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HomeMy WebLinkAboutNCC230253_FRO Submitted_20230130FINANCIAL RESPONSIBILITY/OWNERSHIP FORM EROSION & SEDIMENTATION CONTROL No person may initiate any land -disturbing activity on one or more acres, '/2 acre or more inside a watershed, as covered by the Sedimentation Pollution Control Act and the Iredell County Land Development Code, before an acceptable erosion and sedimentation control plan has been submitted and approved by the Iredell County Planning & Development, Erosion Control Section. (Please type or print) Part A. 1. Project Name Lakeshore at Windstone formerly known as Lakeshore Subdivision /i 3. 4. 5. 6. 7. S. Al Location of land -disturbing activity: County Iredell City or Township Mooresville Highway/Street Penn Road/Lakeshore school Rd. Latitude 35.610805 Longitude -80.891378 Approximate date land -disturbing activity will commence: February 2023 Purpose of development (residential, commercial, industrial, institutional, etc.): Residential Total acreage disturbed or uncovered (including off -site borrow and waste areas): 20 Amount of fee enclosed: $ N/A . An application fee of $175.00 per acre (rounded up to the next acre) is assessed without a ceiling amount (Example: a 8.10-acre application fee is $1575). For projects > than 0.5 acres but no greater than 0.99 acres in a water supply watershed, a flat fee of $100.00 is assessed. Has an erosion and sediment control plan been filed? Yes x No Enclosed Person to contact should erosion and sediment control issues arise during land -disturbing activity: Name George Bartley Carroll E-mail Address BCarroll@drhorton.com Telephone 704-620-7373 Cell # SAME Fax# Landowner(s) of Record (attach accompanied page to list additional owners): D.R. Horton, Inc. 704-620-7373 Name Telephone Fax Number 8025 Arrowridge Blvd. SAME Current Mailing Address Current Street Address Charlotte. NC 28273 City State Zip City State Zip 10. Deed Book No. 2971 Page No. 26-29 Provide a copy of the most current deed. Part B. 1. Person(s) or firms) who are financially responsible for the land -disturbing activity (Provide a comprehensive list of all responsible parties on an attached sheet): George Bartley Carroll (D.R. Horton, Inc.) BCarroll@drhorton.com Name E-mail Address 8025 Arrowridge Blvd SAME Current Mailing Address Current Street Address Charlotte NC 28273 City State Zip City State Zip Telephone 704-620-7373 Fax Number __ Page 1 of 2 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 State Telephone. E-mail Address Current Street Address Zip City State Fax Number 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: CT Coporation System Name of Registered Agent 160 Mine Lake Ct Current Mailing Address Raleigh NC 27615 City State Zip Telephone 919-821-7139 info@atadvantage.com E-mail Address Current Street Address City State Fax Number Zip 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 by any change in the information provided herein. George Bartley Carroll Typ r print na e Sign ure NPDES Manager Title or Authority 1 /23/2023 Date ILonQ1 a Notary Public of the County of JMeCXlehbN_ (� eareersonall before me this da State of North Carolina, hereby certify that C 80%e:H � ap' Y Y and being duly sworn acknowledged that the above orm was executell by him. Witness my hand and notarial seal, this ?! day of Uh 20�-� otary Seal �' a2Do�� My commis/onxpires _ EMy LOGAN F. CREECH tary Public, North Carolina Mecklenburg County Commission Expires March 03, 2027 Page 2 of 2