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Home My WebLink AboutNCC232338_FRO Submitted_20230811 Check if this project is ARPA-funded ❑ 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, including any activity under a common plan of development of this size as covered by the NCGO1 permit, 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 Pitt Solar - Tree Clearing *If this project involves American Rescue Plan Act (ARPA) funds, list the Project Name below under which you applied for funding through the Division of Water Infrastructure (DWI). 2. Location of land-disturbing activity: County Pitt City or Township Bethel BigOak Rd 35.801171 -77.353426 Highway/Street LatitUde(decimal degrees) Longitude(decimal degrees) 3. Approximate date land-disturbing activity will commence:ASAP 4. Purpose of development (residential, commercial, industrial, institutional, etc.): Solar Facility 5. Total acreage disturbed or uncovered (including off-site borrow and waste areas):584 6. Amount of fee enclosed: $58,400 . 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 Derek Ivie E-mail Address derek.ivie@sunenergy1 .com Phone: Office# (704) 337-5237 Mobile# 9. Landowner(s) of Record (attach accompanied page to list additional owners): CHRISTOPHER C JAMES Name Phone: Office# Mobile# PO BOX 788 Current Mailing Address Current Street Address BETHEL NC 27812 City State Zip City State Zip 10. Deed Book No.2058 Page No.746 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). Pitt Solar, LLC project.development@sunenergyl .com Company Name E-mail Address 595 Summer St, 4th Floor 595 Summer St, 4th Floor Current Mailing Address Current Street Address Stamford CT 06901 Stamford CT 06901 City State Zip City State Zip Phone: Office# (203)983-7875 Mobile# (704)337-5237 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: Cogency Global, Inc N/A Name of Registered Agent E-mail Address 212 S. Tryon St, Ste 1000 212 S. Tryon St, Ste 1000 Current Mailing Address Current Street Address Charlotte NC 28281 Charlotte NC 28281 City State Zip City State Zip Phone: Office# (866)775-01 14 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: N/A 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. N/A 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. Kenny Habul Manager / CEO Type or print name Title or Authority 4/24/23 Signature Date Amy Jean Wakefield , a Notary Public of the County of Mecklenburg State of North Carolina, hereby certify that Kenny Habul 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 25th day of April 20 23 Vogu-e▪) et, Notary � t' �\ Mycommission expires 6/26/23 e�L pue-o° f3 .V8URGGa: .."sid/11u N 11M ,',S 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: JOHN L GURGANUS III Name Phone: Office # Mobile# 831 TETTERTON RD 831 TETTERTON RD Current Mailing Address Current Street Address STOKES NC 27884 STOKES NC 27884 City State Zip City State Zip Deed Book No.4365 Page No.316 Provide a copy of the most current deed. Landowner 3 of Record: JANIE E MANNING Name Phone: Office# Mobile# 784 HIGHWAY 64 E 784 HIGHWAY 64 E Current Mailing Address Current Street Address BETHEL NC 27812 BETHEL NC 27812 City State Zip City State Zip Deed Book No.729 Page No. 130 Provide a copy of the most current deed. Landowner 4 of Record: CHRISTOPHER CLYDE JAMES Name Phone: Office# Mobile# PO BOX 788 Current Mailing Address Current Street Address BETHEL NC 27812 City State Zip City State Zip Deed Book No. 1431 Page No.33 Provide a copy of the most current deed. Landowner 5 of Record: IVES WILDA ANDREWS HEIRS Name Phone: Office# Mobile# 214 HILLSBOROUGH ST 214 HILLSBOROUGH ST Current Mailing Address Current Street Address CARRBORO NC 27510 CARRBORO NC 27510 City State Zip City State Zip Deed Book No. XXX Page No.XXX 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: CHARLIE L MANNING III Name Phone: Office# Mobile# 7599 MAIN ST 7599 MAIN ST Current Mailing Address Current Street Address BETHEL NC 27812 BETHEL NC 27812 City State Zip City State Zip Deed Book No. 1802 Page No.51 1 Provide a copy of the most current deed. Landowner 3 of Record: COUNTRY FARMS LLC Name Phone: Office# Mobile# 144 LONG MEADOW RD 144 LONG MEADOW RD Current Mailing Address Current Street Address GREENVILLE NC 27858 GREENVILLE NC 27858 City State Zip City State Zip Deed Book No.782 Page No.306 Provide a copy of the most current deed. Landowner 4 of Record: THE BUNTING FARMS INC Name Phone: Office# Mobile# 815-4 MARLOWE RD 815-4 MARLOWE RD Current Mailing Address Current Street Address RALEIGH NC 27609 RALEIGH NC 27609 City State Zip City State Zip Deed Book No.232 Page No.477 Provide a copy of the most current deed. Landowner 5 of Record: WALLACE L JAMES JR Name Phone: Office# Mobile# 2706 FLAT SWAMP RD 2706 FLAT SWAMP RD Current Mailing Address Current Street Address ROBERSONVILLE NC 27871 ROBERSONVILLE NC 27871 City State Zip City State Zip Deed Book No. 974 Page No.829 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: GROUP THREE HOLDING LLC Name Phone: Office# Mobile# 115E PUTNAM AVE 115E PUTNAM AVE Current Mailing Address Current Street Address GREENWICH CT 06830 GREENWICH CT 06830 City State Zip City State Zip Deed Book No. 3400 Page No.71 9 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 City State Zip Deed Book No. Page No. 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.