NCC223505_FRO Submitted_20221011

NuPr4 C
Mecklenburg County Soil Erosion and
E ' Sedimentation Control Ordinance
C p rFinancial Responsibility/Ownership Form
F/ F
No person shall initiate any land -disturbing activity covered by Section 6 of the Mecklenburg
County, Mint Hill or Davidson Sedimentation and Erosion Control Ordinances prior to
completing and filing this form with Mecklenburg County Land Use and Environmental
Services. The financially responsible parry will be on record as the party to accept any Notices
of Violation or related documents for any non-compliance with the above Ordinances. If the
financially responsible parry is out of State, a North Carolina agent must be assigned.
1
Please Type or Print
Project where land -disturbing activity is to be undertaken: Windsor Run - Recreational Path
Site Improvement Plans (PID 22760112, 22760105 & 22760109)
2. Address of land -disturbing activity: 2220 Windsor Run Lane
3. Approximate date land -disturbing activity will commence: June
Month Day
4. Purpose of development (Residential, Commercial, Industrial, etc.): commercial
5. Approximate acreage of land to be disturbed or uncovered. 1.54 AC
6_ Total site acreage- 73.76 ac
7. Landowners of record (use blank pages to list additional owners as necessary):
Owner 41 Name: Windsor Run, LLC
Address: 701 Maiden Choice Ln, Baltimore, MD 21228
Telephone:
410-402-2484
Fax:
Email Address: [e-mail]
Owner 42 Name:
Address:
Telephone:
Email Address:
Fax:
2022
Year
8. Indicate Book and Page where the deed or instrument is filed (use blank pages to list
additional deeds or instruments as necessary):
Book MB 64 page 163
Book DB 29150 page 416
Book Page
Book Page
Form Revised 8-2014
(continue on back or separate pages as necessary)

Continue - Financial Responsibility/Ownership Form
PART B
Person(s) or firm(s) financially responsible for this land -disturbing activity:
Person or Firm: Windsor Run, LLC
Address: 701 Maiden Choice Ln, Baltimore, MD 21228
Telephone: [phone]
Fax:
Email Address: [e-mail]
2. North Carolina agent for the person or firm who is financially responsible:
Person or Firm: Brian Rossi (EMH&T)
Address: 5500 New Albany Road
Columbus, OH 43054
Telephone: [phone] Fax:
Email Address: brossi@a emht.com
3. The above information is true and correct to the best of my knowledge and belief and was
provided by me while under oath. (This form must be signed by the financially responsible
person if an individual or by an officer, director, partner, attorney -in -fact, or other person
with authority to execute instruments for the financially responsible company or entity, if not
an individual.) i
David Be
Printed Nano
Senior Director, Development
Title
3
Date
I, 01 / f" Cow f"K , a Notary Public of the
County of c%4z' , State of , hereby
certify that 0V" a 44-4 e. ri` 2err>`9.-, personally appeared
before me this day and under oath acknowledged that this form was executed by him/her.
Witness my hand and notarial seal, is d-3 ay of /uk rr� , 20 2- Z
Notary Signature: \��11 VA;!,!
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My Commission expires: 1o1(K ?�Z G �%�V
NOTApj,
Mecklenburg County Land Use awl fYnvito�LthCServic z_
700 N. Tryon C 282 k�_'
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Charlotte, NC 28N'UN�[phone].�/1111111��\\
FAX [phone]