NCC243284_FRO Submitted_20241025

u',
°FiE
. .,A4,
Mecklenburg County Soiil Erosion and
E�' Sedimentation Control Ordinance
P
� �, Financial Responsibility/Ownership Form
No person shall initiate any land-disturbing activity covered by Section 6 of the Mecklenburg
County, Mint Hill or Davidson Sedimentation and Erosion Control Ordinances prior to
completing and filing this form with Mecklenburg County Land Use and Environmental
Services. The financially responsible party will be on record as the party to accept any Notices
of Violation or related documents for any non-compliance with the above Ordinances. If the
financially responsible party is out of State, a North Carolina agent must be assigned.
Please Type or Print
PART A
1. Project where land-disturbing activity is to be undertaken: The Vineyards at Cheval
Mint Hill, NC
2. Address of land-disturbing activity: 16505 Grande Vineyards Dr
Mint Hill, NC 28227 (see list of parcels on page 3)
3. Approximate date land-disturbing activity will commence: Sept. 30 2024
Month Day Year
4. Purpose of development (Residential,Commercial, Industrial, etc.): Residential
5. Approximate acreage of land to be disturbed or uncovered: 3.20
6. Total site acreage: 60.19 acres
7. Landowners of record(use blank pages to list additional owners as necessary):
Owner#1 Name: Vineyard Row LLC
Address: 1100 S Mint Street Suite 102
Charlotte, NC 28203
Telephone: [phone] Fax:
Email Address: [e-mail]
Owner#2 Name:
Address:
Telephone: Fax:
Email Address: P
8. Indicate Book and Page where the deed or instrument is filed(use blank pages to list
additional deeds or instruments as necessary):
Book 39086 Page 633 Book Page
Book Page Book Page
(continue on back or separate pages as necessary)
Form Rcvised 12-20I6

Continue - Financial Responsibility/Ownership Form
PART B
1. Person(s) or firm(s) financially responsible for this land-disturbing activity:
Person or Firm: Vineyard Row LLC
Address: 1100 S Mint Street Suite 102
Charlotte, NC 28203
Telephone: [phone] Fax:
Email Address: [e-mail]
2. North Carolina agent for the person or firm who is financially responsible:
Person or Firm: Timothy A. Arey
Address: 822 McGregor Ct. NE
Concord, NC 28025-2571
Telephone: [phone] Fax:
Email Address: [e-mail]
11
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 I
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.)
Timothy A. Arey Manager
Printed Na Title
1 i 7Pt ni le 4 "7 /0 - ? ,le Z51
Signature v Date
I, A 144 6t' f V"r OL 1i IA I I , a Notary Public of the
County of IWZA l`10 INV' 19?sirState of N O r' C aJ 0 "f{i , hereby
certify that 1—i Wi O 71 I vl I personally appeared
before me this day and under oath acknowledged this form was
_ executed by him/her.
Witness my hand and notarial seal,this day of 0 t/ 0 K0`�Y - ,20 .
Notary Signature: PO
I ,, ALEXANDRA SKULL
My Commission expires: l 2 . 0 . 9,0 NOTARY PUBLIC
Mmklenbnrg-eounty
North Carolina
My Commission Expires December 16,2026
•
Mecklenburg County Land Use and Environmental Services Agency
2145 Suttle Ave.
Charlotte,NC 28208-5237
Phone[phone]

IA# Parcel IQ
1 19509162
2 19509193
3 19509194
4 19509195
5 19509196
6 19509197
7 19509142
8 19509192
1 19509115
2 19509117
3 19509119
4 19509120
5 19509121
6 19509123
7 19509125
8 19509126
9 19509127
10 19509128
11 19509129
12 19509132
13 19509133
14 19509134
15 19509135
16 19509136
17 19509137
18 19509138
19 19509139
20 19509140
21 1950914/
22 19509163
23 19509164
24 19509165
25 19509166
26 19509167
27 19509169
28 19509170
29 19509172