NCC242707_FRO Submitted_20240904

NC Dept of Environmental Qualin
FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
SEDIMENTATION POLLUTION CONTROL ACT MAR 2 Q
EXPRESS PERMITTING OPTION
No person may initiate any land-disturbing activity on one or more acres as covered by the ActOftf : inai Office
and an acceptable erosion and sedimentation control plan have been completed and approved be =
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 Legacy Phase 2
2 Location of land-disturbing activity: County Franklin City or Township Youngsvllle
Highway/Street Hicks Road Latitudea eidegr,e 36.1:69626 Long itudem meiae9reeg) 78458302
3 Approximate date land-disturbing activity will commence.April 2023
4 Purpose of development (residential, commercial, industrial, institutional, etc.):Residential
5 Total acreage disturbed or uncovered (including off-site borrow and waste areas): 32.06
$3,CC.,.Q0+$2,000 00 -t 430� -pi/y\
6. Amount of fee enclosed The Express Permitting application fee is a dual charge
The normal fee of$100 00 per acre (rounded up to the next acre) is assessed without a ceiling amount
In addition, the Express Permitting supplement is$250 per acre up to eight acres, after which the Express
Permitting supplemental fee is a fixed$2,000 00 (Example 8 10-acre application fee is$2,900). Checks
should be addressed to NCDEQ
7 Has an erosion and sediment control plan been filed? Yes❑x Enclosed ❑x No ❑
8. Person to contact should erosion and sediment control issues arise during land-disturbing activity:
Name LGI Homes [e-mail]
Phone: Office# N/A Mobile# [phone]
9. Landowner(s) of Record (attach accompanied page to list additional owners):
TRINITY GROUP INVESTMENTS LLC N/A 919-669-7570
Name Phone: Office# Mobile#
Steven D. Hayes 28 HAYES CT
Current Mailing Address Current Street Address
28 HAYES CT Frankliton, NC 27525
City State Zip City State Zip
10. Deed Book No.2026 Page No. 642-644 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)rs
an individual(s), the name(s)of the owner(s)may be listed as the financially responsible party(ies).
LGI Homes [e-mail]
Company Name E-mail Address
5511 Capital Center Drive, Suite 560 5511 Capital Center Drive, Suite 560
Current Mailing Address Current Street Address
Raleigh NC 27612 Raleigh NC 27612
City State Zip City State Zip
Phone: Office# N/A Mobile# [phone]
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:
LGI Homes-NC, LLC [e-mail]
Name of Registered Agent E-mail Address
5511 Capital Center Drive, Suite 560 5511 Capital Center Drive, Suite 560
Current Mailing Address Current Street Address
Raleigh NC 27612 Raleigh NC 27612
City State Zip City State Zip
Mobile# [phone]
Phone: Office# N/A
Josh Spiegel
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:
N/A N/A
Name of Registered Agent E-mail Address
N/A N/A
Current Mailing Address Current Street Address
N/A N/A
City State Zip City State Zip
Phone: Office# N/A Mobile# N/A
N/A
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.
N/A
Company DBA Name
(d) If order to facilitate Express 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:
The Nau Comapny, PLLC [e-mail]
Engineering firm or other consultant E-mail Address
Timothy P. Nau, PE N/A 919-625-3090
Individual contact person (type or print) Phone: Office# Mobile#
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.
Josh Spiegel /t/4,,,, :74-1 -
Type or print n me Title or Authority
--r/Zo/S o Z3
ignature Da
I, MPrt\N . &..ehu iO , a Notary Public of the County of ��GE
State of North Carolina, hereby certify that 1GS EC'lElr 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 1,0 day of MI Ct- , 20 21
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Continued from Items 9 & 10 in Part A of the Financial Responsibility/Ownership Form for multiple
owners. Attach copies of this page as needed to list all landowners.
Landowner 2 of Record:
N/A N/A N/A
Name Phone: Office# Mobile#
N/A N/A
Current Mailing Address Current Street Address
N/A N/A
City State Zip City State Zip
Deed Book No. N/A Page No. N/A Provide a copy of the most current deed
Landowner 3 of Record
N/A N/A N/A
Name Phone Office # Mobile#
N/A N/A
Current Mailing Address Current Street Address
N/A N/A
City State Zip City State Zip
Deed Book No N/A Page No. N/A Provide a copy of the most current deed
Landowner 4 of Record:
N/A N/A
Name Phone: Office# Mobile #
N/A N/A
Current Mailing Address Current Street Address
N/A N/A
City State Zip City State Zip
Deed Book No. N/A Page No. N/A Provide a copy of the most current deed
Landowner 5 of Record:
N/A N/A N/A
Name Phone: Office# Mobile#
N/A N/A
Current Mailing Address Current Street Address
N/A N/A
City State Zip City State Zip
Deed Book No. N/A Page No. N/A Provide a copy of the most current deed

Continued from Item 9 in Part B of the Financial Responsibility/Ownership Form for multiple parties.
Attach copies of this page as needed to list all financially responsible parties.
N/A N/A
Company 2 Name E-mail Address
N/A N/A
Current Mailing Address Current Street Address
N/A N/A
City State Zip City State Zip
Phone: Office# Mobile# N/A
N/A N/A
Company 3 Name E-mail Address
N/A N/A
Current Mailing Address Current Street Address
N/A N/A
City State Zip City State Zip
Phone: Office# N/A Mobile# N/A
N/A N/A
Company 4 Name E-mail Address
N/A N/A
Current Mailing Address Current Street Address
N/A N/A
City State Zip City State Zip
Phone: Office# N/A Mobile# N/A
N/A N/A
Company 5 Name E-mail Address
N/A N/A
Current Mailing Address Current Street Address
N/A N/A
City State Zip City State Zip
Phone: Office# N/A Mobile# N/A