NCC215291_FRO Submitted_20210927

FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
EROSION & SEDIMENTATION CONTROL
No person may initiate any land -disturbing activity on one or more acres, '/2 acre or more inside a
watershed, as covered by the Sedimentation Pollution Control Act and the Iredell County Land
Development Code, before an acceptable erosion and sedimentation control plan has been submitted
and approved by the Iredell County Planning & Development, Erosion Control Section.
(Please type or print.)
Part A.
1. Project Name Falls Cove Phase 5-7
2.
3.
4.
Location of land -disturbing activity: County Iredell City or Township Troutman
f,
Highway/Street Autumn Leaf Road Latitude,' �.`.a`'�L� `jll�'a Ill Longitude 00 66 �
Approximate date land -disturbing activity will commence: September/October 2021
Purpose of development (residential, commercial, industrial, institutional, etc.): Residential
5. Total acreage disturbed or uncovered (including off -site borrow and waste areas): 6 -LS
6. Amount of fee enclosed: $ IUlP� . An application fee of $175.00 per acre (rounded up to the next acre) is
assessed without a ceiling amount (Example: a 9-acre application fee is $1575). For projects > than 0.5 acres but no
greater than 0.99 acres in a water supply watershed, a flat fee of $135.00 is assessed.
7. Has an erosion and sediment control plan been filed? Yes X No Enclosed
8. Person to contact should erosion and sediment control issues arise during land -disturbing activity:
Name George Bartley Carroll E-mail Address [e-mail]
Telephone [phone] Cell # Fax #
9. Landowner(s) of Record (attach accompanied page to list additional owners):
D.R. Horton, Inc. 704-620-7373
Name Telephone Fax Number
8025 Arrowridge Blvd
Current Mailing Address Current Street Address
Charlotte NC 28273
City State Zip City State Zip
10. Deed Book No. Page No. Provide a copy of the most current deed.
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):
George Bartley Carroll (D.R. Horton, Inc.) [e-mail]
Name E-mail Address
8025 Arrowridge Blvd
Current Mailing Address Current Street Address
Charlotte NC 28273
City State Zip City State Zip
Telephone [phone] Fax Number
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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:
CT Corp [e-mail]
Name E-mail Address
150 Fayetteville Street
Current Mailing Address Current Street Address
Raleigh NC 27601
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
Telephone Fax Number
State Zip
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.
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Type or --on t namr� - e Title or Authority
Signature Date
I, h V. dddrS ��a°°Notary Public ofthe County of I/�C
State of North Carolina, hereby certify that l-rP( 'CaP LL=c+ie�l l Uo appeared personally before me this day
and being duly sworn acknowledged that the above Urn was exe ted by him.
Witness my hand and notarial seal, this day of ' E?M Pr , 20
s
a �La
Seal Notary
My commission expires )
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