NCC241873_FRO Submitted_20240625

FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
I ' EROSION & SEDIMENTATION CONTROL
1 lR L l.)E L i_ No person may initiate any land-disturbing activity on one or more acres, % acre or more inside a
watershed, as covered by the Sedimentation Pollution Control Act and the Iredell County Land
Development Code, before an acceptable erosion and sedimentation control plan has been submitted
and approved by the Iredell County Planning&Development,Erosion Control Section.
(Please type or print)
Part A.
1. Project Name Crossrail Townhomes _
2. Location of land-disturbing activity: County Iredell City or Township Mooresville
Highway/Street Crossrail Rd Latitude 35.5515 Longitude -80.8475
3. Approximate date land-disturbing activity will commence: 7/1/2022
4. Purpose of development(residential,commercial, industrial, institutional,etc.): Residential
5. Total acreage disturbed or uncovered(including off-site borrow and waste areas): 9.40
6. Amount of fee enclosed:$ . An application fee of$175.00 per acre(rounded up to the next acre)is
assessed without a ceiling amount(Example: a 8.10-acre application fee is $1575). For projects >than 0.5 acres but no
greater than 0.99 acres in a water supply watershed, a flat fee of$100.00 is assessed.
7. Has an erosion and sediment control plan been filed? Yes X No Enclosed
8. Person to contact should erosion and sediment control issues arise during land-disturbing activity:
Name CJ Dellinger E-mail Address CJ.Dellinger: Meritagehomes.com
Telephone Cell# 704 421 2536 Fax#
9. Landowner(s)of Record(attach accompanied page to list additional owners):
Meritage Homes of the Carolinas, Inc.
Name Telephone Fax Number
13925 Ballantyne Corporate PI. STE 300
Current Mailing Address Current Street Address
Charlotte NC 28277
City State Zip City State Zip
10. Deed Book No. 3061_ Page No. 1059-1066 Provide a copy of the most current deed.
Part B.
1. Person(s)or firm(s)who are financially responsible for the land-disturbing activity(Provide a comprehensive list of all
responsible parties on an attached sheet):
Meritage Homes of the Carolinas Tim.Sheehy meritayehomes.com
Name E-mail Address
13925 Ballantyne Corporate PI Ste. 300 Same
Current Mailing Address Current Street Address
Charlotte NC 28277 _
City State Zip City State Zip
Telephone [phone] Fax Number
Page 1 of 2

2. (a) If the Financially Responsible Party is not a resident of North Carolina, give name and street address of the designated
North Carolina Agent:
Name E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Telephone Fax 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 name and street
address of the Registered Agent:
Corporation Service Company
Name of Registered Agent E-mail Address
2626 Glenwood Avenue, Suite 550 Same
Current Mailing Address Current Street Address
Raleigh NC 27608
City State Zip City State Zip
Telephone [phone] Fax 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 the authority to execute instruments for the Financially Responsible Person). I agree to
provide corrected information should there by any change in the information provided herein.
Tim Sheehy Vice President of Land Development and Entitlement
Type or r' t name Title or Authority
i.n/L5..... ....,--".--t5/Z Z/ a`-)
Signature Date
I, �6. Q .\,ct Q r , a Notary Public of the County of P&c,VA G ..t lav-eS
State of North Carolina, hereby certify that 1 k M . N appeared personally before me this day
and being duly sworn acknowledged that the above form was executed by hirYi.
,1.o1
Witness my hand and notarial seal,this.22 day of aw 20 Z..
i `` `+:0., AIIIIIIp �O' Not
Seal `�.Q'
My commission expires Z. Z. 2.S
4OTA13y 1
r.
7.
nnmmmn+►
Page 2 of 2