NCC232429_FRO Submitted_20230811

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= ° a SOIL EROSION and SEDIMENTATION CONTROL
Lincoln County Natural Resources Department
RP.SOG es 115 West Main Street, Lincolnton, NC 28092 704-736-8501 Fax: [phone]
FINANCIAL RESPONSIBILITY / OWNERSHIP FORM
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 has been completed and approved by the Lincoln County Natural Resources Department.
(Please type or print. 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 Stratford Subdivision Phases 3&4
2. Location of land-disturbing activity: Latitude 35.512771 Longitude-80.997556
Parcel Identification Number(PIN)29612 Watershed Areallone
Highway/Street Address 2720 N NC 16 Business Hwy
3. Approximate date land-disturbing activity will commence:8/14/23
4. Purpose of development(residential,commercial,industrial,institutional,etc.): Residential
5. Total acreage disturbed or uncovered(including off-site borrow and waste areas):21.9
6. Amount of fee enclosed:$Paid previously .The Standard Permitting application fee of$200.00 per acre
(rounded up to the next acre)is assessed without a ceiling amount(Example:9 acres total$1,800).The Express
Permitting application fee is a dual charge. The normal fee of$200.00 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$3,800.00).
7. Has an erosion and sediment control plan been filed? YesX No Enclosed
8. Local appointed person to contact should erosion and sediment control issues arise during land-disturbing activity:
NameChris Collins E-mail [e-mail]
Telephone[phone] Cell# 336-580-8892 Fax#
9. Landowner(s)of Record (attach accompanied page to list additional owners):
Stanley Martin Homes,LLC 704.423.8988
Name Telephone Fax Number
11710 Plaza America Dr Suite 1100 11710 Plaza America Dr Suite 1100
Current Mailing Address Current Street Address
Reston VA 20190 Reston VA 20190
City State Zip City State Zip
10. Deed Book No.3027 Page No.884-886 most recently filed in Lincoln County Register of Deeds.
11. Future Landowner(s)if applicable: (attach accompanied page to list additional owners):
N/A
Name Telephone Fax Number
Current Mailing Address Current Street Address
City State Zip City State Zip

ArgilSOIL EROSION and SEDIMENTATION CONTROL
Lincoln County Natural Resources Department
115 West Main Street, Lincolnton, NC 28092 704-736-8501 Fax: [phone]
FINANCIAL RESPONSIBILITY / OWNERSHIP FORM
Part B
1. Person(s)or firm(s)who are financially responsible for the land-disturbing activity(Provide a comprehensive
list of all responsible parties on an attached sheet):
Stanley Martin Homes, LLC
Name E-mail Address
820 Forest Point Cr Suite 100
Current Mailing Address Current Street Address
Charlotte NC 28273
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:
Name E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Telephone 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:
Name of Registered Agent E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Telephone Fax Number
(c)In order to facilitate 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:
CES Group Engineers LLP [e-mail]
Engineering Firm or other consultant E-mail Address
3525 Whitehall Park Dr Suite 150 Charlotte NC 28273
Current Mailing Address City State Zip
Sean Coldren 704-325-5425 N/A
Individual contact person(type or print) Telephone Fax Number

G°�N �oGy SOIL EROSION and SEDIMENTATION CONTROL
Lincoln County Natural Resources Department
&wg - 115 West Main Street, Lincolnton, NC 28092 704-736-8501 Fax: [phone]
FINANCIAL RESPONSIBILITY / OWNERSHIP FORD
(d)Contractors and/or Subcontractors(person(s)or firm(s)engaging in the land-disturbing activity:
SM Smith and Sons, Inc
Name of Person or Firm Name of Person or Firm
261 Hwy 24/27 W
Current Mailing Address Current Street Address
Midland NC 28107
City State Zip City State Zip
Mark Turner
Individual contact person(type or print)Individual contact person(type or print)
704-545-4177
Telephone Telephone
Fax Number704-545-4172 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 by any change in the information provided
herein and any other associated documents. I understand that all documents that are associated with this project and
project number are parts of the complete project document.
Permission to Enter on Land
I certify that I am authorized to grant and do in fact grant permission to the Natural Resources Erosion Control Inspector
and his agents to enter on the land in question in connection and/or related to this permit.
Ron Willing Director of Land Development
Typ t me
Title or Authority
8/8/23
Signature Date
I, ' esboglitSiloNIN GAV i di0. ,a Notary Public of the County of , kr tu'bo r
State of North Carolina,hereby certify that ROB C.v►1ti ng appeared personally before
me this day and being duly sworn acknowledged that the above form was executed by him.
Witness my hand and notarial seal,this p day of u ,20 .23
Seal SEBASTIAN GAVIDIA ( ry
I Notary Public-North Carolina I My commission expires a 11ZS/la2''
( Mecklenburg County
My Commission Expires Jan 25,2027