NCC240787_FRO Submitted_20240319

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 party will be on record as the party 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
PART A •
1. Project name: The Groves Townhomes
2. Address of land—disturbing activity:William Ficklen Drive& Ben Craig Drive Charlotte NC 28269
William Ficklen Drive& Ben Craig Drive Charlotte NC 28269
3. Approximate date land-disturbing activity will commence: December 15 2023
Month Day Year
4. Purpose of Development(Residential, Commercial, Industrial, etc.): Residential
5. Total acreage of land to be disturbed or uncovered: 6.50 AC
6. List total site acreage: 6.94 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:HS Mallard Creek Center, LLC
Address: 101 South Tryon Street Suite 2410, Charlotte, NC 28280
Telephone: Fax:
(Area Code) (Area Code)
Email Address:
Name:
Address:
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
Deed
instruments) Meook 31467 page 296 Book Page
p
Book 27 Page 245 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
person(s) or firm(s)has an out-of-state address, a North Carolina agent must be designated in item 2 below):
Person or Firm:Canvas Residential CC Venture, LLC
Address:
1111 Metropolitan Avenue, Suite 700 Charlotte N Z e z- ,.( _ _ _
Telephone: [phone] Fax:
(Area Code) (Area Code)
Email Address:[e-mail]
2. If the Financially Responsible Party is not a resident of North Carolina, give name and street address of the
designated North Carolina agent:
Person or Firm:
Address:
Telephone: Fax:
(Area Code) (Area Code)
Email Address:
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.)
=c ‘..—tL N/t,h r.►"-cos- z
Printed e Title
Signature Date
I, c' rrc t✓-e_ ikS il , a Notary Public of The County
of on t v h , State of Wo✓frh 60.-vii rl , hereby
certify that C ram.;911-1-o r1 d I personally
appeared before me this day and under oath acknowledge that this form was executed by him/her.
Witness my hand and notarial seal, this 19441 day of Sn P , 20a 3
Notary Signature:
My Commission expires: A q. Z aug
• 44 LORRAINE ENGLISH
NOTARY PUBLIC
. (CO) UNION COUNTY,NC
L My Commission Expires
SM
charlottenc.gov
Storm Water Services—Land Development
600 East Fourth Street,Charlotte,North Carolina 28202-2844
Telephone:[phone]
http://charlottenc.gov/deve lopm entcenter
Rev.09/2021 Page 2

June 20,2023
RE: Owner Consent Letter for The Groves Townhomes located at William Ficklen & Ben Craig—
Financial Responsibility
To whom it may concern:
This letter provides permission to Canvas Residential CC Venture, LLC to seek and obtain plan approval
to perform grading and/or sitework associated with the above referenced project. By signing below, the
undersigned parties agree to the following:
Land development and subdivision of approximately 6.935 acres of land, also known as Mecklenburg
County parcel ID 027-03-212, located at William Ficklen Drive and Ben Craig Drive Charlotte NC 28269
for the development of 82 individually platted townhomes.
Signature of property owner or authorized representative
Daniel Farrar—HS Mallard Creek Owner, LLC
Printed name of property owner, company, group, corporation, or individual and authorized
representative
101 South Tryon Street,Suite 2410 Charlotte NC 28280
Mailing address of owner