NCC243148_FRO Submitted_20241011

FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
EROSION & SEDIMENTATION CONTROL
IREDE_L ' No person may initiate any land-disturbing activity on one or more acres, 1/2 acre or more inside a
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 Brantley
2. Location of land-disturbing activity: County Iredell City or Township Town of Mooresville
Highway/StreetCoddle Creek HighwaLatitude 35°33'15.55"N Longitude 80°46'42.09"W
3. Approximate date land-disturbing activity will commence:
July 2023
4. Purpose of development(residential, commercial, industrial, institutional, etc.): Residential
5. Total acreage disturbed or uncovered (including off-site borrow and waste areas): 18.654 ac.
6. Amount of fee enclosed: $ 3,325 . 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 Enclosed X
8. Person to contact should erosion and sediment control issues arise during land-disturbing activity:
Name Tommy Leppert E-mail Address [e-mail]
Telephone [phone] Cell# N/A Fax# N/A
9. Landowner(s)of Record(attach accompanied page to list additional owners):
BBC BRANTLEY, LLC 704-751-7110 N/A
Name Telephone Fax Number
7224 JAMESON WAY 7224 JAMESON WAY
Current Mailing Address Current Street Address
STANLEY NC 28164 STANLEY NC 28164
City State Zip City State Zip
10. Deed Book No. 2924 Page No. 1351-1355 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 BRANTLEY, 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 N/A
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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:
BRIAN MAHONEY [e-mail]
Name of Registered Agent 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 N/A
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 r-•istered agent with the authority to execute instruments for the Financially Responsible Person). I agree to
provide correc -• • mation should th-re by any change in the information provided herein.
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Si••rature Date
I, 1.1. �,, r ,a Notary Public of the County of (l tom/
State of Carolina, hereby certify that .�.1,sS) .I QJ appeared personally before me this day
and being duly sworn acknowledged that the above form was executed by hi n .
Witness my hand and notarial seal,this7t_day of ,20
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