NCC222526_FRO Submitted_20220727

°°uyy Gaston County
Gaston Natural Resources Department
d 1303 Cherryville Highway, Dallas, NC 28034 Telephone: [phone]
ea
Soil Erosion & Sedimentation Control
Financial Responsibility/Ownership
No person may initiate any land -disturbing activity on one (1) or more acres of property in all portions of
Gaston County, except for that property within the city limits of the incorporated municipalities of Gaston
County who have not adopted the Gaston County Soil Erosion & Sedimentation Control Ordinance,
before this form and an acceptable Soil Erosion & Sedimentation Control Plan have been completed and
approved by the Gaston County Natural Resources Department's staff.
(Please type or print and, if question is not applicable, place N/A in blank)
PART A:
2.
3.
4.
Project Name Villages at Cramerton Mills Phase 2E
Location of land -disturbing activity
City Cramerton Highway/Street S. New Hope Road
Approximate date land -disturbing activity will commence January 1, 2021
Purpose of development (residential, commercial, industrial, etc.) Residential
5. Total acreage disturbed or uncovered (including off -site borrow and waste areas) 3.43 acres
6. Amount of fee enclosed $ 1,200 `/
7. Soil Erosion & Sedimentation Plan Filed? Yes `' No
8. Landowner(s) of Record (Use blank page to list additional owners)
VCM Bowman, LLC
Name
13815 Cinnabar Place
Mailing Address
Huntersville NC 28078
City State Zip
704-875-9704
Telephone Number
Name
Mailing Address
City State Zip
Telephone Number
9. Indicate Deed Book and Page where deed(s) or instrument(s) are recorded
Deed Book 5029 Page 1923,1935
Deed Book 4988 Page 639
10. Tax Map No.3574723071, 3574714818, Block
3574725056,3574715727,
3574718903
Lot No.
Page 1

PART B:
1. Person(s) or firm(s) who are financially responsible for this land -disturbing activity
VCM Bowman, LLC
Name
13815 Cinnabar Place
Mailing Address
Huntersville NC 28078
City State Zip
704-875-9704
Telephone Number
Name
Mailing Address
City State Zip
2. If the Financially Responsible Party is not a resident of North Carolina, give name and street
3. 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 Part is a Corporation give name and street address of the Registered Agent.
Name
Mailing Address Street Address
City State Zip Telephone 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 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. �2
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Type or Print Name Title or Authority
�d L
ature Ilk Date
I, a- a Notary P blic of the County of — o , State of North
Carolina, hereby ce ify that appearecT 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 ;L day of 6LIaB a 2010
.
0j
Notary� .``� SEAL � '% My Commission Expires
File: Financial Responsibility -Ownership Form.mw
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Gastor, Z: Page 2
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