NCC233112_FRO Submitted_20231018

Pitt County
c���co�� Planning Department
I ,N ® Development Services Building
1717 W. 5th Street
Greenville, North Carolina 27834-1696
Telephone: [phone] James F Rhodes,AICP
Fax: [phone] Director
Financial Responsibility/Ownership Form
Soil Erosion and Sedimentation Control Ordinance
No person may initiate any land-disturbing activity on one or more contiguous acres as
covered by the Act before this form and an acceptable erosion and sedimentation control plan
have been completed and approved by the Pitt County Planning Department. (Please type or
print and, if question is not applicable,place N/A in the blank.)
Part A.
1. Project Name East Ridge Subdivsion- Phase 1
2. Location of land-disturbing activity: County Pitt
City or Township Avden , and Highway/Street Ayden Golf Club Rd./Queensland Ln.
3. Approximate date land-disturbing activity will be commenced: May 2023
4. Purpose of development(residential, commercial, industrial, etc.): residential
5. Approximate acreage of land to be disturbed or uncovered:10.6 acres
6. Has an erosion and sedimentation control plan been filed? Yes No X
7. Person to contact should sedimentation control issues arise during land-disturbing activity:
Name Tracey Davis Telephone [phone]
8. Landowner(s) of Record(Use blank page to list additional owners):
East Ridge Development Corporation
Name(s) Name(s)
1700 Tottenham Cir.
Current mailing address Street address
Winterville NC 28590
City State Zip City State Zip
9. Recorded in Deed Book No. 4396 Page No. 516
Part B.
1. Person(s) or firm(s) who are financially responsible for this land-disturbing activity (Use
the blank page to list additional persons or firms):
D.R. Horton -Tracey Davis
Name of person(s)or Firm(s) Name(s)
7208 Falls of Neuse Rd., Suite 201
Current mailing address Street Address
Raleigh NC 27615
City State Zip City State Zip
919-497-2163
Telephone Telephone

2. (a) If the Financially Responsible Party is a Corporation, give name and street address of
the Registered Agent.
Name(s)
Current mailing address Street Address
City State Zip City State Zip
Telephone Telephone
(b) If the Financially Responsible Party is a Partnership give the name and street address
of each General Partner(Use blank page to list additional partners):
Name(s) Name(s)
Current mailing address Current mailing address
City State Zip City State Zip
Telephone Telephone
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/her attorney-in-fact or if not an individual by an officer, director, partner, or
registered agent with 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. T -ThArLcScb n NPDES Aarn'om.rkrjr
Ty or rin��'ame ' Title r Authority
(Q `F� i Z'2023
Signature ���� Jr Date
I, mvn S0.LLi1 c e) S , a Notary Public of the County of W Ctk '- State
of North Ca olina,hereby certify that f m. e ! I l nA.Vl S
appeared personally before me this day and being day sworn acknowledged that the above form
was executed by him.
Witness my hand and notarial seal this I 2_ day of Op(1 I . 20 a 3
� SAUAid,",,, Notary !! I r rn
�1S51pn,O�'�',i� My co ission expires u l `i (90.2
� NOTAR).
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