NCC240605_FRO Submitted_20240305

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 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 Twin Oaks Landscaping Site Improvements
2. Location of land-disturbing activity: County Watauga City or Township Foscoe
Highway/Street Hwy 105 Latitude 36: 9'24.74"N Longitude 81346'38.41"W
3. Approximate date land-disturbing activity will commence: December 2023
4. Purpose of development (residential, commercial, industrial, institutional, etc.): Commercial
5. Total acreage disturbed or uncovered (including off-site borrow and waste areas): 2.50
6. Amount of fee enclosed: $ 450.00 . The application fee of S150 per acre (rounded
up to the next acre) is assessed without a ceiling amount (Example: a 9-acre application fee is S135U).
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 Thomas Reece E-mail Address thomastwinoaksls.com
Telephone [phone] Cell # [phone] Fax # [phone]
9. Landowner(s) of Record (attach accompanied page to list additional owners):
Daves Mtn LLC [phone] [phone]
Name Telephone Fax Number
8970 NC Highway 105 S, STE 2 8970 NC Highway 105 S, STE 2
Current Mailing Address Current Street Address
Boone NC 28607 Boone NC 28607
City State Zip City State Zip
10. Deed Book No. 2305 Page No. 212 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):
Thomas Reece [e-mail]
Name E-mail Address
8970 NC Highway 105 S, STE 2 8970 NC Highway 105 S, STE 2
Current Mailing Address Current Street Address
Boone NC 28607 Boone NC 28607
City State Zip City State Zip
Telephone (828) 434-5016 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 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:
Name of Registered Agent E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Telephone 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.
Thomas Reece Owner
Type or print name Title or Authority
Signature Date
•
I, }ja :Cl� , a Notary Public of the County of aa://t/4-).
State of North Carolina, hereby certify that JIACTIACtj LkJ . .l'( C 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 LO day of /) httikix420 d 3
HALLIE D WILLIS '
NOTARY PUBLIC (1164.
Notary
Coa nission Expires 3.18-2026
My commission expires �j - / . dO