NCC233526_FRO Submitted_20231130

cot, Pitt County
6 ¢ 4, Planning Department
1 Development Services Building
0 �< 1717 W. 5th Street
coos. Greenville, North Carolina 27834-1696 James F.Rhodes,,vCP
Telephone: [phone] Director
Fax: [phone]
Financial Responsibility/Ownership Form
Soil Erosion and Sedimentation Control Ordinance
No person may initiate any land-disturbing activity on one or more contiguous acres as
covered by the Act before this form and an acceptable erosion and sedimentation control plan
have been completed and approved by the Pitt County Planning Department. (Please type or
print and, if question is not applicable, place N/A in the blank.)
Part A.
1. Project Name Harris Ridge Subdivision, Phase 4
2. Location of land-disturbing activity: County Pitt
City or Township Swift Creek , and Highway/Street Harris Ridge Road
3. Approximate date land-disturbing activity will be commenced: 12-1-23
4. Purpose of development (residential, commercial, industrial, etc.): residential
5. Approximate acreage of land to be disturbed or uncovered: 11.53 Ac
6. Has an erosion and sedimentation control plan been filed? Yes x No
7. Person to contact should sedimentation control issues arise during land-disturbing_activity:
Name Leo Venters Telephone [phone]
8. Landowner(s) of Record (Use blank page to list additional owners):
A.T. Venters Properties, LLC
Name(s) Name(s)
1700 Tottenham Court
Current mailing address Street address
Winterville, NC 28590
City State Zip City State Zip
r
9. Recoraea in ruoed Book No. 2132 Page No. 195
Part B.
1. Person(s) or firm(s) who are financially responsible for this land-disturbing activity (Use
the blank page to list additional persons or firms):
4V Corporation
Name of person(s)or Firm(s) Name(s)
1700 Tottenham Court
Current mailing address Street Address
Winterville, NC 28590
Cit State Zip City State Zip
252-327-8100
Telephone Telephone

2. (a) If the Financially Responsible Party is a Corporation, give name and street address of
the Registered Agent.
Name(s)
Current mailing address Street Address
City State Zip City State Zip
Telephone Telephone
(b) If the Financially Responsible Party is a Partnership give the name and street address
of each General Partner(Use blank page to list additional partners):
Name(s) Name(s)
Current mailing address Current mailing address
City State Zip City State Zip
Telephone Telephone
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/her attorney-in-fact or if not an individual by an officer, director, partner, or
registered agent with 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.
Leo Venters President
Type or print w` L�1 ie Title or Authority
V/ / 10 - 2 �- Z3
Signs a Date
I, 7u aarr C V✓.kt2wic..jc-- , a Notary Public of the County of I�I'f'r State
of North Carolina, hereby certify that Lem eKronks
appeared personally before me this day and being duly sworn acknowledged that the above form
was executed by him. \`\���tcl 1IBt///1//
Alyias my harts notarial seal this Z? day of Deraz . 2023.
fc:i •
. NOTARY
• * * *
PUBLIC • = Notary
•• •
My commission expires 0y/e'z r 2.1