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HomeMy WebLinkAboutNCC221168_FRO Submitted_20220330FINANCIAL RESPONSIBILITY/OWNERSHIP FORM EROSION & SEDIMENTATION CONTROL No person may initiate any land -disturbing activity on one or more acres, Ya 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 Evolve at Lake Norman 2. Location of land -disturbing activity: County I REDELL City or township MDORESVILLE HighwayfStreet 720 RIVER HIGHEWAY Latitude 35.599051 Longitude -84-882378 3. Approximate date land -disturbing activity will commence. July 1' 2022 4. Purpose of development (residential, commercial, industrial, institutional, etc.): VULTI.FAMILY AND TOWNHOMES 5. Total acreage disturbed or uncovered (including off -site Morrow and waste areas): 41 acres 5. Amount of fee enclosed: $ 7175.00 An application fee of $175.00 per acne (rounded up to the next acre) is assessed without a ceiling amount (Example: a 9-acre application fee is $1575). For projects a than 0.5 acres but no greater than 0.99 acres in a water supply watershed, a flat fee of $135.00 is assessed, 7. Has an erosion and sediment control plan been filed? Yes No le Enciosed 8. Person to contact should erosion and sediment control issues arise during land -disturbing activity: Name Matt Rogers E-mail Address matt@evolvecos.com Telephone 919-455-1051 Cell # Fax # 9. Landowner(s) of Record: (attach accompanied page to list additional owners): Mooresville Housing LLC N ame Telephone Fax Number 2918 Martinsville Road Suite A 2918 Martinsville Road Suite A Current Mailing Address Current Street Address Greensboro NC 27408 Greensboro NC 27408 City State Zip City State Zip 10, Deed Book No. 2802 Page Nu.2016 Provide a copy of the most Current deed. Part B. 1. Person(s) or tinn(s) who are financially responsible for the land -disturbing activity (Provide a comprehensive list of all responsible parties on an attached sheet): Evolve Companies matt@evolvecos.com Name E-mail Address 2012 Eastwood Road 2012 Eastwood Road Current Mailing Address Current Street Address Wilmington 28403 28403 Wilmington NC 28403 City State Zip City State Zip Telephone 919-455-1051 Fax Number pane 1 of 9 2. (a) If the Financially Responsible Party is not a resident of North Carolina, give name and street address of the designated North Carolina AgenC Name E-mail Address Current Mailing Address Current Street Address - City State Zip City State Zip Telephone Fax Number fib} 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 Cumenl Ma:ing Address E-maii Address Current Street Address City State Zip City Telephone Fax Number State Zip The above information is true and correct to the best of my knowledge and belief and was provided by me under oath (This forth must be signed by the Financially Responsible Person if an individual or his attomeyin-fact, or if not an Individual, by an officer, director, partner, or registered agent with the authority to execute instruments far the Financially Responsible Person), I agree to provide corrected information should there by any change in the irtforma6on provided herein - Type or print name Signature TWe or Authority - - 'Date t, .a�1 r� a Notary Public of the County of State of North Carolina, hereby certify that _[.>l `C and being duly swam acknowledged that the above form wag xecuted by hire, appeared personally before me this day f, Witness my hand and notarial seal, this J t day of &N(kW Zp L- — Sea! �Jjtj Ito Notary [[�� !_ `mot>> �V S 5u_,� i��, My commission exprres �, 2�rL��T,q�, ��=❑L Pane 2 of 9