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Home My WebLink AboutNCC231291_FRO Submitted_20230503 FINANCIAL RESPONSIBILITY/OWNERSHIP FORM )US 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 HIGHLANDS - DOMINION HOMES 2. Location of land-disturbing activity: County Brunswick City or Township BSL Highway/Street Fifty Lakes Drive Latitude(dec�ma�degrees)34.0213 Longltude(decima�degrees)-78.0529 3. Approximate date land-disturbing activity will commence: March 1 , 2023 4. Purpose of development(residential, commercial, industrial, institutional, etc.): Residential 5. Total acreage disturbed or uncovered (including off-site borrow and waste areas): 15.75 6. Amount of fee enclosed: $ 1 ,600.00 . 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❑ Enclosed ❑x No ❑ 8. Person to contact should erosion and sediment control issues arise during land-disturbing activity: Name J. Phillip Norris, P.E. E-mail Address pnorris@ntengineers.com Phone: Office# 910-287-5900 Mobile# 910-471-9638 9. Landowner(s) of Record (attach accompanied page to list additional owners): BSL LAND HOLDINGS LLC 910-791-1196 Name Phone: Office# Mobile# P.O. Box 3167 2201 Burnett Blvd. Current Mailing Address Current Street Address Wilmington NC 28406 Wilmington NC 28401 City State Zip City State Zip 10. Deed Book No. SEE ATTACHED Page No. 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). Dominion Land Corporation sancohomes@sancohomes.com Company Name E-mail Address P.O. Box 3167 2201 Burnett Blvd. Current Mailing Address Current Street Address Wilmington NC 28406 Wilmington NC 28401 City State Zip City State Zip Phone: Office# 910-791-1196 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: Nathan S. Sanders sancohomes@sancohomes.com Name of Registered Agent E-mail Address P.O. Box 3167 2201 Burnett Blvd. Current Mailing Address Current Street Address Wilmington NC 28406 Wilmington NC 28401 City State Zip City State Zip Phone: Office# 910-791-1196 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. Nathan S. Sanders ?re 5;fie.,,`11-- Typ por print name Title or Authority Sit nature Date I, N`-„ \ e R r-- , a Notary Public of the County of �� J \-\,pr,cw e(— State of North Carolina, hereby certify that ‘Ar•,\\.cs\ er5 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 y day of rt , 'Dj %h .........W HEE , \ �.•��•, <F,A• otary NOTARY ▪ 1▪ .1 My commission expires me 1 l a6a- 3 • Z rCi A% PUBLIC :Z• 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: Tros Properties, Inc. Name Phone: Office# Mobile# 413 N. Shore Dr. 413 N. Shore Dr. Current Mailing Address Current Street Address Southport NC 28461-9570 Southport NC 28461-9570 City State Zip City State Zip Deed Book No. See Attached Page No. Provide a copy of the most current deed. Landowner 3 of Record: Jeff Heilman Name Phone: Office# Mobile# Current Mailing Address Current Street Address City State Zip City State Zip Deed Book No. 2593 Page No. 589 Provide a copy of the most current deed. Landowner 4 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. 