NCC243317_FRO Submitted_20241029

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 and/
or fax information unavailable, place N/A in the blank.)
Part A.1. Project NameHarris Landing Subdivision (Lots 1-26, 84-87)
2. Location of land-disturbing activity: County Pitt City or TownshipGrifton
Highway/Street Bow Drive Latitude35'3966 _Longitude-77'4411
3. Approximate date land-disturbing activity will commence:June 2024
4. Purpose of development(residential, commercial, industrial, institutional, etc):Residential
5. Total acreage disturbed or uncovered(including off-site borrow and waste areas):7.1
6. Amount of fee enclosed: $ 800.00 The application fee of$100.00 per acre
(rounded up to the next acre) is assessed without a ceiling amount(Example: 8.10 ac=$900.00).
7. Has an erosion and sediment control plan been filed? YesX No EnclosedX
8. Person to contact should erosion and sediment control issues arise during land-disturbing activity:
NameAdam Wilcox E-mail [e-mail]
Telephone Cell# 919-627-0538 Fax# N/A
9. Landowner(s)of Record (attach accompanied page to list additional owners):
WJH LLC 336-517-2738
Name Telephone Fax Number
2325 Lakeview Parkway, Suite 600 2325 Lakeview Parkway, Suite 600
Current Mailing Address Current Street Address
Alpharetta GA 30009 Alpharetta GA 30009
City State Zip City State Zip
10. Deed Book No.91 Page No.187-188 Provide a copy of the most current deed.
Part B.
1. Company(ies) or firm(s) 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.
WJH LLC [e-mail]
Name E-mail Address
2325 Lakeview Parkway, Suite 600 2325 Lakeview Parkway, Suite 600
Current Mailing Address Current Street Address
Alpharetta GA 30009 Alpharetta GA 30009
City State Zip City State Zip
Telephone[phone] Fax Number N/A

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:
Kurt Stawarz KurtS©centurycommunities.com
Name E-mail Address
9325 Center Lake Dr, Suite 160 9325 Center Lake Dr, Suite 160
Current Mailing Address Current Street Address
Charlotte NC 28216 Charlotte NC 28216
City State Zip City State Zip
Telephone[phone] Fax Number N/A
(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:
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
Telephone N/A Fax Number N/A
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 be any change in the information provided herein.
Kurt Stawarz Regional President-Mid Atlantic Region
Type or print na darAIIImmr Title or Authority
10/22/2024
g a . 0 Date
I, L>n 11,e el") ilOt , a Notary Public of the County of
State of North Carolina, hereby certify that i.ti4 -.34,:v 1, r Z- appeared
personally before me this day and being duly sworn acknowledged that the above form was
executed by him.
Witness my tkeakierrdrrldtAyial seal, this.- ,- day of , 20 c
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