HomeMy WebLinkAboutNCC220673_FRO Submitted_20220215POLZ:A
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 NIA in the blank.)
Part A. Wantlands Ferry
1. Project Name
2. Location of land -disturbing activity: CountyOnIsoW City or TownshipSWansboro
Highway/Street Rocky Run Road Latitude 34.741 Longitude-77.303
3. Approximate date land -disturbing activity will commence: 2/5/2022
4. Purpose of development (residential, commercial, industrial, institutional, etc.): Residential
5. Total acreage disturbed or uncovered (including off -site borrow and waste areas): y
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 X No Enclosed X
8. Person to contact should erosion and sediment control issues arise during land -disturbing activity:
Name Donald Aiken E-mail Address daiken@drhorton.com
Telephone Cell # 910-508-0017 Fax #
9. Landowner(s) of Record (attach accompanied page to list additional owners):
D.R. Horton, Inc. 910-515-9561
Name Telephone Fax Number
4049 Belle Terre Blvd 4049 Belle Terre Blvd.
Current Mailing Address Current Street Address
Myrtle Beach SC 27597 Myrtle Beach SC 27597
City State Zip City State Zip
10. Deed Book No, 5660 Page No. 150 - 153 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.
D.R. Horton, Inc. elsheiton@drhorton.com
Name E-mail Address
131 Racine Dr., Suite 201 131 Racine Dr., Suite 201
Current Mailing Address Current Street Address
Wilmington NC 28403 Wilmington NC 28403
City State Zip City State Zip
Telephone 910-515-9561 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
Current Mailing Address
City
Telephone
E-mail Address
Current Street Address
State Zip City State Zip
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:
Elizabeth Shelton
Name of Registered Agent
131 Racine Dr., Suite 201
Current Mailing Address
Wilmington NC 29403
City
elshelton@drhorton.com
E-mail Address
131 Racine Dr., Suite 201
Current Street Address
Wilmington NC 29403
State Zip City
Telephone 901-515-9651
Fax Number
State Zip
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.
Donald Aiken
Type or print Ujam
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Assistant Secretary
Title or Authority
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I , � f�► l�v� - r/ , _ _ a Notary Public of the County of _& I�_i 62AA�
State of North Carolina, hereby certify that Jmr LVA appeared
personally before me this day and being duly sworn acknowledged that the above form was
executed by him.
Witness my A*iohaQO notarial seal, this 12"day of J�1u�-lit 20
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