NCC240283_FRO Submitted_20240201

Gaston County
Gaston Natural Resources Department
IN 1303 Cherryville Highway, Dallas, NC 28034 Telephone: [phone]
+ol3RAL Soil Erosion & Sedimentation Control
Financial Responsibility/Ownership
cm
No person may initiate any land-disturbing activity on one (1) or more acres of property in all portions of
Gaston County, except for that property within the city limits of the incorporated municipalities of Gaston
County who have not adopted the Gaston County Soil Erosion & Sedimentation Control Ordinance,
before this form and an acceptable Soil Erosion & Sedimentation Control Plan have been completed and
approved by the Gaston County Natural Resources Department's staff.
(Please type or print and, if question is not applicable, place N/A in blank)
PART A:
1. Project Name Boulder Ridge
2. Location of land-disturbing activity
City Gastonia Highway/Street Stagecoach Road
3. Approximate date land-disturbing activity will commence October 2023
4. Purpose of development(residential, commercial, industrial, etc.) Residential
5. Total acreage disturbed or uncovered (including off-site borrow and waste areas) 144 ac
6. Amount of fee enclosed $43,200
7. Soil Erosion & Sedimentation Plan Filed? Yes X No
8. Landowner(s) of Record (Use blank page to list additional owners)
Name Name
Mailing Address *SEE ATTACHED SHEET FOR PROPERTY INFORMATION*
City State Zip City State Zip
Telephone Number Telephone Number
9. Indicate Deed Book and Page where deed(s)or instrument(s)are recorded
Deed Book Pane
Deed Book *SEE ATTACHED SHEET FOR
PROPERTY INFORMATION*
10. Tax Map No. Lot No.
Page 1

PART B:
1. Person(s) or firm(s) who are financially responsible for this property.
Mul Homes of Charlotte, LLC Jeremy Horton
Name Contact Name for Inspection Reports
5350 77 Center Drive Unit 100 5350 77 Center Drive Unit 100
Mailing Address Email Address
Charlotte NC 28217 Charlotte NC 28217
City State Zip Telephone Number
704.597.4535 704.597.4535
Telephone Number Fax Number
2. If the Financially Responsible Party is not a resident of North Carolina, give name and street
address of a North Carolina agent.
Name
Mailing Address Street Address
City State Zip Telephone Number
3. 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 Part is a Corporation give name and street address of the Registered Agent.
Name
Mailing Address Street Address
City State Zip Telephone Number
4. 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).
agree to provide corrected information should there be any change in the information provided
herein.
Type or int Name Title or Authority
,Gt��� V di a 2 3
Sig ure I Date
I, 1412G-;i;k M t i-cif++) , a Notary Public of the County of MLck1cn Jut I , State of North
Carolina, hereby certify that 'Tete 4 appeared personally efore me this day
and being duly sworn acknowledged ttlat the +o4 'fbinrni y as executed by him.
Witness my hand and notarial seal, this.14,c,tlaVa , 2023 .
m :.� to: ttin to r �, 2 JL5
Notary VA.t. UARY 16, remissionExpires
•m 2025 File:Financial Responsibility-Ownership Form.mw
..• .... g�. 23 Page 2
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1. STAGECOACH ROAD LLC
C/O SOUTHEAST LAND MGT LLC
2820 SELWYN AVE STE 500.
CHARLOTTE, NC 28209-1791
DB: 4285
PG: 0570
Tax Parcel: 143088
PIN: 3533795446
2- HWY 321 - STAGECOACH ROAD LLC
C/O SOUTHEAST LAND MGT LLC
2820 SELWYN AVE STE 500,
CHARLOTTE, NC 28209-1791
DB: 4104
PG: 1817
Tax Parcel: 143135
PIN: 3533789387
3. HWY 321 - STAGECOACH ROAD LLC
C/O SOUTHEAST LAND MGT LLC
2820 SELWYN AVE STE 500,
CHARLOTTE, NC 28209-1791
DB: 4104
PG: 1817
Tax Parcel: 143139
PIN: 3533779760
4. HWY 321 - STAGECOACH ROAD LLC
C/O SOUTHEAST LAND MGT LLC
2820 SELWYN AVE STE 500,
CHARLOTTE, NC 28209-1791
DB: 4104
PG: 1817
Tax Parcel: 143118
PIN: 3543075624