NCC240449_FRO Submitted_20240216

JOHNSTON COUNTY 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
Johnston County Department of Public Utilities. (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 Neuse Ridge
2. Location of land-disturbing activity: City or Township Johnston County
Highway/Street Cascade Knoll Drive Latitude 35'6203 Longitude-78.3646
3. Approximate date land-disturbing activity will commence:ASAP
4. Purpose of development (residential, commercial, industrial, institutional, etc.): Residential
5. Total acreage disturbed or uncovered (including off-site borrow and waste areas): 7.61
8. Amount of fee enclosed: $3,040 . The application fee of$380.00 per acre (rounded
PAID up to the next acre) is assessed for the first 10 acres and an additional $125 per acre for each
06/20/2023 additional acre (rounded up to the next acre). Individual residential lots plans are$100 per lot.
7. Has an erosion and sediment control plan been filed? Yes ❑� No Enclosed
8. Person to contact should erosion and sediment control issues arise during land-disturbing activity:
Name Brandee Melcher E-mail Address brandee.melcher©Igihomes.com
Telephone N/A Cell# 240-217-4665 Fax# N/A
9. Landowner(s) of Record (attach accompanied page to list additional owners):
LGI Homes - NC, LLC N/A N/A
Name Telephone Fax Number
1450 Lake Robbins Drive 1450 Lake Robbins Drive
Current Mailing Address Current Street Address
The Woodlands TX 7380 The Woodlands TX 7380
City State Zip City State Zip
10. Deed Book No.6603 Page No. 116-119
Part B.
1. 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):
LGI Homes- NC, LLC [e-mail]
Name E-mail Address
5511 Capital Center Dr. Ste 560 5511 Capital Center Dr. Ste 560
Current Mailing Address Current Street Address
Raleigh NC 27606 Raleigh NC 27606
City State Zip City State Zip
Telephone [phone] 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:
Josh Spiegel [e-mail]
Name E-mail Address
5511 Capital Center Dr. Ste 560 5511 Capital Center Dr. Ste 560
Current Mailing Address Current Street Address
Raleigh NC 27606 Raleigh NC 27606
City State Zip City State Zip
Telephone [phone] Fax Number N/A
(b) If the Financially Responsible Party is a Partnership or other person engaging in businesls 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:
Josh Spiegel [e-mail]
Name of Registered Agent E-mail Address
5511 Capital Center Dr. Ste 560 5511 Capital Center Dr. Ste 560
Current Mailing Address Current Street Address
Raleigh NC 27606 Raleigh NC 27606
City State Zip City State Zip
Telephone [phone] 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.
Josh Spiegel Authorized Agent
Type or print/name Title or Authority
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/. /,-ignat�r Date
I, (\i\ cS' �, NR,ZCIZJN , a Notary Public of the County of WPM'
State of North Carolina, hereby certify that 70SYS rr.re\E . appeared
personally before me this day and being duly sworn acknowledged that the above form was
executed by him.
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Witness my hand and notarial seal, this �� day of ‘O , 20 24....
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