NCC230535_FRO Submitted_20230321

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 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.
Project Name: Cross Charlotte Trail - Orr to Rocky River Road (02R2)
2. Location of land -disturbing activity: County: Mecklenburg City or Township: Charlotte
Highway/Street: Orr Road Latltude(declmai degrees): 35.265661 Longltude(decimai degrees):-80.768421
3. Approximate date land -disturbing activity will commence: Fall 2023
4. Purpose of development (residential, commercial, industrial, institutional, etc.): Commercial
5. Total acreage disturbed or uncovered (including off -site borrow and waste areas): 12.89 acres
6. Amount of fee enclosed: $1300. 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 x❑ No ❑
Person to contact should erosion and sediment control issues arise during land -disturbing activity:
Name: Sharon Buchanan E-mail Address: Sharon. Buchanan(@charlottenc.gov
Phone: Office #: (704)-336-2044 Mobile #: [phone]
9. Landowner(s) of Record (attach accompanied page to list additional owners):
CITY OF CHARLOTTE
Name
Phone: Office # Mobile #
600 E 41h St 141' FL 5800 North Tryon Street
Current Mailing Address Current Street Address
Charlotte NC 28202 Charlotte NC 28213
City State Zip City State Zip
10. Deed Book No. 35978 Page No. 167 Provide a copy of the most current deed. SEE ATTACHED.

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 orif the landowner(s) is
an individual(s), the name(s) of the owner(s) may be listed as the financially responsible party(ies).
City of Charlotte (Contact: Sharon Buchanan) Sharon. [e-mail]
Company Name E-mail Address
600 E. 4th Street
Current Mailing Address
600 E. 41h Street
Current Street Address
Charlotte NC 28202 Charlotte NC 28202City
State Zip City State Zip
Phone: Office # (704)-336-2044 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:
Name of Registered Agent E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Phone: Office # 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:
Kimley-Horn and Associates
Name of Registered Agent
200 South Tryon Street, Suite 200
Current Mailing Address
alexandra.mcintyre(a-)kimley-horn.com
E-mail Address
Current Street Address
Charlotte NC 28202
City State Zip City State Zip
Phone: Office # 704-636-1192 Mobile #
Alex McIntyre
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 individuals)
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.
Type or print name
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Signature
v. t
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Title or Authority
Date
4
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t a Notary Public of the County of
t
State of North Carolina, hereby certify that T appeared personally
before me this day and being duly sworn acknowledged that the above'form was executed by him/her.
Witness my hand and notarial seal, this da
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My commission expires' vy `.

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:
Storage Trust Properties L P
Name
PO Box 25025
Current Mailing Address
Phone: Office #
5748 N Tryon St
Current Street Address
Mobile #
Glendale CA 91201 Charlotte NC 28213
City State Zip City State Zip
Deed Book No.07990 Page No.597 Provide a copy of the most current deed.
Landowner 3 of Record:
Pecan Grove MHP LLC
Name Phone: Office # Mobile #
206 College St 5816 ORR RD 56
Current Mailing Address Current Street Address
Pineville NC 28134 Charlotte NC 28213
City State Zip City State Zip
Deed Book No.31304 Page No.981 Provide a copy of the most current deed.
Landowner 4 of Record:
Martin Landscaping CO
Name
7600 Shady LN
Current Mailing Address
Phone: Office #
5707 ORR RD
Current Street Address
Mobile #
Charlotte NC 28215 Charlotte NC 28213
City State Zip City State Zip
Deed Book No.32095 Page No.925 Provide a copy of the most current deed.
Landowner 5 of Record:
Martin Landscaping CO
Name Phone: Office # Mobile #
7600 Shady LN 5717 Shady Ln
Current Mailing Address Current Street Address
Charlotte NC 28215 Charlotte NC 28213
City State Zip City State Zip
Deed Book No.11241 Page No.189 Provide a copy of the most current deed.

