NCC220853_FRO Submitted_20220222

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 King Creek at Cherry Branch Phase Three — Individual Lot Erosion Control
2. Location of land -disturbing activity: County Craven City or Township Township #5
Highway/Street Wainwright CourtLatitude 34.929795 N Longitude-76.804590 W
3. Approximate date land -disturbing activity will commence: Winter 2022
4. Purpose of development (residential, commercial, industrial, institutional, etc.): Residential
5. Total acreage disturbed or uncovered (including off -site borrow and waste areas): 8 acres
6. Amount of fee enclosed: $ $800.00 The application fee of $100.00 per acre (rounded up to the next
acre) is assessed without a ceiling amount.
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 Jess Meyer E-mail Address iameyerCa�drhorton.com
Telephone Cell # 919.215.6561 Fax #
9. Landowner(s) of Record (attach accompanied page to list additional owners):
D. R. Horton, Inc. 919 215 6561
Name Telephone Fax Number
2000 Aerial Center Parkway, Suite 110 2000 Aerial Center Parkway, Suite 110
Current Mailing Address Current Street Address
Morrisville, NC 27560 Morrisville, NC 27560
City State Zip City State Zip
10. Deed Book No. 3708 Page No. 173 Provide a copy of the most current deed.
Part B.
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):
D. R. Horton, Inc. 0ameyer(@drhorton com
Name E-mail Address
2000 Aerial Center Parkway, Suite 110 2000 Aerial Center Parkway, Suite 110
Current Mailing Address Current Street Address
Morrisville, NC 27560
City State Zip
Morrisville, NC 27560
City State Zip
Telephone [phone] Fax Number 703.996.8095

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:
Name of Registered Agent
Current Mailing Address
City
Telephone
State
E-mail Address
Current Street Address
Zip City State Zip
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 by any change in the information provided herein.
Jessica Meyer Central Carolina NPDES Technical Compliance Administrator — D. R. Horton Inc
T pe or print name Title or Authority
r�04�
ig ature Date
a Notary Public of the' County of OYS { l
State of North Carolina, hereby certify that ScC / `�L0 appeared
personally before me this day and being ly worn acknowledged that the above form was
executed by him.
Witness my hand and notarial seal, this
S ELAINE HUDSPETH
Notary Public
North Carolina
Seal Forsyth County
day of , 20 2 2
ota ry
My commission expires u �ZZ

CERTIFICATE OF OFFICER
The undersigned hereby certifies as follows:
1. He is a duly elected, qualified and acting Vice President and Secretary of D.R.
Horton, Inc., a Delaware corporation (the "CompanX'), is familiar with the facts herein certified and
is duly authorized to certify the same.
2. The following is a true, correct and complete copy of resolutions related to the subj ect
matter as adopted by the Consent of Executive Committee of the Board of Directors of the Company
dated August 25, 2015 (the "Resolutions'). The Resolutions have not been amended, rescinded or
modified and remain in full force and effect as of the date hereof.
Election of Assistant Secretary and NPDES Administrator
RESOLVED, that Jessica A. Meyer is hereby elected to the office of
Assistant Secretary of the Company (the " Assistant Secretary') in the Company's
Carolina Division (the "Division'), to serve until the next annual meeting of
directors of the Company and until her successor is duly elected and qualified or until
her earlier death, resignation or removal.
RESOLVED FURTHER, that the Assistant Secretary is hereby authorized
and empowered, in the Division and in the name and on behalf of (i) the Company,
(ii) any partnership of which the Company is a general partner, manager or agent, and
(iii) any limited liability company of which the Company is a member, manager or
agent (collectively, the "Entities ") to sign, modify and terminate, from time to time
as she deems it to be in the best interest of the Entities, permit applications,
notifications, exemption requests, agreements, reports and documents related to
federal, state or local implementation of National Pollutant Discharge Elimination
System ("NPDES') storm water or associated wetlands related matters for the
Division including, but not limited to, independent contractor and subcontractor
agreements, consultant agreements, Storm Water Pollution Prevention Plans
("SWPPPs'), Notices of Intent ("NOIs'), Notices of Termination ("NOTs"), plans
and other similar or equivalent agreements or documents for the Division relating to
the business of the Entities but excluding any enforcement related documents
including, but not limited, to settlement agreements and consent decrees.
IN WITNESS WHEREOF, the undersigned has signed the 30`h day of September, 2020.
4,,,AA— A oi,.L-
Thomas B. Montano
Vice President and Secretary
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