NCC230270_FRO Submitted_20230203

City of Charlotte Soil Erosion and
Sedimentation
Control Ordinance
Financial Responsibility/Ownership Form
No person shall initiate any land -disturbing activity on one or more acres as covered by Chapter 17 of the Charlotte
City Code of Ordinances before this form and an acceptable erosion and sedimentation control plan have been completed
and approved by the City of Charlotte. The financially responsible parry will be on record as the parry to accept any Notices
of Violation or related documents for any non-compliance of the City of Charlotte Soil Erosion and Sedimentation
Ordinance. If the financially responsible party is out of State, a North Carolina agent must be assigned. All relevant
items on this form must be filled out accurately and completely
Please Type or Print
1. Project name: The Exchange
2. Address of land —disturbing activity: 316 Rountree Rd
Charlotte, NC 28217
Approximate date land -disturbing activity will commence: Jan
POPAI
Month Day Year
4. Purpose of Development (Residential, Commercial, Industrial, etc.): Residential
Total acreage of land to be disturbed or uncovered:
6. List total site acreage: 15.83 ac
9.36 ac
7. Landowners of Record (attach accompanied page to list additional owners). If the landowner of record is not
the person(s) or firm(s) financially responsible as listed in Part B, item 1, a separate letter of consent signed
by the landowner of record or their authorized agent is required:
Name: TDC 77 CENTER DRIVE LAND LLC
Address: 5310 South Alston Ave, Suite 210
Durham, NC 27713
Telephone:
(Area Code)
Email Address:
Name:
Address:
Fax:
(Area Code)
Telephone: Fax:
(Area Code) (Area Code)
Email Address:
8. Indicate Book and Page where deed or instrument is filed (Use blank page to list additional deeds or
instruments) Book 34280
Page 217
Book Page
Book Page
Book Page
Page 1

Continue - Financial Responsibility/Ownership Form
PART B
1. Person(s) or firm(s) financially responsible for this land -disturbing activity (Note: If the financially responsible
l ei°son(s) or firm(5) has an otit-of-state address, a North Carolina agent mast be designated in item 2 beloli):
Person or Firm: Dominion Realty Partners LLC
Address: 501 Fayetteville St Suite 100
Raleigh, NC 27601
Telephone: [phone] Fax:
(Area Code) (Area Code)
Email Address: 'murra DRP-LLC.com
2. If the Financially Responsible Party is not a resident of Nortli Carolina, give name and street address of the
designated North Carolina agent:
Person or Firm:
Address:
Telephone:
(Area Code)
Email Address:
Fax:
(Area Code)
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 insist 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.)
Joe Murray
Printed
I,
of *1 0,Xr- Cv N
certify that —To S�tO\ ,
ro
Vice President
Title
State of 0 OA.
r
6/90—
Dait
a Notaay Public of the Counot
appeared before tare this day and aander oath aclaaowledge that IN fibrin was executed by hint/her.
Witness nay hand andjj&kQZial seal, this ay of C,r 20
Notary Signature;
My Commission exp . es: kA CL"'-&\
s,
Qua No�Ar�r ��'n
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iu�,;,.����' chalrlottenc.gov t
Storm Water Services - Land Development
600 Fast Fourth Street, Charlotte, North Carolina 28202-2844
Telephone: [phone]
h ://charlottene. ,ov/develo 3mentcenter
hereby
Rev.09/2021
Page 2