Landowner 6 of Record:
Storage Trust Properties L P
Name Phone: Office # Mobile #
PO Box 25025 5751 ORR RD
Current Mailing Address Current Street Address
Glendale CA 91201 Charlotte NC 28213
City State Zip City State Zip
Deed Book No.07990 Page No.597 Provide a copy of the most current deed.
Landowner 7 of Record:
5801 ORR Road LLC
Name
Phone: Office #
Mobile #
2525 N Pennsylvania St
5801 & 5803 ORR RD
Current Mailing Address
Current Street Address
Indianapolis IN
46205 Charlotte NC
28213
City State
Zip City State
Zip
Deed Book No.36813 Page No.309 Provide a copy of the most current deed.
Landowner 8 of Record:
5801 ORR Road LLC
Name
Phone: Office #
Mobile #
2525 N Pennsylvania St
5807 ORR RD
Current Mailing Address
Current Street Address
Indianapolis IN
46205 Charlotte NC
28213
City State
Zip City State
Zip
Deed Book No.36813 Page No.287 Provide a copy of the most current deed.
Landowner 9 of Record:
Carolinas Finest Plumbing
Name
Phone: Office #
Mobile #
5821 ORR RD
5821 ORR RD
Current Mailing Address
Current Street Address
Charlotte NC
28213 Charlotte NC
28213
City State
Zip City State
Zip
Deed Book No.35229 Page No.493
Provide a copy of the most current deed.
Landowner 10 of Record:
T & L of North Carolina LLC
Name
Phone: Office #
Mobile #
5831 ORR RD 5833 ORR RD
Current Mailing Address Current Street Address
Charlotte NC 28213 Charlotte NC 28213

City State Zip City State Zip
Deed Book No.29392 Page No.748 Provide a copy of the most current deed.
Landowner 11 of Record:
1111 MO W1"iT-MIN ?
Name
Phone: Office #
Mobile #
PO Box 44130
Current Mailing Address
Current Street Address
Charlotte NC 28215
City State Zip
City State
Zip
Deed Book No.21949 Page No.926 Provide a copy
of the most current deed.
Landowner 12 of Record:
National Retail Properties LP of North Carolina
Name
Phone: Office #
Mobile #
450 South Orange Ave STE 900% CNL Center at City Common
Current Mailing Address
Current Street Address
Orlando FL 32801
City State Zip
City State
Zip
Deed Book No.21018 Page No.611 Provide a copy of the most current deed.
Landowner 13 of Record:
6161 McDaniel Lane, LLC,
Name
Phone: Office #
Mobile #
6161 McDaniel Lane LLC
6161 McDaniel Lane, LLC.
Current Mailing Address
Current Street Address
Charlotte NC 28213
Charlotte NC
28213
City State Zip
City State
Zip
Deed Book No.34946 Page No.731 Provide a copy of the most current deed.
Landowner 14 of Record:
United States of America
Name
Phone: Office #
Mobile #
PO Box 10068
6115 North Hills CR
Current Mailing Address
Current Street Address
Charleston SC 29411
Charlotte NC
28213
City State Zip
City State
Zip
Deed Book No.06655 Page No.598 Provide a copy of the most current deed.
Landowner 15 of Record:
Charlotte Hills Mobile Home Park
Name
Phone: Office #
Mobile #

