NCC243211_FRO Submitted_20241017

CARP
x �T FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
f� sySEDIMENTATION POLLUTION CONTROL ACT
No person may initiate any land-disturbing activity that disturbs one or more acres as covered by the Town of
Clayton Soil Erosion and Sedimentation Control Ordinance before this form and an acceptable erosion and
sedimentation control plan have been completed and approved by the Town of Clayton. Lots smaller than one
acre that are part of a larger plan of development are also subject to Town of Clayton Soil Erosion and
Sedimentation Control Ordinance and are required to complete this form. (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 Country Lane
2. Location of land-disturbing activity: County JOHNSTON City or Township CLAYTON
Highway/Street Country Lane Latitude 35 deg 37' 25" Longitude 78 deg 28' 26"
3. Approximate date land-disturbing activity will commence:Fall 2025
4. Purpose of development (residential, commercial, industrial, institutional, etc.): Residential
5. Total acreage disturbed or uncovered (including off-site borrow and waste areas):82 acres
6. Has an erosion and sediment control plan been filed? Yes No Enclosed ✓
7. Person to contact should erosion and sediment control issues arise during land-disturbing activity:
NameJayson Buffkin E-mail Address)buffkin@a withersravenel.com
Telephone[phone] Cell # Fax#
8. Landowner(s)of Record (attach accompanied page to list additional owners):
Meritage Homes of the Carolinas, Inc 925-640-0967
Name Telephone Fax Number
18655 North Claret Dr., Suite 400 18655 North Claret Dr., Suite 400
Current Mailing Address Current Street Address
Scottsdale AZ 85255 Scottsdale AZ 85255
City State Zip ,1 City State Zip
9. Deed Book No.671 8 Page No.843 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.
Meritage Homes of the Carolinas, Inc. [e-mail]
Name E-mail Address
3300 Paramount Parkway, Suite 120 3300 Paramount Parkway, Suite 120
Current Mailing Address Current Street Address
Morrisville NC 27560 Morrisville NC 27560
City State Zip City State Zip
Telephone [phone] Fax Number

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:
Corporation Service Company [e-mail]
Name E-mail Address
2626 Glenwood Avenue, Suite 550 2626 Glenwood Avenue, Suite 550
Current Mailing Address Current Street Address
Raleigh NC 27608 Raleigh NC 27608
City State Zip City State Zip
Telephone[phone] 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:
Scott Roylance [e-mail]
Name of Registered Agent E-mail Address
3300 Paramount Parkway, STE 120 3300 Paramount Parkway, STE 120
Current Mailing Address Current Street Address
Morrisville NC 27560 Morrisville NC 27560
City State Zip City State Zip
Telephone[phone] 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.
Scott Roylance Division President
Typ r print come Title or Authority
10 /is /2 4-
Signature Date
11—vey(•-•e <"Lc n , a Notary Public of the County of (A)c t4 L
State of North Carolina, hereby certify that ��G�� ''�"`� �r�� appeared
personally before me this day and being duly sworn acknowledged that the above form was executed
by him. 0 ,I
Witness my hand and,�n ri�r6, eal, this 5 day of C n cf , 20 2-4
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