NCC232614_FRO Submitted_20230829

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FINANCIAL RESPONSIBILITY/OWNERSHIP FORM PN ? 2Q22
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 Duality. Submit the completed form to the appropriate
Regional Office. (Please type or print and,If the question is not applicable or the e-mail and/or fax information
unavailable,place NIA in the blank.)
Part A.
1. Project Name Logan
2. Location of land-disturbing activity: County OnsloW City or Township Holly Ridge
157 Spicer Lake Lane
Highway/Street Latitude 3� ^-
-y Longitude 1 • LA
3. Approximate date land-disturbing activity will commence: 7/4/22
4. Purpose of development(residential,commercial,industrial,institutional,etc.):_Residential
5. Total acreage disturbed or uncovered(including off-site borrow and waste areas): O •
6. Amount of fee enclosed: $ N/A Waived by DEQ The application fee of$85.00 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 X No Enclosed
8 Person to contact should erosion and sediment control issues arise during land-disturbing activity.
Name David Rogers E-mail Address drogers©Ioganhomes.com
Telephone [phone] Ceti# Fax#
9 Landowner(s)of Record(attach accompanied page to list additional owners).
Logan Developers, Inc 910-452-7175
Name Telephone Fax Number
60 Gregory Rd
Current Mailing Address Current Street Address
Belville, NC 28451
City State Zip City State Zip
10 Deed Book No. 5717 Page No. 829-831 Provide a copy of the most current deed.
Part B.
1 Company (ies) or firm(s) who are financially responsible for the land-disturbing activity (Provide a
comprehensive list of all responsible parties on an attached sheet) If the company or firm is a sole
proprietorship the name of the owner or manager may be listed as the financially responsible party
Logan Developers, Inc [e-mail]
Name E-mail Address
60 Gregory Rd
Current Mailing Address Current Street Address
Belville, NC 28451
City State Zip City State Zip -.

Telephone [phone] 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 T'— u - - ,-.
_
Current Mailing Address Current Street Address
City State Zip City State Zip
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
D LoAan [e-mail]
Name of Registered Agent E-mail Address
6.0 Gregory Rd
Current Mailing Address Current Street Address
Belville, NC 28451 _ _
City State Zip City State Zip
Telephone [phone] Fax Number
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.
Nancy Melton Preconstruction Coordinator
Type or print name Title or Authority
Signalur Date
I, 6tS4-itv, 0,4 4, _ , a Notary Public of the County of /rittil WI t C
State of North Carolina, hereby certify that 1IIill Of I _ appeared
personally before me this day and being duly sworn acknd fn Wedged that the above form was executed
by him.
Witness my hand and notarial seal,th•is o.'St day of Aori
i 20 �_
Kristine Case
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NOTARY PUBLIC Notary i
. '•eat ��t
Brunswick County,NC My commission expires L� �f,
My Commission Expires August 08,2026 _