HomeMy WebLinkAboutNCC230568_FRO Submitted_20230323FINANCIAL 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. Avalon Lots onlyfor D. R. Horton
1. Project Name
2. Location of land -disturbing activity: County Brunswick City or Township Lockwood Folly
Highway/Street Old Lennon Road Latitude 34d 00' 0811 Longitude 78d 12' 18"
3. Approximate date land -disturbing activity will commence: March 2022
4. Purpose of development (residential, commercial, industrial, institutional, etc.): Residential
5, Total acreage disturbed or uncovered (including off -site borrow and waste areas): 12.80
6. Amount of fee enclosed: $ N/A . 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 X
8. Person to contact should erosion and sediment control issues arise during land -disturbing activity:
Name Ryan Darrough Email Address rdarrough@drhorton.com
Telephone Cell # 910.666.0206 Fax # n/a
9. Landowner(s) of Record (attach accompanied page to list additional owners):
D. R. Horton, Inc.
910.515.9561 n/a
Name
Telephone Fax Number
131 Racine Dr., Suite 201
Current Mailing Address
Current Street Address
Wilmington NC 28403
City State Zip
City State Zip
10. Deed Book No. See Page No. attached 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.
elshelton@drhorton.com
Name
E-mail Address
131 Racine Dr., Suite 201
Current Mailing Address
Current Street Address
Wilmington NC 28403
City State Zip
City State Zip
Telephone 910-515-9561
Fax Number n/a
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.
Libby Shelton
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Division President
Title ohorit r ut
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Date
En a Notary Public of the County of EdLVT—
State of North Carolina, hereby certify that LA bb SW+O--) appeared
personally before me this day and being duly sw m acknowledged that the above form was
executed by him.
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