NCC230523_FRO Submitted_20230227

FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
EROSION & SEDIMENTATION CONTROL
No person may initiate any land -disturbing activity on one or more acres, '/2 acre or more inside a
watershed, as covered by the Sedimentation Pollution Control Act and the Iredell County Land
Development Code, before an acceptable erosion and sedimentation control plan has been submitted
and approved by the Iredell County Planning & Development, Erosion Control Section.
(Please type or print)
Part A.
1. Project Name Lake Norman Multifamily
2. Location of land -disturbing activity: County Iredell City or Township Mooresville
NC HWY 150 /
Highway/Street Perth Road Latitude 35.6036 Longitude-80.8985
3. Approximate date land -disturbing activity will commence: 01/2023
4. Purpose of development (residential, commercial, industrial, institutional, etc.): Multi -Family Apartments
5. Total acreage disturbed or uncovered (including off -site borrow and waste areas): 32.90
6. Amount of fee enclosed: $ 5,775.00 . An application fee of $175.00 per acre (rounded up to the next acre) is
assessed without a ceiling amount (Example: a 8.10-acre application fee is $1575). For projects > than 0.5 acres but no
greater than 0.99 acres in a water supply watershed, a flat fee of $100.00 is assessed.
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 Scott Kavanaugh
E-mail Address scottka-carocon.com
Telephone [phone] Cell#
980-253-4171 Fax#
9.
Landowner(s) of Record (attach accompanied page
to list additional owners):
Peggy P Brotherton
Name
Telephone Fax Number
193 Swift Creek lane
990 River Highway
Current Mailing Address
Current Street Address
Mooresville NC 28115
Mooresville NC 28117
City State Zip
City State Zip
10.
Deed Book No. 1206 Page No. 1547
Provide a copy of the most current deed.
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):
Perth Road Associates, LLC
[e-mail]
Name
E-mail Address
300 South Tryon Street, Suite 200
Same as Current Mailing Address
Current Mailing Address
Current Street Address
Charlotte NC 28202
Same as Current Mailing Address
City State Zip
City State Zip
Telephone [phone]
Fax Number
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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:
Stephen McClure
Name
300 South Tryon Street, Suite 200
Current Mailing Address
Charlotte NC 28202
City State Zip
Telephone [phone]
[e-mail]
E-mail Address
Same as Current Mailing Address
Current Street Address
Same as Current Mailing Address
City State Zip
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:
Name of Registered Agent
Current Mailing Address
City State
Telephone
E-mail Address
Current Street Address
Zip City State
Fax Number
Zip
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.
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Type or, print name
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Sig ature ]
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Title or Au iori
Date
I, a Notary Public of the County of MQt�V-len►.
State of North Carolina, hereby certify that S LL� "_01. appeared personally before me this day
and being duly sworn acknowledged that the above fdrm was executed by him.
Witness my hand and notarial seal, this _,2_a day of 5�-� .20
C�VvkizA 1�
Notary
Seal
My commission expires 11a�
Jaclyn Kempf
Notary Public
Mecklenburg County, NC
My Commission Expires 10/11/2026
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