NCC230933_FRO Submitted_20230404

AUGp � 4o22
FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
SEDIMENTATION POLLUTION CONTROL ACT BY--�--.
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. Submit the completed form to the appropriate
Regional Office. (Please type or print and, if the question is not applicable or the e-mail address or phone
number is unavailable, place N/A in the blank.)
Part A.
1. Project NameSaltgrass Landing Phase 1
2. Location of land-disturbing activity: County Brunswick City or Township Bolivia
Highway 87 -78.09 34.12
Highway/Street Latitudeoecimal degrees) LongitUde(decimal degrees)
3. Approximate date land-disturbing activity will commence:August 12, 2022
4. Purpose of development (residential, commercial, industrial, institutional, etc.):Residential
5. Total acreage disturbed or uncovered (including off-site borrow and waste areas): 75.85 AC
6. Amount of fee enclosed: $76 AC*$100=$7,600 The application fee of$100.00 per acre (rounded
up to the next acre) is assessed without a ceiling amount (Example: 8.10-acre application fee is$900).
Checks should be addressed to NCDEQ.
7. Has an erosion and sediment control plan been filed? Yes❑ Enclosed ❑ No ❑x
8. Person to contact should erosion and sediment control issues arise during land-disturbing activity:
Name Ian Flannery E-mail Address [e-mail]
Phone: Office# Mobile# [phone]
9. Landowner(s) of Record (attach accompanied page to list additional owners):
Thomas Young Jr
Name Phone: Office# Mobile#
PO BOX 14
Current Mailing Address Current Street Address
Winnabow NC 28479-0014
City State Zip City State Zip
10. Deed Book No.396 Page No. 179 Provide a copy of the most current deed.

Part B.
1. Company(ies)who are financially responsible for the land-disturbing activity(Provide a comprehensive list
of all responsible parties on accompanied page.)If the company is a sole proprietorship or if the landowner(s)is
an individual(s), the name(s)of the owner(s)may be listed as the financially responsible party(ies).
D.R. Horton, Inc. [e-mail]
Company Name E-mail Address
1341 Horton Circle 1341 Horton Circle
Current Mailing Address Current Street Address
Arlington TX 76011 Arlington TX 76011
City State Zip City State Zip
Phone: Office# (817} 390-8200 Mobile#
Note: If the Financially Responsible Party is not the owner of the land to be disturbed, include with this form
the landowner's signed and dated written consent for the applicant to submit a draft erosion and sedimentation
control plan and to conduct the anticipated land disturbing activity.
2. (a) If the Financially Responsible Party is a domestic company registered on the NC Secretary of State
business registry, give name and street address of the Registered Agent:
Elizabeth Shelton [e-mail]
Name of Registered Agent E-mail Address
1341 Horton Circle 1341 Horton Circle
Current Mailing Address Current Street Address
Arlington TX 76011 Arlington TX 76011
City State Zip City State Zip
Phone: Office# [phone] Mobile#
Name of Individual to Contact (if Registered Agent is a company)
(b) If the Financially Responsible Party is not a resident of North Carolina, give name and street address
of the designated North Carolina agent who is registered on the NC Secretary of State business registry:
CT Corporation System
Name of Registered Agent E-mail Address
160 Mine Lake Ct Ste 200 160 Mine Lake Ct Ste 200
Current Mailing Address Current Street Address
Raleigh NC 27615-6417 Raleigh NC 27615-6417
City State Zip City State Zip
Phone: Office# 877-564-7529 Mobile# [phone]
Ian Flannery
Name of Individual to Contact (if Registered Agent is a company)

(c) If the Financially Responsible Party is engaging in business under an assumed name, give name under
which the company is Doing Business As. If the Financially Responsible Party is an individual, General
Partnership, or other company not registered and doing business under an assumed name, attach a copy
of the Certificate of Assumed Name.
Company DBA Name
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(s)
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 Party). I agree to provide
corrected information should there be any change in the information provided herein.
Elizabeth Shelton Vice President
Type or rint name Title or uthority
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tatu Date
Ian Flannery , a Notary Public of the County of New Hanover
State of North Carolina, hereby certify that Elizabeth Shelton appeared personally
before me this day and being duly sworn acknowledged that the above form was executed by him/her.
ii
Witness my hand and notarial seal, this irr(4 day of SU t-- , 20.2.2
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N�9.,,� Notary
�`�`�`'' '��'� 05/17/2025
NOTARY = My commission expires
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Continued from Items 9 & 10 in Part A of the Financial Responsibility/Ownership Form for multiple
owners. Attach copies of this page as needed to list all landowners.
Landowner 2 of Record:
Aveline Young
Name Phone: Office# Mobile#
PO Box 14
Current Mailing Address Current Street Address
Winnabow NC 28479-0014
City State Zip City State Zip
Deed Book No. 396 Page No. 179 Provide a copy of the most current deed.
Landowner 3 of Record:
Name Phone: Office# Mobile#
Current Mailing Address Current Street Address
City State Zip City State Zip
Deed Book No. Page No. Provide a copy of the most current deed.
Landowner 4 of Record:
Name Phone: Office# Mobile#
Current Mailing Address Current Street Address
City State Zip City State Zip
Deed Book No. Page No. Provide a copy of the most current deed.
Landowner 5 of Record:
Name Phone: Office# Mobile#
Current Mailing Address Current Street Address
City State Zip City State Zip
Deed Book No. Page No. Provide a copy of the most current deed.