NCC221251_FRO Submitted_20220405

City of Charlotte & Mecklenburg County
Soil Erosion and Sedimentation
Control Ordinance
Financial Responsibility/Ownership Form
No person shall iniliate any land -disturbing activity covered by Chapter 17, Article 2 of the Charlotte City Code or
Section G of the Mecklenburg County Sedimentation and Erosion Control Ordinance prior to completing and filing this
form with the City orCharlottc Engineering and Properly Management Department, Land Development Services Division
or Mecklenburg County Land Development Services. The financial responsibility party will be on record as the party to
accept any Notices of Violation or related documents for any non-compliance of the City of Charlotte Soil Erosion and
Sedimentation Ordinance. 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 Townes at Brier Village
2. Address of land —disturbing activity: 1903 Village Creek Court, Charlotte, NC 28262
3. Approximate date land -disturbing activity will commence: July 1, 2021
Month Day Year
4. Purpose of Development (Residential, Commercial, Industrial, etc.): Townhome Development
5. Approximate acreage of land to be disturbed or uncovered:13.0 Acres
6. List total site acreage: 18.4 Acres
7, Landowners of Record (Use blank page to list additional owners):
Name: Highway 49, LLC
Address: 175 Davidson Highway
Concord, NC 28027
Telephone: 70`1I - y6 7^ 1718 1 Fax:
(ArSi Cpdet � . A_ I (Area Code)
Finail Address: Cuft
Signature -
Name: �� rr t pp
Name: _� ►'l •
Address: l 7 S Q a vi d J uiA- 44 w c4
Telephone:
(Area Code)
Frnail
Signature:
c. Z Y n 1;
Fax:
(Area Code)
8. Indicate Book and Page where deed or instrument is filed (Use blank page to Iist additional deeds or
instruments) Book 11768 Page 140
Book Page
Book Page
Book Page
Page t

Continue - Financial Responsibility/Ownership Form
PART B
1. Person(s) or firm(s) financially responsible for this land -disturbing activity:
Person or Firm: Bart Carroll (D.R. Horton, Inc.)
Address: 8001 Arrowridge Blvd., Charlotte, NC 28273
Telephone: [phone] Fax:
(Area Code) (Area Code)
Email Address: BCarroll(adrhorton.com
2. North Carolina agent, for the person or firm who is financially responsible:
Person or Firm: CT Corp System
Address: 150 Fayetteville Street, Raleigh, NC 27601
Telephone: [phone] Fax:
(Area Code)
Email Address:info(a ctadvantage.com
(Area Code)
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 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.)
Bart Carroll
Printed N
NPDES Manager
Title
3/24/2021
Sig -nature " Date
I, a Notary Public of the County
of _ Ga S +0ki State of NaM�l-L! CGL1-V jl ki A , hereby
certi, that 13a.t-4 Od—ks Dll personally
appeared before me this day and under oath acknoiWedge that this form was executed by him/her.
Witness Inj hand and notarial seal, this// a q day of ' p a tt—t 20
� .�.02
Notan) Signature: Ju-L.-� M
My Commission expires: J~' oZ *7 • ;L S
Rachel Martin Hayes
NOTARY PUBLIC
Gaston County
North Carolina
nib My Commission Expires May 27, 2025
l.dlA W 1 l L.
ENGINEERING & PROPERTY
MANAGEMENT
Land Development Division
600 East Fourth Street, Charlotte, North Carolina 28202-2844
Telephone: [phone] Fax: [phone]
http://laiidpermits.chaniieck.org
Page 2