NCC230884_FRO Submitted_20230331

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 and/or fax information
unavailable, place N/A in the blank.)
Part A.
1. Project Name Christenbury Greene Townhomes
2. Location of land -disturbing activity: County Cabarrus City or Township Concord
Highway/Street Edenbury Drive Latitude 35.381055 Longitude -80.729969
3. Approximate date land -disturbing activity will commence: March 15, 2022
4. Purpose of development (residential, commercial, industrial, institutional, etc.):_ Residential
5. Total acreage disturbed or uncovered (including off -site borrow and waste areas): 9.16
6. Amount of fee enclosed: $ 650.00 . 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 No Enclosed x
8. Person to contact should erosion and sediment control issues arise during land -disturbing activity:
NameLawrence Dugan E-mail Address [e-mail]
Telephone [phone] Cell # [phone] Fax # N/A
9. Landowner(s) of Record (attach accompanied page to list additional owners):
Christenbury Farms Inc C/O Ken Christenbury [phone]
Name Telephone Fax Number
3801 Beard Rd 9101 Edenbury Dr
Current Mailing Address Current Street Address
Concord NC 28027 Concord NC 28027
City State Zip City State Zip
A portion of
10. Deed Book No. 5027 Page No 54 Provide a copy of the most current deed.
Part B.
1. Company (ies) or firm(s) who are financially responsible for the land -disturbing activity (Provide a
comprehensive list of all responsible parties on an attached sheet.) If the company or firm is a sole
proprietorship the name of the owner or manager may be listed as the financially responsible party.
Orleans Conservatory Group Partners, L.P. [e-mail]
Name E-mail Address
1911 Associates Ln
Current Mailing Address Current Street Address
Charlotte NC 28217
City State Zip City State Zip

Telephone [phone] Fax Number
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:
Name of Registered Agent E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Telephone
Fax 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
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.
Lawrence Dugan
Senior Vice -President
Type or int name Title or Authority
7 X.'?�
Signature Date ' /'
I,J601�l _�i h' 21� a Notary Public of the County of r ILA OGP1414
PEdNs'0AAUTA
State of+k4h-Ga;eliaa, hereby certify that 'j.1/..'j 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 Q ]�) day of Juk. , 20
Cgmmonwealth of Pennsylvania - Notary seal
JOAN DMA JW Notary Public OV44t-ft A aAz4_
Philadeiphla county N otary
* Commission Expires January 25, 2025
Commission Number 1387787
My commission expires ►
I I

Orleans -Conservatory Group Partners, LP rrstrust Savings Bank
1819 John F. Kennedy Blvd. Suitc 360 1515 Market St
Philadclphia. PA 19103 Philadelphia, PA 19102
3-7380/2360
PAY Six Hundred Fifty Dollars and 00/100.
To the
order of NCDEQ - Land Quality Section
NCDEQ - Land Quality Section
217 West Jones Street
Raleigh, NC 27603
DATE
JUL 16, 2021
AMOUNT
$*************650.00
^r �
4446
Orleans -Conservatory Group Partners, LP
Invoice # Date Description Amount Discount Net Due
CHRISTENBURY TH
M
07/14/21 Christenbury TH 650.00 650.00

Page 1 of 1 650.00