HomeMy WebLinkAboutNCC232898_FRO Submitted_20231016 D' ; �
J4N i i 2021
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 Environment and Natural Resources. (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 Waterside - Phase 1 B & 2
2. Location of land-disturbing activity: County Pender City or Township Surf City
Highway/Street HWY 50 Latitude 34.441 Longitude -77.556
3. Approximate date land-disturbing activity will commence: In Progress
4. Purpose of development (residential, commercial, industrial, institutional, etc.): Residential Homebuilding
5. Total acreage disturbed or uncovered (including off-site borrow and waste areas): 45.93
6. Amount of fee enclosed: $ . 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 Donald Aiken E-mail Address daiken@drhorton.com
Telephone NA Cell# 910-508-0017 Fax# 844-801-2132
9. Landowner(s) of Record (attach accompanied page to list additional owners):
D.R. Horton, Inc. 910-515-9561
Name Telephone Fax Number
4049 Belle Terre Blvd. 4049 Belle Terre Blvd.
Current Mailing Address Current Street Address
Myrtle Beach SC 29579 Myrtle Beach SC 29579
City State Zip City State Zip
10. Deed Book No. 4725 Page No. 1780 - 1783 Provide a copy of the most current deed.
4734 1014 - 1019
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 an attached sheet):
D.R. Horton, Inc. elshelton@drhorton.com
Name E-mail Address
131 Racine Dr., Suite 201 131 Racine Dr., Suite 201
Current Mailing Address Current Street Address
Wilmington NC 28403 Wilmington NC 28403
City State Zip City State Zip
Telephone 910-515-9561 Fax Number 844-801-2132
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 E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Telephone 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:
Elizabeth Shelton elshelton@drhorton.com
Name of Registered Agent E-mail Address
131 Racine Dr., Suite 201 131 Racine Dr., Suite 201
Current Mailing Address Current Street Address
Wilmington NC 28403 Wilmington NC 28403
City State Zip City State Zip
Telephone 910-515-9561 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.
Elizabeth Shelton Vice President
Type-or r'nt-name trvi Title or A thority
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I, 1 NJ 1t,Pr ti E , a Notary Public of the County of A)EU AAA1oL2£r`
State of North Carolina, hereby certify that .F L 17-F a►_;i•I S It =LTo) 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 5 rot day of J(kn) a 1 i , 20,1 I
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14eTA0k Notary
Seal
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