Ryan -Signed Financial Forms_v1
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Created:April 22, 2024 11:45:52 -8:00
Pages:5
Electronic Notary:Yes / State: NC
Financial_Responsibility_Form_Nov2021_Fillable_3.pdf
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E-Signature Summary
E-Signature Notary: Debbie Eubanks (DE)
April 22, 2024 11:48:48 -8:00 [A5C79DB79466] [139.180.44.230]
debbieeubanks2@gmail.com
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DocVerify ID:85EA82F9-236D-4FA0-9238-34475A9E773C
Created:April 22, 2024 04:20:43 -8:00
Pages:4
E-Sign:Yes
Financial Responsibility Form Nov2021 Fillable 3.pdf
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E-Signature Summary
E-Signature 1: Ryan Christman (RC)
Apr 22, 2024 11:27:33 -8:00 [749B70AC5054] [136.56.59.188]
rchristman@archaea.energy
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Page 1 of 5 127C58745EAB3
APPLICATION FOR PERMIT FOR A
LAND DISTURBING ACTIVITY
Under the conditions set forth by
The New Hanover County
Soil Erosion and Sedimentation Control Ordinance
Engineering Department
Applicant or Applicant’s Agent: ____________________________________________________________________________
Mailing Address: ________________________________ Telephone Number: _______________Fax Number: _____________
______________________________________________ Email Address: ____________________________________________
Total Acres of Land Disturbance: ___________ Purpose of Development: ___________________________________________
Description of Land Disturbance: ____________________________________________________________________________
Address of Land Disturbance _________________________________Latitude:________________Longitude:______________
______________________________________________________________________________________________________
STATEMENT OF FINANCIAL RESPONSIBILITY
Land owner(s) of record: Person or firm(s) financially responsible for the
land disturbing activity. If not a North Carolina
resident, you MUST have a N.C. agent. (List Below)
Name: __________________________________________ Name: ________________________________________________
Address: ________________________________________ Address: ______________________________________________
City/State: _______________________________________ City/State: ____________________________________________
Zip Code: _________________________________________Zip Code: _____________________________________________
Telephone Number: ________________________________ Telephone Number: _____________________________________
Email: ____________________FaxNumber______________Email:________________________FaxNumber: ______________
Location of deed(s) or instrument(s): County: _______________________________ Book: _______ Page: _______________
The above information is true and correct to the best of my knowledge and belief and was provided by me while under oath.
(This form must be signed by the financially responsible person if an individual and by an officer, director, partner, attorney-in-
fact, or other person of authority to execute instruments for the financially responsible person if not an individual.) I agree to
provide corrected information should there be any change in the information provided herein.
Date: ____________________ Name _____________________________________ Title _________________________
Signature __________________________________________
_________________________________________________________________________________________________
I, _____________________________________ a Notary Public of the County of __________________________ State of
North Carolina, hereby certify that __________________________________ appeared personally before me this day and
being duly sworn acknowledged that the above form was executed by him.
Witness my hand and notary seal, this _______ day of _________________________, 20_____________.
Notary __________________________________________ My commission expires ________________________.
SEAL
Permission to Enter on Land
I certify that I am authorized to grant and do in fact grant permission to the Erosion Control Inspector and his agents to enter on
the land in question in connection related to this permit application.
______________________________________________________________________________________________________
Application Signature and Date
PLEASE COMPLETE ALL PORTIONS OF APPLICATION
File #_______
LD Fee ______ Review Fee _____
Date Pd ______Date Pd _______
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Page 1 of 4 134475A9E773C
Archaea Energy Operating LLC
201 Helios Way, Floor 6
Houston, TX 77079
304-790-0502
eaddessi@archaea.energy
5.02 Renewable Natural Gas (RNG) Facility
Construction activities related to RNG Facility. Storm sewer pipes, compressor equipment, etc.