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 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: Shiloh Holdings LLC 910-791-1196 Name Phone: Office# Mobile# P.O. Box 3167 2201 Burnett Blvd. Current Mailing Address Current Street Address Wilmington NC 28406 Wilmington NC 28401 City State Zip City State Zip Deed Book No.4019 Page No. 1380 Provide a copy of the most current deed. Landowner 3 of Record: Terrific Land Holdings, LLC 910-791-1196 Name Phone: Office# Mobile# P.O. Box 3167 2201 Burnett Blvd. Current Mailing Address Current Street Address Wilmington NC 28406 Wilmington NC 28401 City State Zip City State Zip Deed Book No.4019 Page No. 1383 Provide a copy of the most current deed. Landowner 4 of Record: Second Adam Holdings, LLC 910-791-1196 Name Phone: Office# Mobile# P.O. Box 3167 2201 Burnett Blvd. Current Mailing Address Current Street Address Wilmington NC 28406 Wilmington NC 28401 City State Zip City State Zip Deed Book No.4019 Page No. 1 31 8 Provide a copy of the most current deed. Landowner 5 of Record: Brotherly Land, LLC 910-791-1196 Name Phone: Office# Mobile# P.O. Box 3167 2201 Burnett Blvd. Current Mailing Address Current Street Address Wilmington NC 28406 Wilmington NC 28401 City State Zip City State Zip Deed Book No.4019 Page No. 1321 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: Canaan Holdings, LLC 910-791-1196 Name Phone: Office# Mobile# P.O. Box 3167 2201 Burnett Blvd. Current Mailing Address Current Street Address Wilmington NC 28406 Wilmington NC 28401 City State Zip City State Zip Deed Book No.4019 Page No. 1324 Provide a copy of the most current deed. Landowner 3 of Record: Delightsome Land Holdings, LLC 910-791-1196 Name Phone: Office# Mobile# P.O. Box 3167 2201 Burnett Blvd. Current Mailing Address Current Street Address Wilmington NC 28406 Wilmington NC 28401 City State Zip City State Zip Deed Book No.4019 Page No. 1327 Provide a copy of the most current deed. Landowner 4 of Record: Excellent Land, LLC 910-791-1196 Name Phone: Office# Mobile# P.O. Box 3167 2201 Burnett Blvd. Current Mailing Address Current Street Address Wilmington NC 28406 Wilmington NC 28401 City State Zip City State Zip Deed Book No.4019 Page No. 1330 Provide a copy of the most current deed. Landowner 5 of Record: Fruitful Land Holdings, LLC 910-791-1196 Name Phone: Office# Mobile# P.O. Box 3167 2201 Burnett Blvd. Current Mailing Address Current Street Address Wilmington NC 28406 Wilmington NC 28401 City State Zip City State Zip Deed Book No.4019 Page No. 1 333 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: Great Land, LLC 910-791-1196 Name Phone: Office# Mobile# P.O. Box 3167 2201 Burnett Blvd. Current Mailing Address Current Street Address Wilmington NC 28406 Wilmington NC 28401 City State Zip City State Zip Deed Book No.4019 Page No. 1336 Provide a copy of the most current deed. Landowner 3 of Record: Harvest Holdings, LLC 910-791-1196 Name Phone: Office# Mobile# P.O. Box 3167 2201 Burnett Blvd. Current Mailing Address Current Street Address Wilmington NC 28406 Wilmington NC 28401 City State Zip City State Zip Deed Book No.4019 Page No. 1339 Provide a copy of the most current deed. Landowner 4 of Record: Incredible Land, LLC 910-791-1196 Name Phone: Office# Mobile# P.O. Box 3167 2201 Burnett Blvd. Current Mailing Address Current Street Address Wilmington NC 28406 Wilmington NC 28401 City State Zip City State Zip Deed Book No.4019 Page No. 1342 Provide a copy of the most current deed. Landowner 5 of Record: Joyland Holdings, LLC 910-791-1196 Name Phone: Office# Mobile# P.O. Box 3167 2201 Burnett Blvd. Current Mailing Address Current Street Address Wilmington NC 28406 Wilmington NC 28401 City State Zip City State Zip Deed Book No.4019 Page No. 1 345 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: