).
The Whiting -Turner Contracting Company Sean. [e-mail]
Company Name
8529 Six Forks Road Forum IV, Suite 150
Current Mailing Address
Raleigh North Carolina 27615
E-mail Address
8529 Six Forks Road Forum IV. Suite 150
Current Street Address
Raleigh North Carolina 27615
City State Zip City State Zip
Phone: Office # 919-256-6471 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
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)

(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.
WEBS VIE IhJ YK A �
Type or print
Sin ure
------------------------------- ----------------------------
. TL. P 12U:fGGT Y A&h,6,wz
Title or Authority
1 4 - h 2vZZ
Date
I, _ f-h' ,ems Vi'l lCm CY-6— _ _, a Notary Public of the County of a,iV A --
State of North Carolina, hereby certify that �'eS-e� aw 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 Iy
Arlene Vlllanova
' ')(NOTARY PUBLIC
Wake County, NC
My Commisslon Expires December 06, 2026
My commission expires

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:
TIMS FARM &FORESTRY LLC
Name
7157 BOBBY JEAN RD
Current Mailing Address
JULIAN NC
City State
Deed Book No. 1729
336-362-2026
Phone: Office #
OFF US 64 W
336-362-2026
Current Street Address
27283 CHATHAM CO. NC 27344
Zip City State Zip
1027 Parcel ID: 72513
Page No. Provide a copy of the most current deed.
Landowner 3 of Record:
TIMS FARM &FORESTRY LLC
Name
7157 BOBBY JEAN RD
Current Mailing Address
JULIAN NC
City State
Deed Book No. 1659
27283
336-362-2026
336-362-2026
Phone: Office # Mobile #
OFF US 64 W
Current Street Address
CHATHAM CO. NC 27344
Zip City
Page No. 0443
Landowner 4 of Record:
TIMS FARM &FORESTRY LLC
Name
7157 BOBBY JEAN RD
Current Mailing Address
JULIAN NC
City State
Deed Book No. 1729
27283
�Iv
Parcel ID: 61119
Provide a copy of the most current deed.
336-362-2026
Phone: Office #
OFF US 64 W
Current Street Address
CHATHAM CO. NC
Zip City
Page No.1027
Landowner 5 of Record:
TIMS FARM &FORESTRY LLC
Name
7157 BOBBY JEAN RD
Current Mailing Address
JULIAN NC
City State
Deed Book No. 1664
336-362-2026
Mobile #
27344
State Zip
Parcel ID: 12580
Provide a copy of the most current deed.
336-362-2026 336-362-2026
Phone: Office # Mobile #
OFF BENJIE WILLIAMS RD
Current Street Address
27283 CHATHAM CO. NC 27344
Zip City State Zip
0515 Parcel ID: 12547
Page No. Provide a copy of the most current deed.

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 6 of Record:
TIMS FARM &FORESTRY LLC
Name
Current Mailing Address
City State
Deed Book No. 1 729
336-362-2026 336-362-2026
Phone: Office # Mobile #
OFF US 64 W
Current Street Address
JULIAN NC 27283
zip City
Page No. 1 027
Landowner 7 of Record:
TIMS FARM &FORESTRY LLC
Name
7157 BOBBY JEAN RD
Current Mailing Address
CHATHAM CO. NC
City State
Deed Book No. 1 704
State Zip
Parcel ID: 82157
Provide a copy of the most current deed.
336-362-2026
Phone: Office #
Current Street Address
27344
Zip City
Page No. 0053
Landowner8 of Record:
G5 Investments LLC
Name
4716 Hilltop Road
336-362-2026
Mobile #
State Zip
Parcel ID: 76879
Provide a copy of the most current deed.
336-382-5200
Phone: Office #
20416 US 64 W
Mobile #
Current Mailing Address Current Street Address
Greensboro NC 27407 Siler City NC 27344
City State Zip City State Zip
Deed Book No. 638 0720 Parcel ID: 63971
Page No. , Provide a copy of the most current deed.
Landowner 9 of Record.
G5 Investments LLC 336-382-5200
Name Phone: Office # Mobile #
4716 Hilltop Road 20266 US 64 W
Current Mailing Address
Greensboro NC
City State
Deed Book No. 1 043
VUII V1 IL JII VOL r%UUI GJJ
27407 Siler City NC 27344
Zip City State Zip
0721 Parcel ID: 78171
Page No. Provide a copy of the most current deed.

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:
G5 Investments LLC 336-382-5200
Name
4716 Hilltop Road
Current Mailing Address
Greensboro NC
City State
Deed Book No. 1713
Landowner 3 of Record
Name
Current Mailing Address
City
Deed Book No.
Landowner 4 of Record:
Name
Current Mailing Address
City
Deed Book No.
Landowner 5 of Record:
Name
Phone: Office # Mobile #
558 Benjie Williams Rd_
Current Street Address
27407 Staley NC 27355
Zip City State Zip
0161 Parcel ID: 12553
Page No. Provide a copy of the most current deed.
Phone: Office #
Current Street Address
State Zip City
Page No.
Mobile #
State Zip
Provide a copy of the most current deed.
Phone: Office #
Current Street Address
State Zip City
Page No.
Mobile #
State Zip
Provide a copy of the most current deed.
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.