5124 US Highway 421 N 34.320390 -77.990946
New Hanover County Landfill Archaea Energy Operating LLC
5120 US Highway 421 N 201 Helios Way, Floor 6
Wilmington, North Carolina Houston, Texas
28401 77079
910-798-4450 304-790-0502
eaddessi@archaea.energy
New Hanover 6321 2596
Attorney-in-FactRyan Christman
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Page 2 of 5 227C58745EAB3
Do
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Debbie Eubanks
Commission # 19971740066
Electronic Notary Public - North Carolina
Onslow County
My Commission Expires Jul 04, 2027
April 22,2024
Debbie Eubanks Onslow
Ryan Christman
22 April 24
Debbie Eubanks July 4, 2027
This application must be sealed by the notary and accompanied by 4 sets of plans, the fee, calculations, dimensions, temporary and
permanent seeding specifications, a maintenance plan for erosion control measures and seeding, and narrative statements as called for by
the ordinance. The following list specifies the minimum requirements.
SEDIMENTS AND EROSION CONTROL PLAN COMPONENTS
1. Name, address of the designer, phone number, fax number and email address.
2. Vicinity map. Address assigned by County Planning or the City of Wilmington.
3. Copy of deed(s) for the property.
4. Latitude and Longitude of Project.
5. DXF File. (On Disk)
6. Existing & Proposed topography.
7. Area to be disturbed (shown as construction limits on the plan with a legend. Include off site work).
8. Proposed site improvements (structures, roads, parking areas, lots, easements, etc.)
9. Construction Sequence.
10. Temporary sediment control measures (locations, dimensions, details and calculations).
11. Graveled construction entrance (dimensions and cross section details).
12. Proposed storm water network (swales, culverts, inlet and outlet structures, etc. with grades, elevations, details,
drainage calculations with velocities) and energy dissipater dimensions.
13. Permanent erosion controls (locations, dimensions, details and calculations)
14. Permanent & temporary seeding specifications (seedbed preparation, soil amendments, seeding rates & schedule).
15. Sediment and erosion control material specifications.
16. General notes.
17. Wetlands, C.A.M.A. areas, 100-year floodplain, 575’ HQW, and Conservation Overlay Districts must be shown on the
plan if applicable.
18. Maintenance plan for all erosion control measures & stabilization methods.
19. Tree protection approval from the City of Wilmington or New Hanover County Planning for subdivisions or New
Hanover County Zoning for Commercial Projects.
NARRATIVE STATEMENT COMPONENTS
1. Name and address of owner and of the financially responsible person, phone number, fax number & email address.
2. Sealed notarized financial responsibility form with a North Carolina agent and individual’s name/signature.
3. Purpose of land disturbing activity.
4. Storm water run off calculations and explanation of the method of determination.
5. Construction sequence and schedule (flow chart if available).
6. Re-vegetation specifications (preparation, seed type and rates; fertilizer, lime and mulch rates and schedule)
The New Hanover County Erosion and Sedimentation Control Ordinance requires that all persons disturbing more than one (1) acre of
land must obtain approval of a soil erosion control plan and be issued a permit prior to the commencement of said land disturbing activity.
Before an application package is considered complete, this application must be completed and submitted along with the fees, plans, the
calculations, dimensions and the narrative to this office. The plans and narrative will be submitted to New Hanover County Soil
Conservation Service and State Stormwater. Plans must be submitted by the applicant to the New Hanover County Planning Department
for Conservation Overlay Review and subdivision tree approval. Commercial tree approval requires submittal to New Hanover County
Zoning. Projects within the City of Wilmington require City tree approval. Commencement of a land disturbing activity under the
jurisdiction of this Act prior to the approval of an erosion and sedimentation control plan is a violation of the Act. The Act further states
that the application package must be filed a minimum of thirty (30) days prior to the activity and the approving authority must approve the
submitted plan within thirty (30) days of receipt. Failure of the approving authority to approve or disapprove the submitted plan within
the thirty (30) day period will be deemed approval of the plan. Additional information may be requested after the 30 day period in order to
meet requirements of the ordinance.