Kindness Holdings, LLC 910-791-1196 Name Phone: Office# Mobile# P.O. Box 3167 2201 Burnett Blvd. Current Mailing Address Current Street Address Wilmington NC 28406 Wilmington NC 28401 City State Zip City State Zip Deed Book No.4019 Page No. 1348 Provide a copy of the most current deed. Landowner 3 of Record: Loveland Holdings, LLC 910-791-1196 Name Phone: Office# Mobile# P.O. Box 3167 2201 Burnett Blvd. Current Mailing Address Current Street Address Wilmington NC 28406 Wilmington NC 28401 City State Zip City State Zip Deed Book No.4019 Page No. 1351 Provide a copy of the most current deed. Landowner 4 of Record: Meek Earth Holdings, LLC 910-791-1196 Name Phone: Office# Mobile# P.O. Box 3167 2201 Burnett Blvd. Current Mailing Address Current Street Address Wilmington NC 28406 Wilmington NC 28401 City State Zip City State Zip Deed Book No.4019 Page No. 1354 Provide a copy of the most current deed. Landowner 5 of Record: New Land Holdings, LLC 910-791-1196 Name Phone: Office# Mobile# P.O. Box 3167 2201 Burnett Blvd. Current Mailing Address Current Street Address Wilmington NC 28406 Wilmington NC 28401 City State Zip City State Zip Deed Book No.4019 Page No. 1357 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: Optimal Land, LLC 910-791-1196 Name Phone: Office# Mobile# P.O. Box 3167 2201 Burnett Blvd. Current Mailing Address Current Street Address Wilmington NC 28406 Wilmington NC 28401 City State Zip City State Zip Deed Book No.4019 Page No. 1341 Provide a copy of the most current deed. Landowner 3 of Record: Peace Land Holdings, LLC 910-791-1196 Name Phone: Office# Mobile# P.O. Box 3167 2201 Burnett Blvd. Current Mailing Address Current Street Address Wilmington NC 28406 Wilmington NC 28401 City State Zip City State Zip Deed Book No.4019 Page No. 1360 Provide a copy of the most current deed. Landowner 4 of Record: Quality Property Holdings, LLC 910-791-1196 Name Phone: Office# Mobile# P.O. Box 3167 2201 Burnett Blvd. Current Mailing Address Current Street Address Wilmington NC 28406 Wilmington NC 28401 City State Zip City State Zip Deed Book No.4019 Page No. 1374 Provide a copy of the most current deed. Landowner 5 of Record: Royal Land Holdings, LLC 910-791-1196 Name Phone: Office# Mobile# P.O. Box 3167 2201 Burnett Blvd. Current Mailing Address Current Street Address Wilmington NC 28406 Wilmington NC 28401 City State Zip City State Zip Deed Book No.4019 Page No. 1 377 Provide a copy of the most current deed. PLYMOUTH LOT# PARCEL OWNER Deed BK Deed PG 156 157PH00109 BSL LAND HOLDINGS LLC 4019 1297 157 157PH00110 BSL LAND HOLDINGS LLC 4019 1297 158 157PH00111 BSL LAND HOLDINGS LLC 4019 1297 159 157PH00112 BSL LAND HOLDINGS LLC 4019 1297 160 157PH00113 BSL LAND HOLDINGS LLC 4019 1297 161 157PH00114 BSL LAND HOLDINGS LLC 4019 1297 162 157PH00115 BSL LAND HOLDINGS LLC 4019 1297 163 157PH00116 BSL LAND HOLDINGS LLC 4019 1297 164 157PH00117 BSL LAND HOLDINGS LLC 4019 1297 165 157PH00118 BSL LAND HOLDINGS LLC 4019 1297 166 157PH00119 BSL LAND HOLDINGS LLC 4019 1297 167 157PH00103 BSL LAND HOLDINGS LLC 4019 1297 172 157OB001 BSL LAND HOLDINGS LLC 4019 1297 173 157OB00101 BSL LAND HOLDINGS LLC 4019 1297 174 157OB00102 BSL LAND HOLDINGS LLC 4019 1297 175 157OB00103 BSL LAND HOLDINGS LLC 4019 1297 176 157OB00104 BSL LAND HOLDINGS LLC 4019 1297 177 157OB00105 BSL LAND HOLDINGS LLC 4019 1297 178 157OB00106 BSL LAND HOLDINGS LLC 4019 1297 179 157OB00107 BSL LAND