HomeMy WebLinkAboutNCC230819_FRO Submitted_20230330FINANCIAL 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. Summerlyn Village
1. Project Name
2. Location of land -disturbing activity: County Cabarrus City or Township Kannapolis
Highway/Street Mooresville Road Latitude 35.488271 Longitude-80.659395
3. Approximate date land -disturbing activity will commence: 3/2023
4. Purpose of development (residential, commercial, industrial, institutional, etc.): Residential
5. Total acreage disturbed or uncovered (including off -site borrow and waste areas): 97.00
6. Amount of fee enclosed: $6,305.00 - PAID The application fee of $65.00 per acre (rounded
up to the next acre) is assessed without a ceiling amount (Example: a 9-acre application fee is $585).
7. Has an erosion and sediment control plan been filed? Yes X No Enclosed
8. Person to contact should erosion and sediment control issues arise during land -disturbing activity:
Name Sam Stalls E-mail Address sam.StallS@lennar.Com
Telephone N/A Cell # 704-516-8181 Fax # N/A
A"
Landowner(s) of Record (attach accompanied page to list additional owners):
Lennar Carolinas, LLC (704) 759-6000
N/A
Name Telephone Fax Number
6701 Carmel Road, Suite 425 6701 Carmel Road, Suite 425
Current Mailing Address Current Street Address
Charlotte NC 28226 Charlotte NC 28226
City
10. Deed Book No. 16392
State
Zip City
Page No. 0148
State
Zip
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.
Lennar Carolinas, LLC N/A
Name E-mail Address
6701 Carmel Road, Suite 425 6701 Carmel Road, Suite 425
Current Mailing Address Current Street Address
Charlotte NC 28226 Charlotte NC 28226
City State
Telephone (704) 759-6000
Zip City
Fax Number N/A
State
Zip
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:
N/A
Name
N/A
Current Mailing Address
N/A
City
Telephone N/A
N/A
E-mail Address
N/A
Current Street Address
N/A
State Zip City State Zip
Fax Number N/A
(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:
N/A
Name of Registered Agent
N/A
Current Mailing Address
N/A
City
Telephone N/A
N/A
E-mail Address
N/A
Current Street Address
N/A
State Zip City State Zip
Fax Number N/A
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.
Mark Henninger
Type or print nam
Signature
Division President
Title or Authority
VZ7_rj
Date
I, IV1 roAp& A-. Fib' he— , a Notary Public of the County of 1 ur
State of North Carolina, hereby certify that fti/rk_ J& n 1A % el appeared
personally before me this day and being duly sworn acknowl dged that the above form was
executed by him.
Witness my hand,flp4,,notarial seal, this day of V A/-& 2o2--3
V Notary Public ti0
Mecklenburg -A Notary
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