NCC215342_FRO Submitted_20210928

Print Form
SOIL EROSION and SEDIMENTATION CONTROL
a Lincoln County Natural Resources Department
Rcsou es 115 West Main Street, Lincolnton, NC 28092 704-736-8501 Fax: [phone]
FINANCIAL RESPONSIBILITY 1 OWNERSHIP FORM
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 has been completed and approved by the Lincoln County Natural Resources Department.
(Please type or print. If the question is not applicable or the e-mail and/or fax information unavailable, place NIA in the blank.)
Part A
1. Project Name Sylvan Creek
2. Location of land -disturbing activity: Latitude35.5263 Longitude-81.0189
Parcel Identification Number (PIN)3695814810 Watershed Area Lake Wylie
Highway/Street Address3387 N NC 16 Business Hwy
3. Approximate date land -disturbing activity will commence: September/October 2021
4. Purpose of development (residential, commercial, industrial, institutional, etc.): Residential
5. Total acreage disturbed or uncovered (including off -site borrow and waste areas): (n �4 . y
6. Amount of fee enclosed: $ N/A . The Standard Permitting application fee of $200.00 per acre
(rounded up to the next acre) is assessed without a ceiling amount (Example: 9 acres total $1,800). The Express
Permitting application fee is a dual charge. The normal fee of $200.00 per acre (rounded up to the next acre) is
assessed without a ceiling amount. In addition, the Express Permitting supplement is $250.00 per acre up to eight
acres, after which the Express Permitting supplemental fee is a fixed $2,000.00 (Example: 9 acres total $3,800.00).
7. Has an erosion and sediment control plan been filed? Yes No Enclosed X
8. Local appointed person to contact should erosion and sediment control issues arise during land -disturbing activity:
Name George Bartley Carroll E-mail Address BCarroll(a,drhorton.com
Telephone[phone] Cell # SAME 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 Arrowridqe Blvd
Current Mailing Address Current Street Address
Charlotte NC 28273
City State Zip City State Zip
10. Deed Book No. Page No. most recently filed in Lincoln County Register of Deeds
11
Future Landowner(s) if applicable: (attach accompanied page to list additional owners):
N/A
Name Telephone Fax Number
Current Mailing Address Current Street Address
City State Zip City State Zip

SOIL EROSION and SEDIMENTATION CONTROL
a Lincoln County Natural Resources Department
er"s" uRs 115 West Main Street, Lincolnton, INC 28092 704-736-8501 Fax: [phone]
FINANCIAL RESPONSIBILITY 1 OWNERSHIP FORM
Part B
1. Person(s) or firm(s) who are financially responsible for the land -disturbing activity (Provide a comprehensive
list of all responsible partiesonan attached sheet):
George Bartley Carroll / R. [e-mail]
Name ! I E-mail Address
8025 Arrowridge Blvd
Current Mailing Address Current Street Address
Charlotte NC 28273
City State Zip
Telephone [phone]
City State Zip
Fax Number
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 Streeet
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
Current Mailing Address
City State
Telepho
E-mail Address
Current Street Address
Zip City State
Fax Number
Zip
(c) In order to facilitate 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:
Stewart Engineering
Engineering Firm or other consultant E-mail Address
101 N Tryon Street Suite 1400
Current Mailing Address City State Zip
James Carpenter
Individual contact person (type or print) Telephone Fax Number

pro SOIL EROSION and SEDIMENTATION CONTROL
:. Lincoln County Natural Resources Department
NATURAL 115 West Main Street, Lincointon, NC 28092 704-736-8501 Fax: [phone]
RPSOGRCFS
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FINANCIAL RESPONSIBILITY 1 OWNERSHIP FORM
(d) Contractors and/or Subcontractors (person(s) or firm(s) engaging in the land -disturbing activity:
Name of Person or Firm
Current Mailing Address
Name of Person or Firm
Current Street Address
City State Zip City State Zip
Individual contact person (type or print) Individual contact person (type or print)
Telephone
Fax Number
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 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 and any other associated documents. I understand that all documents that are associated with this project and
project number are parts of the complete project document.
Permission to Enter on Land
I certify that I am authorized to grant and do in fact grant permission to the Natural Resources Erosion Control Inspector
and his agents to enter on the land in question in connection and/or related to this permit.
George Bartley Carroll
7,,,,r print na e
1
Signature
NPDES Manager
Title or Authority
9/16/2021
Date
1PS a Notary Public of the County of
State of North Carolina, hereby certify that Gee- aS-�tie,A Lof {C\ � appeared personally before
me this day and being duly sworn acknowledged thathe above for as executed by him.
Witness my hand and notarial seal, this day of 20 ` n
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Notary
Seal
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My commission expires +

Sylvan Creek
NOTICE:
On 9/16/2021, NC16-198, LLC. closed on the sale of the Sylvan Creek project and transferred all
asset(s) and related entities to D.R. Horton, Inc.
NC16-198, LLC. Has granted permission and approval to D.R. Horton, Inc. to transfer and
continue to use the State/County approved plans for Sylvan Creek.
NC16-198, LLC. Is submitting a request for Lincoln County to terminate coverage(s) and all
liabilities related to the Sylvan Creek Project.
Print Name: Zach Tran
Signature: zacnr ep16,202110:47EDT) Date: 09/16/2021