NCC216968_FRO Submitted_20211216

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. (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 Name Dolcetto Subdivison - Phase 1
2. Location of land -disturbing activity: County Davidson
City or Township Lexington
Highway/Street Biesecker Rd & west center St Latitude 35.8452 Longitude-80.2766
3. Approximate date land -disturbing activity will commence: Summer 2021
4. Purpose of development (residential, commercial, industrial, institutional, etc.):
Residential
5. Total acreage disturbed or uncovered (including off -site borrow and waste areas): 19.25 ac
6. Amount of fee enclosed: $ 1 ,300 . The application fee of $65.00 per acre (rounded
up to the next acre) is assessed without a ceiling amount (Example: a 9-acre application fee is $585).
7. Has an erosion and sediment control plan been filed? Yes X No Enclosed X
8. Person to contact should erosion and sediment control issues arise during land -disturbing activity:
Name Jessica Meyer E-mail Address [e-mail]
Telephone [phone] cell # n/a Fax # n/a
9. Landowner(s) of Record (attach accompanied page to list additional owners):
NEW VENTURES LAND DEVELOPMENT LLC n/a
Name Telephone
3409 UNION GROVE RD n/a
n/a
Fax Number
Current Mailing Address
Current Street Address
WINSTON SALEM NC 27127
n/a
City State Zip
City State Zip
10. Deed Book No. 2390 Page No. 1 1 1 1 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.
DR Horton
[e-mail]
Name
E-mail Address
2000 Aerial Center, Suite 110
n/a
Current Mailing Address
Current Street Address
Morrisville NC 27560
n/a
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:
n/a n/a
Name E-mail Address
n/a n/a
Current Mailing Address
n/a
City State Zip
Telephone n/a
Current Street Address
n/a
City State Zip
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
Name of Registered Agent
n/a
Current Mailing Address
n/a
City
Telephone n/a
n/a
E-mail Address
n/a
Current Street Address
n/a
State Zip City State Zip
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.
Jess i c'1' M-wr- � U�S-Tp cbyxj c, l Oo/np tidnu ir►-,�ni
Type or print name Title or Authority
q,gLtq
Sig ture Date
a Notary Public of the County of Rk�C.�y'F
State of North Carolina, hereby certify that,J�SS��—Pr ����cl�- appeared
personally before me this day and being duly sworn acknowledged that the above form was
executed by him.
Witness my hand and notarial seal, this "1 day ofAC&CeLA - ri 20 ,:,-�
NOTARY PUBLIC
GINA K. I'ACTSINGER
FORSYTH COUNTY, NO
My Ccvrcnissbn DO —Seal
otary
t
My commission expires

The lots are currently split amongst two owners: Zebulon Mini -Storage
Group, LLC and SDH Raleigh, LLC. The intent of this land disturbance
permit is to provide coverage for lots 38-57 & 61-83. SDH Raleigh, LLC
owns Lots 39-42, 44, 75, 77-80. Zebulon Mini -Storage Group, LLC owns
the remaining lots: 38, 43, 45-57, 61-74, 76, 81-83. Zebulon Mini -Storage
Group LLC contact information is as follows:
Zebulon Mini -Storage Group, LLC
701 Patetown Road
Goldsboro, NC 27530