NCC215671_FRO Submitted_20211104

FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
SEDIMENTATION POLLUTION CONTROL ACT
No person may initiate any land -disturbing activity on one or more acres as covered by the Act before this
form and an acceptable erosion and sedimentation control plan have been completed and approved by
the Land Quality Section, N.C. Department of Environmental Quality. Submit the completed form to the
appropriate Regional Office. (Please type or print and, if the question is not applicable or the e-mail and/
or fax information unavailable, place N/A in the blank.)
Part A. Afton Run Greenway
1. Project Name
2. Location of land -disturbing activity: County Cabarrus City or Township Concord
Highway/Street Poplar Tent Rd Latitude 35.411114 Longitude -80.673660
3. Approximate date land -disturbing activity will commence: Fall 2021
4. Purpose of development (residential, commercial, industrial, institutional, etc.): Greenway
5. Total acreage disturbed or uncovered (including off -site borrow and waste areas): 1.65
6. Amount of fee enclosed: $ 130 (Paid) . The application fee of $65.00 per acre (rounded
up to the next acre) is assessed without a ceiling amount (Example: a 9-acre application fee is $585).
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 Brian Morris Email Address [e-mail]
Telephone [phone] cell # 704-361-2051 Fax # [phone]
9. Landowner(s) of Record (attach accompanied page to list additional owners):
City of Concord 704-920-5555 704-786-4521
Name Telephone Fax Number
PO Box 308 35 Cabarrus Ave. W
Current Mailing Address Current Street Address
Concord NC 28026 Concord NC 28025
City State Zip City State Zip
10. Deed Book No. Multiple, see plans Page No. Provide a copy of the most current deed.
Part B.
1. Company(ies) or firm(s) who are financially responsible for the land -disturbing activity (Provide a
comprehensive list of all responsible parties on an attached sheet.) If the company or firm is a sole proprietorship,
the name of the owner or manager may be listed as the financially responsible party.
Ike's Construction, Inc. [e-mail]
Name
303 Executive Park Dr. NE
Current Mailing Address
Concord, NC 28025
City
E-mail Address
303 Executive Park Dr. NE
Current Street Address
Concord, NC 28025
State Zip City
State
Telephone [phone] Fax Number 704-788-2164

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:
Jeff Isenhour [e-mail]
Name of Registered Agent E-mail Address
303 Executive Park Dr. NE 303 Executive Park Dr. NE
Current Mailing Address Current Street Address
Concord NC 28025 Concord NC 28025
City State Zip City State Zip
Telephon
704-788-2139 Fax Number 704-788-2164
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 be any change in the information provided herein.
Jeff Isenhour
Type or print name
a
Brian R. Morris
President
Title or Authority
10/5/21
Date
a Notary Public of the County of Cabarrus
State of North Carolina, hereby certify that Jeff Isenhour 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 5th
day of October 2021
Notary
My commission expires 09/23/2023