NCC242989_FRO Submitted_20240926

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 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 address or phone
number is unavailable, place N/A in the blank.)
Part A.
1. Project Name Calabash Pointe
2. Location of land-disturbing activity: County Brunswick City or Township n/a
US-17 (Ocean Hwy W) 33.933167 78.572633
Highway/Street Latitude(decimal degrees) Longitude(decimal degrees) -
3. Approximate date land-disturbing activity will commence: February 2025
4. Purpose of development(residential, commercial, industrial, institutional, etc.): Residential
5. Total acreage disturbed or uncovered(including off-site borrow and waste areas):26 AC
6. Amount of fee enclosed: $2,600.00 . The application fee of$100.00 per acre (rounded
up to the next acre) is assessed without a ceiling amount (Example: 8.10-acre application fee is$900).
Checks should be addressed to NCDEQ.
7. Has an erosion and sediment control plan been filed? Yes 0 Enclosed tEl No ❑
8. Person to contact should erosion and sediment control issues arise during land-disturbing activity:
Name Nathan Pound, PE E-mail Address [e-mail],[e-mail]
Phone: Office# [phone] Mobile# [phone]
9. Landowner(s) of Record (attach accompanied page to list additional owners):
Delana Holden [phone]
Name Phone: Office# Mobile#
5365 Main Street
Current Mailing Address Current Street Address
Shallotte, NC 28470
City State Zip City State Zip
10. Deed Book No.03353 Page No.071 Provide a copy of the most current deed.

Part B.
1. Company(ies)who are financially responsible for the land-disturbing activity(Provide a comprehensive list
of all responsible parties on accompanied page.) If the company is a sole proprietorship or if the landowner(s)is
an individual(s), the name(s)of the owner(s)may be listed as the financially responsible party(ies).
Lennar Carolinas, LLC [e-mail]
Company Name E-mail Address
5505 Waterford District Drive same
Current Mailing Address Current Street Address
Miami, Florida 33126 same
City State Zip City State Zip
Phone: Office# 704-975-0887 Mobile# same
Note: If the Financially Responsible Party is not the owner of the land to be disturbed, include with this form
the landowner's signed and dated written consent for the applicant to submit a draft erosion and sedimentation
control plan and to conduct the anticipated land disturbing activity.
2. (a) If the Financially Responsible Party is a domestic company registered on the NC Secretary of State
business registry, give name and street address of the Registered Agent:
Corporate Creations Network, Inc.
Name of Registered Agent E-mail Address
700 NW 107th Ave, Ste 400 15720 Brixham Hill Avenue #300
Current Mailing Address Current Street Address
Miami, FL 33172 Charlotte, NC 28277
City State Zip City State Zip
Phone: Office# Mobile#
Name of Individual to Contact(if Registered Agent is a company)
(b) If the Financially Responsible Party is not a resident of North Carolina, give name and street address
of the designated North Carolina agent who is registered on the NC Secretary of State business registry:
Name of Registered Agent E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Phone: Office# Mobile#
Name of Individual to Contact(if Registered Agent is a company)

(c) If the Financially Responsible Party is engaging in business under an assumed name, give name under
which the company is Doing Business As. If the Financially Responsible Party is an individual, General
Partnership, or other company not registered and doing business under an assumed name, attach a copy
of the Certificate of Assumed Name.
LFMNYR l n ARQLIfIRS, LLC-
Company DBA Name
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(s)
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 Party). I agree to provide
corrected information should there be any change in the information provided herein.
5 rrr E. W IT►tINGTON \11
Type or print name Title or Authority
_�- —1/aq 1 o DIA
Signature Date
I, t\hCOu; , a Notary Public of the County of RCARY
State of North Carolina, hereby certify that 5c-T I .. WiTliiNGTONA appeared personally
before me this day and being duly sworn acknowledgedyy�� that the above form was executed by him/her.
Witness my hand and notarial seal, this or- day of NA.L.Y , 20 �y
Nicole Bruce Notary
Nota 'Public My commission expires 11/off/ 03o2
State of South Carolina
My comm. expires 11/21/2032

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B622848982284898
Lennar Corporation PAGE: 1 of 1
Lennar Carolinas,LLC
Coastal Carolina Division DATE:August 6,2024
1505 King Street Extension Suite#100 CHECK NUMBER:2284898
Charleston,SC 29405 AMOUNT PAID:$2,600.00
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00004 11682 (KS SD 24219 - 0002284898 NNNNNNNNNNNN 21,951000174203 XIP3B6 C u�f
NCDEQ ti '
%DIVISION OF MITIGATION SERVICES s
1652 MAIL SERVICE CENTER }
RALEIGH NC 27699-1652
Vendor No: 12835101
Date CO a Invoice Number Payment Advice Gross Amount Discount Net Amount
07/29/24 31145 202407 260000 FEE MV-Calabash Pointe NCDEQ $2,600.00 $0.00 $2,600.00
TOTALS $2,600.00 $0.00 $2,600.00
- 5 . . . •; fr '• i . . - - -i- --
Lennar Corporation CHECK 70 2322
Lennar Carolinas.LLC NUMBER 2284898 719
Coastal Carolina Division
1505 King Street Extension Suite#100 August 6, 2024
Charleston.SC 29405
'*'VOID AFTER 180 DAYS'—
PAY NCDEQ
TO THE %DIVISION OF MITIGATION SERVICES
ORDER OF: 1652 MAIL SERVICE CENTER
RALEIGH,NC 27699-1652 CHECK AMOUNT
$2 , 600 . 00
EXACTLY *********2,600 DOLLARS AND 00 CENTS LLI Ow.on back. i
s ;
JPMorgan Chase Bank,N A 1
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Chicago,IL (�7 4t.L
ea(AAAAA—
Authorized Signature

ENDORSE HERE
X
DO NOT WRITE,STAMP OR SIGN BELOW THIS LINE
RESERVED FOR FINANCIAL INSTITUTIONAL USE*
*FEDERAL RESERVE BOARD OF GOVERNORS REG.CC
8t
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