NCC231659_FRO Submitted_20230601

Financial Responsibility/Ownership Form Sedimentation Pollution Control Ordinance
No person may initiate any land-disturbing activity on one or more acres as covered by the ordinance before this form
and an acceptable erosion and sedimentation control plan have been completed and approved by the Rowan County
Environmental Management Department.
Part A Parcel ID Number
462005,462006001,
460152
1.Project Name*
Grants Landing Single Family Subdivision
2.Location of land-disturbing activity(Highway/Street)*
Rowan Mill Road
Latitude Longitude
35.357 -80.525
3.Approximate date land-disturbing activity will be commenced
6/1/2023
4.Purpose of development(residential,commercial,industrial,etc.)
Residential
5.Approximate acreage of land to be disturbed or uncovered*
67
6.Person to contact should sediment control issues arise during land-disturbing Cell Phone Number*
activity* 704-216-1657
Johnny Evans
*this information will be made available on the Rowan County Planning&Development website.
Email Address
[e-mail]

7.Landowner of Record Landowner of Record
Century Communities Southeast LLC
Name Name
Current Mailing Address Current Mailing Address
7401 Carmel Executive Park Drive
Suite 310
Charlotte, NC 28226
8.Recorded in Deed Book Number Page Number
1416 322
Part B
1.Person or Firm who are financially responsible for this Person or Finn who are financially responsible for this land-
land-disturbing activity disturbing activity
Century Communities Southeast LLC
Name of Person(s)or Firm(s) Name of Person(s)or Firm(s)
Current Mailing Address Current Mailing Address
7401 Carmel Executive Park Drive
Suite 310
Charlotte, NC 28226
Phone Number Phone Number
704-754-5460
a.If the Financially Responsible Party is not a resident of North Carolina,give name and street address of a North Carolina
Agent.
Name of Agent Name of Agent
Current Mailing Address Current Mailing Address

Phone Number Phone 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 the name and street
address of the Registered Agent.
Name of Registered Agent
National Registered Agents
Current Mailing Address Current Street Address
160 Mine Lake Ct SE
Raleigh, NC 27612
Telephone Number Telephone 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 authority to execute instruments for the Financially Responsible Person).
I agree to provide correctional information should there be any change in the information provided herein.
Name Title or Authority
Henry Kirchner Senior Vice President of Land Development&Operations
Date
mm/dd/yyyy
445
i, Elizabeth Rountree ,a Notary Public of the County of Mecklenburg State of North Carolina,
hereby certify that Henry Kirchner appeared personally before me this day and being duly sworn acknowledged
that the above form was executed by him/her.Witness my hand and seal of Notary,this 18 day of May ,2023
Notary My commission expires
mm/dd/yyyy 12/15/24
ebyt-jac )- ()
Seal y Notary Public
W Mecklenburg m c
Checklist _ County
My Comm. Exp, —
Download a copy of the Erosion and Sedimentation f1. 12-16-202q
Control Plan Checklist(PDF) :, `����`
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