NCC222440_FRO Submitted_20220707

PLAN REVIEW/FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
CATAWBA COUNTY CODE OF ORDINANCES, CHAPTER 16 ARTICLE V
SOIL EROSION AND SEDIMENTATION CONTROL
No person may initiate any land -disturbing activity on one or more acres as covered by the Ordinance before this form
and an acceptable erosion and sedimentation control plan have been completed and approved by the Catawba County
Utilities and Engineering Department. (Please type or print, and if question is not applicable, please N/A in the blank)
PART A
1. Job Name Fhe Villages of Maiden
2. PIN or 911 Address 364705099676,364705290614,364817117545,364817114334,364705097932,364705098919,364705098428
3. Purpose of development (residential, commercial, industrial, institutional,etc.) Residential
4. Approximate soil disturbance date duly 8, 2022
5. Total acreage disturbed or uncovered (including off -site borrow and waste areas) 175 acres
6. Has an erosion and sedimentation control been filed? 5 Yes F- No r Attached
7. If you have an Erosion Control billing account, would you like this to be billed? F Yes No
Account Number IN/A
PEOPLE
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 # same Fax #
9. Landowner(s) of Record (attach accompanied page to list additional owners)
Name lCarolina Mills 1/JW Abernathy Plant. Telephone N/A Fax #
Current Mailing Address jPO Box 157
City Maiden State
Current Street Address 13364 S US 321 HWY
NC Zip 28650
City Maiden State rN C Zip F8650
10. Deed Book No. 2811 Page No. 1406
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 attached sheet):
Name D.R. Horton/George Bartley Carroll E-mail address [e-mail]
Current Mailing Address 18025 Arrowridge Blvd
City harlotte State C Zip 8273

Current Street Address 025 Arrowridge Blvd
City harlotte State FN C ZipF8273
Telephone [phone] Fax #
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:
NameF___ E-mail address
Current Mailing Address
City
Current Street Address
State Zip
City State Zip
Telephone 1 Fax # 1
2. (b) If the financially responsible party is a Partnership or other person engaging in business under 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 iCT Corporation System E-mail address [e-mail]
Current Mailing Address 160 Mire Lake Ct suite 200
City Raleigh State FC Zip 27615
Current Street Address 1160 Mire Lake Ct suite 200
City Raleigh State NC ZipF7615
Telephone [phone] Fax #
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.
�Cor 2 'Bartle Carroll NPDES Ma�ncke.r
Type rint e Title of Authority
611�12o2z
SignattdK Date
I, IMAM t, %�E EGH a Notary Public of the County of State of North
Carolina, hereby certify that L'qg�`Fi[,+q �(�►�� appeared personally fore me this day and being duly
sworn acknowledge that the above was exec ted by him.
Witness my hand and notary seal, this 1 D'yday of �VV t , 20a
Seal
LOGAN F. CREECH Not
Notary Public, North Carolina 313�
Mecklenburg County M om ssion expires
My Commission Expires
March 03, 2027 Print Form