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HomeMy WebLinkAboutNCC231766_FRO Submitted_20230607 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 Covington Place Subdivision 2. Location of land-disturbing activity: County Caldwell City or Township Cajahs Mountain Highway/Street Covington Way Latitude(decimal degrees)35.8481 Longitude(decimal degrees)-81.5341 3. Approximate date land-disturbing activity will commence: 3-15-23 4. Purpose of development (residential, commercial, industrial, institutional, etc.): Residential 5. Total acreage disturbed or uncovered (including off-site borrow and waste areas): 18.00 1,800-Already PAID 6. Amount of fee enclosed: $ . 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 ❑ Enclosed X No ❑ 8. Person to contact should erosion and sediment control issues arise during land-disturbing activity: Katie Dyess katie.dyess@centurycommunities.com Name E-mail Address 704-488-1100 704-488-1100 Phone: Office# Mobile# 9. Landowner(s)of Record (attach accompanied page to list additional owners): WJH LLC 704-488-1100 Name Phone: Office# Mobile# 9390 E. Crescent Pky Ste. 650 Current Mailing Address Current Street Address Greenwood Village, CO 80111 City State Zip City State Zip 10. Deed Book No. 2077 Page No. 1823 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). WJH LLC katie.dyess@centurycommunities.com Company Name E-mail Address 9390 E. Crescent Pky Ste. 650 Current Mailing Address Current Street Address Greenwood Village, CO 80111 City State Zip City State Zip Phone: Office# 704-488-1100 Mobile# 704-488-1100 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: 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) (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: CT Corporation System Name of Registered Agent E-mail Address 160 Mine Creek Ct.; Ste 200 Current Mailing Address Current Street Address Raleigh NC 27615 City State Zip City State Zip Phone: Office# 919-944-4780 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. 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 b any change in the information provided herein. Kurt Stawarz Regional President Type or print name Title or Authority • .5/7/a?O0.5 Si ature Date I, (1 t—L%kir-.l 11- 7 )Lr a-> , a Notary Public of the County of k.. ;1 State of North Carolina, hereby certify that V r appeared personally before me this day and being duly sworn acknowledged that the above form was executed by him/her. Witness my hand and notarial seal, this day of VV A-Oi_ , 20 2) GLENN R BIRD NOTARY PUBLIC Notary Union County North Carolina My commission expires '(6 7 E7— i My Commission Expires August 23,2C 27 BK 2077 PG 1823 - 1824 (2) DOC# 10081842 This Document eRecorded: 03/01/2023 11:20:20 AM Fee: $26.00 Tax: $1,125.00 Caldwell County, North Carolina Wayne L. Rash, Register of Deeds NORTH CAROLINA GENERAL WARRANTY DEED This instrument was prepared by Merritt Law, PLLC,a licensed North Carolina attorney.Delinquent taxes,if any,to be paid by the closing attorney to the county tax collector upon disbursement of closing proceedings. Excise Tax: $1,125.00 Parcel ID No(s). 03 72 4 1, 03 72 4 2, 03 72 4 5, 03 72 4 6, 03 72 4 7, 03 72 4 8, 03 72 4 9, 03 72 4 11, 03 72 4 12, 03 72 4 13, 03 72 4 14, 03 72 4 15, 03 72 4 16, 03 72 4 18, 03 72 4 19 Mail/Box to: GRANTEE This instrument was prepared by: Merritt Law, PLLC; 1610 Dale Earnhardt Blvd., Kannapolis, NC 28083 Brief description for the Index: Lot Nos. 1,2, 5-9, 11 - 16, 18 and 19 THIS DEED, made this the 27T"day of February, 2023 by and between GRANTOR: ALL 4 U HOMES, LLC, a North Carolina Limited Liability Company (herein referred to as Grantor) whose mailing address is:4177 Olivia Lane, Rockwell, NC 28138 GRANTEE: WJH LLC,a Delaware Limited Liability Company (herein referred to as Grantee)whose mailing address is: 3091 Governors Lake Drive, Suite 300, Norcross, CA 30071 WI TNESSETH: For valuable consideration from Grantee to Grantor, the receipt and sufficiency of which is hereby acknowledged, Grantor hereby gives, grants, bargains, sells and conveys unto Grantee in fee simple, subject to the Exceptions and Reservations hereinafter provided,if any,the following described property located in Hudson Township,Caldwell County, North Carolina and more particularly described as follows: BEING ALL OF Lots Nos. 1,2; 18, and 19 COVINGTON PLACE, Phase IV, Map 1 of 2, recorded in Plat Book 38, Page 84 of the Caldwell County Registry,to which plat reference is hereby made for a more complete description thereof and ALL OF LOT Nos. 5,6, 7, 8, 9, 1'1, 1.2, 13, 14, 15, and 16,COVINGTON PLACE, Phase IV,Map 2 of 2,recorded in Plat Book, 38, Page 85 of The Caldwell County Registry,to which plat reference is hereby made for a more complete description thereof. Portion of Parent parcel No. 03-72-1-48 Property Address: Covington Place, Lenoir, NC 28645 Said property having been previously conveyed to Grantor by instrument(s) recorded in Book 2056, Page 769. A map showing the above-described property is recorded in Map Book 38, Page 85. submitted electronically by "Black, slaughter & Black, PA" in compliance with North Carolina statutes governing recordable documents and the terms of the submitter agreement with the Caldwell County Register of Deeds. BK 2077 PG 1824 DOC# 10081842 TO HAVE AND TO HOLD unto Grantee, together with all privileges and appurtenances thereunto belonging, in fee simple, subject to the Exceptions and Reservations hereinafter and hereinabove provided, if any. And Grantor hereby warrants that Grantor is seized of the premises in fee and has the right to convey same in fee simple, that title is marketable and is free and clear of encumbrances other than as set forth herein, and that Grantor will forever warrant and defend the title against the lawful claims of all persons or entities whomsoever, This conveyance is made subject to the following Exceptions and Reservations: 1) All easements, restrictions and rights of way of record 2) Those matters that a current survey would disclose 3) Ad valorem taxes for 2022 and subsequent years All references to Grantor and Grantee as used herein shall include the parties as well as their heirs, successors and assigns, and shall include the singular, plural, masculine,feminine or neuter as required by context. IN WITNESS WHEREOF, Grantor has executed this instrument as of the day and year first above written. ALL 4 U HOMES, LLC (Entity Name) . (SEAL) By: Nicole Merritt Patterson Title: Authorized Signatory STATE OF NORTH CAROLINA COUNTY OF CABARRUS I, Samara Chak, a Notary Public of the State of North Carolina County of Cabarrus do hereby certify that Nicole Merritt Patterson, Authorized Signatory of ALL 4 U HOMES, LLC personally appeared before me this day and acknowledged the due execution of the foregoing instrument for the purposes therein expressed. This the day of February,2023. \``\``�,�111f�flffJJO � s (SEAL) , `t` Notary Public Ali r' 0 My commission expires: 05/26/2026 � 's ! G r$,ltlli l6liltitii 4`