NCC230043_FRO Submitted_20230109

cow Pitt County
Planning Department
Development Services Building
1717 W. 5th Street
C Greenville, North Carolina 27834-1696
Telephone: [phone] James F. Rhodes, AICP
Fax: [phone] Director
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 Stanfield Subdivision - Ph 2
2. Location of land -disturbing activity: County Pitt
City or Township Ayden , and Highway/Street Old Snow Hill Rd.
3. Approximate date land -disturbing activity will be commenced: November 2022
4. Purpose of development (residential, commercial, industrial, etc.): residential
5. Approximate acreage of land to be disturbed or uncovered: 9 acres
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 Tracey Davis Telephone [phone]
8. Landowner(s) of Record (Use blank page to list additional owners):
AH Builders, LLC
Name(s) Name(s)
2729 Willow Rock Ln.
Current mailing address Street address
Apex NC 27523
City State Zip City State Zip
9. Recorded in Deed Book No. 4155 Page No. 773
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):
D.R. Horton - Central Carolina Div. - Tracey Davis
Name of person(s) or Firm(s) Name(s)
7208 Falls of Neuse, Suite 201 _
Current mailing address Street Address
Raleigh NC 27615
City State Zip City State Zip
919-497-2163
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. -� . �S
► ► gj pr1 I �l (S Gi 1 tX
Typ it print ri.rie Title or Authority
101Z712Z
Signature Date
I,
otary Public of the County of
of Forth Carolina, hereby certify that_ "C
appeared personally before me this day and
was executed by him.
State
duly sworn acknowledged that the above form
Witness my hand and notarial seal thisQrj day o 20
Janis Perez Notary
NOTARY PUBLIC My commission expires
Johnston County
North Carolina
My Commission Expires August4, 2026