No activity should proceed on site without the issuance of a land disturbing activity unless the approving authority fails to notify the
applicant (usually the engineer) within the 30 day submittal period. If an environmental document is required, the application will be
deemed incomplete until the document is available for review by the County. In this case, the applicant will be notified that the 30 day
time limit for a review of the plan shall not begin until a complete environmental document is available for review. Revisions or
amendments to existing plans must be submitted for review 15 days prior to any site changes. Until such time as the revision is approved
by the County, the land disturbing activity shall not proceed. Any previously permitted site that requires additional work no matter
what size, must submit an amended erosion control plan for approval prior to any changes on site. All land disturbing activity
on a tract since 1988 is cumulative towards the one acre threshold and requires a permit. NO work should begin on site without a
preconstruction erosion control conference.
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Page 3 of 5 327C58745EAB3
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 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 and/
or fax information unavailable, place N/A in the blank.)
Part A. 1.Project Name_______________________________________________________________________
2.Location of land-disturbing activity: County_________________ City or Township_________________
Highway/Street___________________ Latitude_________________ Longitude__________________
3.Approximate date land-disturbing activity will commence:_____________________________________
4.Purpose of development (residential, commercial, industrial, institutional, etc.):____________________
5.Total acreage disturbed or uncovered (including off-site borrow and waste areas):_________________
6.Amount of fee enclosed: $____________________. The application fee of $100.00 per acre
(rounded up to the next acre) is assessed without a ceiling amount (Example: 8.10 ac = $900.00).
7.Has an erosion and sediment control plan been filed? Yes________ No________ Enclosed_________
8.Person to contact should erosion and sediment control issues arise during land-disturbing activity:
Name________________________________ E-mail Address_______________________________
Telephone_________________________ Cell # ___________________ Fax # _________________
9. Landowner(s) of Record (attach accompanied page to list additional owners):
____________________________________ ________________________ _________________
Name Telephone Fax Number
____________________________________ ___________________________________________
Current Mailing Address Current Street Address
____________________________________ ___________________________________________
City State Zip City State Zip
10.Deed Book No._______________ Page No.______________ Provide a copy of the most current deed.
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.
____________________________________ ___________________________________________
Name E-mail Address
____________________________________ ___________________________________________
Current Mailing Address Current Street Address
____________________________________ ___________________________________________
City State Zip City State Zip
Telephone____________________________ Fax Number_________________________________
Part B.
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Page 3 of 4 334475A9E773C
New Hanover RNG Facility
New Hanover Wilmington
US Hwy 421 N 34.320390 -77.990946
1/7/2025
Commercial
5.02
600
X
Eric Addessi eaddessi@archaea.energy
304-790-0502
New Hanover County Landfill
5120 US Highway 421 N 5120 US Highway 421 N
Wilmington, NC 28401 Wilmington, NC 28401
6321 2596
Archaea Energy Operating LLC
201Helios Way, Floor 6
Houston, TX 77079
304-790-0502
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Page 4 of 5 427C58745EAB3
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.
_____________________________________ _______________________________________
Type or print name Title or Authority
_____________________________________ _______________________________________
Signature Date
------------------------------------------------------------------------------------------------------------------------------------
I, __________________________________, a Notary Public of the County of _________________
State of North Carolina, hereby certify that _____________________________________ 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 ______day of _________________, 20_______
_______________________________________
Notary
Seal
My commission expires_____________________
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Page 4 of 4 434475A9E773C
Corporation Service Company
2626 Glenwood Avenue, Suite 550
Raleigh, NC 27608
800-927-9801
Ryan Christman Attorney-in-Fact
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Page 5 of 5 527C58745EAB3
Do
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Debbie Eubanks
Commission # 19971740066
Electronic Notary Public - North Carolina
Onslow County
My Commission Expires Jul 04, 2027
Debbie Eubanks Onslow
Ryan Christman
22 April 24
Debbie Eubanks
July 4, 2027