300 E Maple RD STE 200 6028 McDaniel Ln 185
Current Mailing Address Current Street Address
Birmingham MI 48009 Charlotte NC 28213
City State Zip City State Zip
Deed Book No.30420 Page No.375 Provide a copy of the most current deed.
Landowner 16 of Record:
Couchell / Tsahakis Properties LLC
Name
Phone: Office #
Mobile #
3362 Smith Farm RD
6001 North Hills CR
Current Mailing Address
Current Street Address
Mathews NC
28105 Charlotte NC
28213
City State
Zip City State
Zip
Deed Book No.08154 Page No.023 Provide a copy of the most current deed.
Landowner 17 of Record:
Charlotte Hills Mobile Home Park
Name
Phone: Office #
Mobile #
300 E Maple Rd STE 200
6150 McDaniel LN
Current Mailing Address
Current Street Address
Birmingham MI
48009 Charlotte NC
28213
City State
Zip City State
Zip
Deed Book No.30420 Page No.020 Provide a copy of the most current deed.
Landowner 18 of Record:
Kingswood NC LLC
Name
Phone: Office #
Mobile #
4600 Cox RD Suite 400
6112 Timberway Dr
Current Mailing Address
Current Street Address
Glen Allen VA
23060 Charlotte NC
28213
City State
Zip City State
Zip
Deed Book No.25297 Page No.817 Provide a copy of the most current deed.
Landowner 19 of Record:
Malcolm B JR Blankenship
Name
Phone: Office #
Mobile #
2250 Godby RD 6607 Old Concord Rd
Current Mailing Address 'Current Street Address
Woodlead NC 27054 Charlotte NC 28213
City State Zip City State Zip
Deed Book No.27255 Page No.451 Provide a copy of the most current deed.

Landowner 20 of Record:
Malcolm B. Blankenship,
JR.
Christopher
E. Hannum,
as trustee of the Blakenship
Timber GST Trust #1 u/a/d July
19 2021
(6 25%)
Christopher
E. Hannum,
as trustee of the Blakenship
Timber GST Trust #2 u/a/d July
19 2021
(6 25%)
Christopher
E. Hannum,
as trustee of the Blakenship
Timber GST Trust #3 u/a/d July
19 2021
(6 25%)
Christopher
E. Hannum,
as trustee of the Blakenship
Timber GST Trust #4 u/a/d July
19 2021
(6.25%)
Name
Phone: Office # Mobile #
2250 Godbev RD 1209 Ann Elizabeth Dr
Current Mailing Address Current Street Address
Woodleaf NC 27054 Charlotte NC 28213
City State Zip City State Zip
Deed Book No.36480 Page No.568-571 Provide a copy of the most current deed.
Landowner 21 of Record:
Malcolm B. Blankenship, JR.
Christopher E. Hannum, as trustee of the Blakenship Timber GST Trust #1 u/a/d July 19. 2021 (6.25%
Christopher E. Hannum, as trustee of the Blakenship Timber GST Trust #2 u/a/d July 19 2021 (6.25%)
Christopher E. Hannum, as trustee of the Blakenship Timber GST Trust #3 u/a/d July 19 2021 (6 25%)
Christopher E. Hannum, as trustee of the Blakenship Timber GST Trust #4 u/a/d July 19, 2021 (6.25%)
Name Phone: Office # Mobile #
2250 Godbey RD
Current Mailing Address
Current Street Address
Woodleaf NC 27054
City State Zip City
State
Deed Book No.36480 Page No.568-571 Provide a copy of the most current deed.
Landowner 22 of Record:
Efrain Reyes Canales
Name
Phone: Office # Mobile #
6243 Donna Dr 6243 Donna Dr
Current Mailing Address Current Street Address
Zip
Charlotte NC 28213 Charlotte NC 28213
City State Zip City State Zip
Deed Book No.31435 Page No.123 Provide a copy of the most current deed.
Landowner 23 of Record:
Jeffrey L Brown
Name
2813 Alish TL
Current Mailing Address
Phone: Office #
Current Street Address
Mount Pleasant NC 28124
City State Zip City
State
Deed Book No.29993 Page No.484 Provide a copy of the most current deed.
Mobile #
WE

Landowner 24 of Record:
Jeffrey L Murphy
Name
7022 Rockland Dr
Current Mailing Address
Phone: Office #
Current Street Address
Charlotte NC 28213
City State Zip City
State
Deed Book No.22571 Page No.500 Provide a copy of the most current deed.
Landowner 25 of Record:
Mecklenburg County
Name
600 E 4"' ST 11"' Floor
Current Mailing Address
Phone: Office #
Current Street Address
Charlotte NC 28202
City State Zip City
State
Deed Book No.06180 Page No.584 Provide a copy of the most current deed.
Mobile #
Mobile #
23