NCC241963_FRO Submitted_20240710

FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
EROSION & SEDIMENTATION CONTROL
IREDELLNo person may initiate any land-disturbing activity on one or more acres, 1/2 acre or more inside a
COUNTY NC 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 Wakefield Master Infrastructure
2. Location of land-disturbing activity: County Iredell City or Township Troutman
Moose Club Road 80.8911
Highway/Street Latitude 35.7320 Longitude
3. Approximate date land-disturbing activity will commence: October 2024
4. Purpose of development(residential, commercial, industrial, institutional, etc.): Infrastructure
5. Total acreage disturbed or uncovered (including off-site borrow and waste areas): 70
6. Amount of fee enclosed: $ 12,250 . 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 No X Enclosed
8. Person to contact should erosion and sediment control issues arise during land-disturbing activity:
Name Steven Bailey E-mail Address [e-mail]
Telephone [phone] Cell# Fax#
9. Landowner(s)of Record (attach accompanied page to list additional owners):
Barium Springs Home for Children
Name Telephone Fax Number
Current Mailing Address Current Street Address
City State Zip City State Zip
10. Deed Book No. 401 Page No. 510 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):
BBC Wakefield, LLC [e-mail]
Name E-mail Address
7224 Jameson Way 7224 Jameson Way
Current Mailing Address Current Street Address
Stanley NC 28164 Stanley NC 28164
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 Cprporation, give name and street
address of the Registered Agent:
Name of Registered Agent E-mail Address
Current Mailing Address Current Street Address
City State Zip City State j Zip
Telephone 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 correctedd information should there by any change in the informatiioon.provided herein.
Type or print name ( Title or Authority
) 1
Signature Date
I. I/III.6b1 A- i VL vY l , a Notary Public of the County of 00 CO\ Y '_
State of North Carolina, hereby certify that 9C V& ` 1V J appeared personally before me this day
and being duly sworn acknowledged that the above form was exeb ed by him J
Witness my hand and notarial seal, this ILi day of ,20 2c_s____2
Notary O/ 3 /a 7
Elizabeth A Brown • My c mission expires
NOTARY PUBLIC
Lincoln County
North Carolina
My Commission Expires June 23,2027
Page 2 of 2