NCC242815_FRO Submitted_20240912

FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
CtriEROSION & SEDIMENTATION CONTROL
IRE D E LL No person may initiate any land-disturbing activity on one or more acres, 1/2 acre or more inside a
c o u N T Y N c 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 Energy United - Mooresville Substation
2. Location of land-disturbing activity: County Iredell City or Township Iredell
Highway/Street off of Bailey Road Latitude 35.623997° Longitude -80.832941°
3. Approximate date land-disturbing activity will commence: January 3, 2024
4. Purpose of development(residential, commercial, industrial, institutional, etc.): Electrical Substation
5. Total acreage disturbed or uncovered (including off-site borrow and waste areas): 2.833
6. Amount of fee enclosed: $ $525.00 . 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 Steve Estes E-mail Address [e-mail]
Telephone [phone] Cell# Fax#
9. Landowner(s)of Record (attach accompanied page to list additional owners):
Energy United [phone]
Name Telephone Fax Number
PO Box 1831 567 Mocksville Highway
Current Mailing Address Current Street Address
Statesville, NC 28625 Statesville, NC 28625
City State Zip City State Zip
10. Deed Book No. 3025 Page No. 892 Provide a copy of the most current deed. Recorded 10/31/2023
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):
Energy United [phone]
Name E-mail Address
PO Box 1831 567 Mocksville Highway
Current Mailing Address Current Street Address
Statesville, NC 28625 Statesville, NC 28625
City State Zip City State Zip
Telephone [phone] Fax Number
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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:
Thomas Golden, CEO
Name of Registered Agent E-mail Address
PO Box 1831 567 Mocksville Highway
Current Mailing Address Current Street Address
Statesville, NC 28625 Statesville, NC 28625
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.
Steve.Estes Manager of System Engineering
Ty• eA int na, Title or utho ity
or-co Date
I, pt. ' ,a Notary Public of the County of Je,F/"IFt I _
State of North Carolina, hereby certify that -rcVE—_ j r appeared personally before me this day
and being duly sworn acknowledged that the above form was executed by him.
Witness my hand and notarial seal,this 14. day of /f ,20��
it& 4/1� .11)T1�
•tary
My commission expires O.. •20,27
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