NCC222779_FRO Submitted_20220804

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 Soil Erosion and
Sedimentation Control Ordinance of the City of Greenville (Title 9, Chapter 8) before this form and an
acceptable erosion and sedimentation control plan have been completed and approved by the City of
Greenville, Engineering Division. (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 Carter Ridge Subdivision — Ph. 1 (Single Family Home Construction
2. Location of land -disturbing activity: County Pitt City or Township Greenville
Highway/Street B's Barbeque Road Latitude 35.617786N _ Longitude-77.426597W
3. Approximate date land -disturbing activitywill commence: July 2022
4. Purpose of development (residential, commercial, industrial, institutional, etc.): residential
5. Total acreage disturbed or uncovered (including off -site borrow and wasteareas): 17.0 acres _
6. Amount of fee enclosed: $ 1.700 _ . The application fee of $100.00 per acre (rounded
to the tenth of acre) is assessed without a ceiling amount (Example: a 9-acre application fee is$900).
7. Has an erosion and sediment control plan been filed? Yes No Enclosed X
8. Person to contact should erosion and sediment control issues arise during land -disturbing activity:
Name Chris Ahlers E-mail Address cahlers(c-Ddrhorton.com
Telephoneg19-460-2943 Cell # _336-312-6567 Fax #
9. Landowner(s) of Record (attach accompanied page to list additional owners):
LeoTerra Greenville. LLC 336-279-7280 N/A
Name Telephone Fax Number
110 Shields Park Drive. Suite A 110 Shields Park Drive, Suite A
Current Mailing Address Current Street Address
Kernersville NC 27284 Kernersville NC 27284
City State Zip City State Zip
10. Deed Book No. 3852 Page No. 661-672 Provide a copy of the most current
deed.
Part B.
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):
DR Horton - Central Carolina Division cahlers(G�,drhorton.com
Name E-mail Address
2000 Aerial Center Parkway, Suite 110 2000 Aerial Center Parkway. Suite 110
Current Mailing Address Current Street Address
Morrisville _
City
NC
State
27560
92
Morrisville NC 27410
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:
Name
Current Mailing Address
City
Telephone
E-mail Address
Current Street Address
State Zip City
Fax Number
State
Zip
(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
E-mail Address
Current Street Address
City State Zip City State Zip
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.
Type or print name Title or Authority r
r'
S natu a 0 Date
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a Notary Public of the County of
State of North Carolina, hereby certify that LEE�CS 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
S ELAINE HUDSPETH
Notary Public
North Carolina
Seal Forsyth County
day of �2 , 20
o ary
My commission expires u ZQ?-L—