NCC243492_FRO Submitted_20241120

T.
+ *** *1 Gaston County
R. '- t' Gaston Natural Resources Department
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846
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\ Soil Erosion & Sedimentation Control
0 , rc;4 Financial Responsibility/Ownership
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No person may initiate any land-disturbing activity on one (1) or more acres of property in all portions of
Gaston County, except for that property within the city limits of the incorporated municipalities of Gaston
County who have not adopted the Gaston County Soil Erosion & Sedimentation Control Ordinance,
before this form and an acceptable Soil Erosion & Sedimentation Control Plan have been completed and
approved by the Gaston County Natural Resources Department's staff.
(Please type or print and, if question is not applicable, place N/A in blank)
PART A:
1. Project Name CROWDERS CREEK-PHASE 1
2. Location of land-disturbing activity
City GASTONIA Highway/Street CARSON ROAD
3. Approximate date land-disturbing activity will commence November 1,2024
4. Purpose of development (residential, commercial, industrial, etc.) RESIDENTIAL
5. Total acreage disturbed or uncovered (including off-site borrow and waste areas) 26.55 AC
6. Amount of fee enclosed $10,800.00
7. Soil Erosion & Sedimentation Plan Filed? Yes X No
8. Landowner(s) of Record (Use blank page to list additional owners)
LENNAR CAROLINAS,LLC
Name Name
6701 CARMEL ROAD,SUITE 425
Mailing Address Mailing Address
CHARLOTTE NC 28226
City State Zip City State Zip
704.619.4658
Telephone Number Telephone Number
9. Indicate Deed Book and Page where deed(s) or instrument(s) are recorded
Deed Book 5508 Page 1194
Deed Book Page
10. Tax Map No. PARCEL ID#311342 Block Lot No.
Page 1

PART B:
1. Person(s) or firm(s)who are financially responsible for this land-disturbing activity. NOTE: if FRP is not the
Landowner of Record Part A: 8., include with this form the landowner's signed and notarized written consent for the
applicant to submit a draft erosion and sedimentation control plan and to conduct the anticipated land disturbing
activity.
LENNAR CAROLINAS,LLC SAM STALLS(VP OF LAND DEVELOPMENT)
Name Contact Name for Inspection Reports
6701 CARMEL ROAD,SUITE 425 [e-mail]
Mailing Address Email Address
CHARLOTTE NC 28226 704.759.6000
City State Zip Telephone Number
704.759.6000
Telephone Number Fax Number
2. If the Financially Responsible Party is not a resident of North Carolina, give name and street
address of a North Carolina agent.
CORPORATE CREATIONS NETWORK,INC
Name
15720 BRIXHAM HILL AVENUE#300
Mailing Address Email Address
Charlotte NC 28277 561.694.8107
City State Zip Telephone Number
3. 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
Mailing Address Email Address
City State Zip Telephone Number
4. 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 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 DIVISION PRESIDENT
Type or Print Title or Authority
/0/71112-11
Signature Date
I, 11/4d\LA 160-- (an ( 11 nS , a N tary Public of the County ofeabar rUS , State of North
Carolina, hereby certify that MG,m_. t'Y InIn appeared personally before me this day
and being duly sworn acknowledged that th above f was executed by him.
Witnes hand and notarial seal, this 2 day of OC-(pbCJ2., 202J+ .
tL (D7,:ir
Notary SEAL My Commi Sion Expires
File:Financial Responsibility-Ownership Form.mw
MELISA CUMMINS
NOTARY PUBLIC
Cabanas County Page 2
North Carolina
My Commission Expires July 4,2028