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HomeMy WebLinkAboutNCC230333_FRO Submitted_20230207FINANCIAL 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 Environment and Natural Resources. (Please type or print and, if the question is not applicable or the e-mail and/or fax information unavailable, place N/A in the blank.) Part A. 1. Project Name Edinborough Phase 1 & 2 2. Location of land -disturbing activity: County Guilford City or Township Rock Creek Highway/Street Highway 61 Latitude 36.12019692 Longitude-79.55264568 3. Approximate date land -disturbing activity will commence: August 1, 2021 4. Purpose of development (residential, commercial, industrial, institutional, etc.): 61 lots 5. Total acreage disturbed or uncovered (including off -site borrow and waste areas): 32.45 Acres 33 AC. - 25 AC. (Previously Paid) = 8 acres 6. Amount of fee enclosed: $ 520.00 . The application fee of $65.00 per acre (rounded up to the next acre) is assessed without a ceiling amount (Example: a 9-acre application fee is $585). 7. Has an erosion and sediment' control plan been filed? Yes No Enclosed X 8. Person to contact should erosion and sediment control issues arise during land -disturbing activity: Name Chad Hill E-mail Address chill@byrondev.com Telephone 336-282-4127 Cell # 336-508-5765 Fax # 9. Landowner(s) of Record (attach accompanied page to list additional owners): Edinborough 7, LLC 336-282-4127 Name Telephone Fax Number 7B Corporate Center Court 7B Corporate Center Court Current Mailing Address Current Street Address Greensboro N.C. 27408 Greensboro N.C. 27408 City State Zip City State Zip 10. Deed Book No. 8381 Page No. 2712 Provide a copy of the most current deed. Part B. 1. Person(s) or firm(s) who are financially responsible for the land -disturbing activity (Provide a comprehensive list of all responsible parties on an attached sheet): Edinborough 7, LLC Name E-mail Address 7B Corporate Center Court 7B Corporate Center Court Current Mailing Address Current Street Address Greensboro N.C. 27408 Greensboro N•C• 27408 City State Zip City State Zip Telephone 336-282-4127 Fax Number 2. (a) If the Financially Responsible Party is not a resident of North Carolina, give name and street address of the designated North Carolina Agent: Name E-mail Address Current Mailing Address Current Street Address City State Zip City Telephone Fax Number (b) If the Financially Responsible Party is a Partnership or other person engaging in business under an assumed name, attach a copy of the Certificate of Assumed Name. If the Financially Responsible Party is a Corporation, give name and street address of the Registered Agent: Name of Registered Agent E-mail Address Current Mailing Address Current Street Address City State Zip City Telephone Fax Number State Zip State Zip 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 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 Person). I agree to provide corrected information should there be any change in the information provided herein. Type or pri Sig ��'►"i� � j�ovl�� !l� COD Title or Authority / Date I, MaS�; L �jg a Notary Public of the County of -Oo'S ,A � State of North Carolina, hereby certify that j�o�-'�^- .I �rC1>�1�.t appeared personally before me this day and being duly sworn acknowledged that the above form was executed by him. Witness my hand and notarial seal, this ` b day of 20 Maggle Pegg NOTARY PUBPO Fors h Cou*.NO Notary My Com Expires Qctpber 04, 2025 My commission expires��