NCC217002_FRO Submitted_20211217

FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
SEDIMENTATION POLLUTION CONTROL ACT
EXPRESS PERMITTING OPTION
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.
1. Project Name,
2.
3.
4.
Craeberne Forest
Location of land -disturbing activity: County Craven
City or Township New Bern
Highway/Street Walton Drive Latitude 35.101111 Longitude
Approximate date land -disturbing activity will commence: October 2021
-77.135278
Purpose of development (residential, commercial, industrial, institutional, etc.): residential
5. Total acreage disturbed or uncovered (including off -site borrow and waste areas): 3.0 Acres
6. Amount of fee enclosed: $ 945.00 . The Express Permitting application fee is a dual
charge. The normal fee of $65.00 per acre (rounded up to the next acre) is assessed without a ceiling
amount. In addition, the Express Permitting supplement is $250.00 per acre up to eight acres, after
which the Express Permitting supplemental fee is a fixed $2,000.00 (Example: 9 acres total is $2,585).
7. Has an erosion and sediment control plan been filed? Yes X No Enclosed X
8. Person to contact should erosion and sediment control issues arise during land -disturbing activity:
Name Jessica Meyer E-mail Address JAM [e-mail]
Telephone [phone] Cell # 919-215-6561
9. Landowner(s) of Record (attach accompanied page to list additional owners):
D.R. Horton, Inc.
Name
2000 Aerial Center Parkway, Suite 110A
Current Mailing Address
Morrisville
City
10. Deed Book No.
NC 27560
State Zip
919-460-2999
Telephone
2000 Aerial Center Parkwa
Current Street Address
Morrisville NC
City State
N/A
Fax Number
Suite 110A
27560
WE
Page No. 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.
D.R. Horton, Inc.
Name
[e-mail]
E-mail Address
2000 Aerial Center Parkway, Suite 110A 2000 Aerial Center Parkway, Suite 110A
Current Mailing Address Current Street Address
Morrisville NC 27560
City State Zip
Morrisville NC 27560
City
State
0

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:
Name
Current Mailing Address
City
Telephone
E-mail Address
Current Street Address
State Zip City
Fax Number
State Zip
(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:
Name of Registered Agent
Current Mailing Address
City
Telephone
E-mail Address
Current Street Address
State Zip City State Zip
Fax Number
(c) In order to facilitate Express Permitting, it is necessary to be able to contact the Engineer or other
consultant who can assist in providing any necessary information regarding the plan and its preparation:
GR IK O cmWh n�-, ba A_p, PU►
Engineering Firm or oth r cons`ulfant
v1 Loq -F n'yu . Y L
Individual contact person (typd or print)
Sct)t z arKra-,Soli nS�ybvP, Gin
E-mail Address
o63 - 15ljFj - I old
Telephone
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.
J�sica mwe,L INPDES __�chni <«I Cb-no Ii An"
TYpe or print name Title or Authority
re
D,2pQ
Date
a Notary Public of the County of GLANZ
State of North Carolina, hereby certify th,appeared personally
before me this day and being duly sworn ackno gleeS� that the above form was executed by him.
Witness my hand and notarial seal, this ZA day of 20
ELAINE HUDSPETH
Notary Public y
Seal North Carolina �(
Forsyth County My commission expires 1 WZ