NCC232723_FRO Submitted_20230911

MAR 31 2021
FINANCIAL RESPONSIBILITY/OWNERSHIP FORM Raleigh Regional Offic©
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 and/or fax information
unavailable,place N/A in the blank.)
Part A.
Laurel Oaks Phase 2 7
1. Project Name
2. Location of land-disturbing activity: County Lee / City or Township Sanford
Highway/Street Commerce Drive Latitude 35°25'16.60" Longitude 79°07'36.67"
3. Approximate date land-disturbing activity will commence: April 2021
4. Purpose of development(residential,commercial, industrial, institutional,etc.): Residential
5. Total acreage disturbed or uncovered(including off-site borrow and waste areas): 30
6. Amount of fee enclosed: $ 1,950 . The application fee of$65.00 per acre (rounded
up to the next acre) is assessed without a ceiling amount (Example: a 9-acre application fee is$585).
7. Has an erosion and sediment control plan been filed? Yes No Enclosed X
8. Person to contact should erosion and sediment control issues arise during land-disturbing activity:
Name Chris Ahlers E-mail Address [e-mail]
Telephone [phone] Cell# 336-312-6567 Fax#
9. Landowner(s)of Record(attach accompanied page to list additional owners):
SFTEN, LLC 919-460-2999
Name Telephone Fax Number
2000 Aerial Center Parkway Suite 110 same
Current Mailing Address Current Street Address
Morrisville, NC 27560 same
City State Zip City State Zip
10. Deed Book No.°1683 Page No.0424 - Provide a copy of the most current deed.
Part B.
1. Company(ies) or firms) 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 [e-mail]
Name E-mail Address
7208 Falls of Neuse Road Suite 201 Same
Current Mailing Address Current Street Address
Raleigh, NC 27615 Same
City State Zip City State Zip
Telephone[phone] Fax Number- -

d �
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:
D.R. Horton, INC d
Name E-mail Address
7208 Earls of Neuse Road Suite 201 same
Current Mailing Address Current Street Address
Raleigh, NC 27615 same
City State Zip City State Zip
Telephone[phone] 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
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 be any change in the information provided herein.
Tracey Davis Division NPDES Administrator
T or print name Title or Authority
02/07/2023
n ure Date
a Notary Public of the County otan
State of North Carolina,hereby certify t TE-4-4 t l�v�(S appeared personally
before me this day and being duly sworn acknowledge that the above form was executed by him/her.
Witness my hand and notarial seal,this day of ,20 a3
*ii.)(N\rvi242_1
anis Perez
NOTARY PUBLIC 1
Johnston County My commission expires ` W p
North Carolina "(�
My Commission Expires August 4,2026