HOLDINGS LLC 4019 1297 180 157OB00108 BSL LAND HOLDINGS LLC 4019 1297 181 157OB00109 BSL LAND HOLDINGS LLC 4019 1297 182 157OB00110 BSL LAND HOLDINGS LLC 4019 1297 183 157OB00111 BSL LAND HOLDINGS LLC 4019 1297 PARKWAY LOT# Parcel OWNER DEED BK DEED PG 188 157O600115 BSL LAND HOLDINGS LLC 4019 1307 191 157O600116 BSL LAND HOLDINGS LLC 4019 1307 192 157OB00117 BSL LAND HOLDINGS LLC 4019 1307 193 157OB00118 BSL LAND HOLDINGS LLC 4019 1307 194 157OB00119 BSL LAND HOLDINGS LLC 4019 1307 195 157O600120 BSL LAND HOLDINGS LLC 4019 1307 196 157OB00121 BSL LAND HOLDINGS LLC 4019 1307 197 157OB00122 BSL LAND HOLDINGS LLC 4019 1307 198 157OB00123 BSL LAND HOLDINGS LLC 4019 1307 199 157O600124 BSL LAND HOLDINGS LLC 4019 1307 MORNINGSIDE LOT# PARCEL OWNER DEED BK DEED PG 220 1570000108 BSL LAND HOLDINGS LLC 4019 1307 221 1570000109 BSL LAND HOLDINGS LLC 4019 1307 222 1570000110 BSL LAND HOLDINGS LLC 4019 1307 223 1570000111 BSL LAND HOLDINGS LLC 4019 1307 228 15700011 BSL LAND HOLDINGS LLC 4934 586 230 15700003 BSL LAND HOLDINGS LLC 4053 472 FIFTY LAKES DRIVE LOT# Parcel OWNER DEED BK DEED PG 247 157OD002 BSL Land Holdings, LLC 4475 904 FOX SQUIRREL LOT# PARCEL OWNER DEED BK DEED PG 16 157PE00204 BSL LAND HOLDINGS LLC 4019 1307 17 157PE00208 BSL LAND HOLDINGS LLC 4019 1307 18 157PE003 BSL LAND HOLDINGS LLC 4115 324 19 157PE00301 BSL LAND HOLDINGS LLC 4115 324 20 157PE00203 BSL LAND HOLDINGS LLC 4019 1307 22 157PE00401 BSL LAND HOLDINGS LLC 4019 1307 25 157PE002 BSL LAND HOLDINGS LLC 4019 1307 26 157PE00210 BSL LAND HOLDINGS LLC 4019 1307 27 157PE00211 BSL LAND HOLDINGS LLC 4019 1307 31 1570A00104 BSL LAND HOLDINGS LLC 4019 1307 32 1570A001 BSL LAND HOLDINGS LLC 4019 1307 33 1570A005 BSL LAND HOLDINGS LLC 4219 65 34 1570A00103 BSL LAND HOLDINGS LLC 4019 1307 35 1570A00105 BSL LAND HOLDINGS LLC 4019 1307 36 1570A00106 BSL LAND HOLDINGS LLC 4019 1307 37 1570A00107 BSL LAND HOLDINGS LLC 4019 1307 38 1570A00108 BSL LAND HOLDINGS LLC 4019 1307 42 1570A002 BSL LAND HOLDINGS LLC 4019 1307 43 1570A00301 BSL LAND HOLDINGS LLC 4019 1307 1 122 157PG00203 BSL LAND HOLDINGS LLC 4133 80 PARKWAY LOT# Parcel OWNER DEED BK DEED PG 189 157OB003 TROS PROPERTIES INC. 2479 1119 190 157OB003 TROS PROPERTIES INC. 2479 1119 213 15700008 TROS PROPERTIES INC. 2292 513 MORNINGSIDE LOT# PARCEL OWNER DEED BK DEED PG 237 157OD004 HEILMAN JEFF &TROS PROPE 2593 589 239 157OD006 TROS PROPERTIES INC 2315 113 FOX SQUIRREL LOT# PARCEL OWNER DEED BK DEED PG 154 157PH00108 KINDNESS HOLDINGS LLC 4019 1348 184 157OB00112 LOVELAND HOLDINGS LLC 4019 1351 185 157OB00113 MEEK EARTH HOLDINGS LLC 4019 1354 187 157OB00114 NEW LAND HOLDINGS LLC 4019 1357 218 1570000106 OPTIMAL LAND LLC 4027 1341 219 1570000107 PEACE LAND HOLDINGS LLC 4019 1360 251 157OD011 QUALITY PROPERTY HOLDINGS LLC 4019 1374 252 157OD00102 ROYAL LAND HOLDINGS LLC 4019 1377 FOX SQUIRREL LOT# PARCEL OWNER DEED BK DEED PG 44 1570A00302 SHILOH HOLDINGS LLC 4019 1380 45 1570A003 TERRIFIC LAND HOLDINGS LLC 4019 1383 57 173AC001 SECOND ADAM HOLDINGS LLC 4019 1318 58 173AC00101 BROTHERLY LAND LLC 4019 1321 59 173AD00201 CANAAN HOLDINGS LLC 4019 1324 60 173AD002 DELIGHTSOME LAND HOLDINGS LI 4019 1327 88 157PF00101 EXCELLENT LAND LLC 4019 1330 89 157PF00102 FRUITFUL LAND HOLDINGS LLC 4019 1333 90 157PF00103 GREAT LAND LLC 4019 1336 91 157PF00104 HARVEST HOLDINGS LLC 4019 1339 121 157PG00116 INCREDIBLE LAND LLC 4019 1342 153 157PH00107 JOYLAND HOLDINGS LLC 4019 1345