NCC223135_FRO Submitted_20220916

City of Charlotte Soil Erosion and
Sedimentation
Control Ordinance
Financial Responsibility/Ownership Form
No person shall initiate any land -disturbing activity on one or more acres as covered by Chapter 17 of the Charlotte
City Code of Ordinances before this form and an acceptable erosion and sedimentation control plan have been completed
and approved by the City of Charlotte. The financially responsible 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. All relevant
items on this form must be filled out accurately and completely
PART A
1. Project name: South Tryon Flats
2
Please Type or Print
Address of land -disturbing activity: 3304 S Tryon St Charlotte NC 28217
3. Approximate date land -disturbing activity will commence:
Month Day Year
4. Purpose of Development (Residential, Commercial, Industrial, etc.):
5. Total acreage of land to be disturbed or uncovered: 3.48
6. List total site acreage: 3.58
7. Landowners of Record (attach accompanied page to list additional owners). If the landowner of record is not
the person(s) or firm(s) financially responsible as listed in Part B, item 1, a separate letter of consent signed
by the landowner of record or their authorized agent is required:
Name: Neal Properties Inc
Address: 226 South St Davidson NC 28036
Signature: , (YS�
Telephone: _10+• S -7,1 - 00 Fax:
(Area Code) (Area Code)
Email Address: ' jCIA
�2� _ A, . c� ✓vim
Name: Lester Moultrie
Address: 3214 May St Charlotte NC 28210
Signature:
Telephone: Fax:
(Area Code) (Area Code)
Email Address:
8. Indicate Book and Page where deed or instrument is filed (Use blank page to list additional deeds or
instruments) Book 02313 page 278 Book 15997 Page 472
Book 01790 page 264 Book 19728 Page 393
Page 1

City of Charlotte Soil Erosion and
Sedimentation
Control Ordinance
Financial Responsibility/Ownership Form
No person shall initiate any land -disturbing activity on one or more acres as covered by Chapter 17 of the Charlotte
City Code of Ordinances before this form and an acceptable erosion and sedimentation control plan have been completed
and approved by the City of Charlotte. The financially responsible 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. All relevant
items on this form must be filled out accurately and completely
Please Type or Print
PART A
1. Project name: South Tryon Flats
2. Address of land —disturbing activity: 3304 S Tryon St Charlotte NC 28217
3. Approximate date land -disturbing activity will commence:
Month Day Year
4. Purpose of Development (Residential, Commercial, Industrial, etc.):
5. Total acreage of land to be disturbed or uncovered: 3.48
6. List total site acreage: 3.58
7. Landowners of Record (attach accompanied page to list additional owners). If the landowner of record is not
the person(s) or firm(s) financially responsible as listed in Part B, item 1, a separate letter of consent signed
by the landowner of record or their authorized agent is required:
Name: Neal Properties Inc
Address: 226 South St Davidson NC 28036
Signature:
Telephone:
(Area Code)
Email Address:
Name: Lester Moultrie
Address: 3214 May St Charlotte NC 28210
Signature:
Fax:
Telephone: Fax:
(Area Code)
Email Address:
(Area Code)
(Area Code)
8. Indicate Book and Page where deed or instrument is filed (Use blank page to list additional deeds or
instruments) Book 02313 page 278 Book 15997 Paize 472
Book 01790 Page 264
Book 19728 Page 393
Page 1

CONTINUE — FINANCIAL RESPONSIBILITY/ OWNERSHIP FORM
Additional Landowners of Record:
Name: Joan Stowe
Address:
Signature:
3214 May St Charlotte NC 28210
Book: Page:
Name:
Address:
Signature:
Book: Page:
Name:
Address:
Signature:
Book: Page:

Continue - Financial Responsibility/Ownership Form
PART B
l . Person(s) or firm(s) financially responsible for this land -disturbing activity(Note: If the financially responsible
person(s) or frrm(s) has an out-of-state address, a North Carolina agent must be designated in item 2 belotiv):
Person or Firm: The NRP Group LLC
Address: 1228 Euclid Avenue #400
Cleveland, Ohio 44115
Telephone: [phone] Fax:
(Area Cade) (Area Code)
Email Address: SoutheastPermits nr rou .com.
2. If the Financially Responsible Parry is not a resident of North Carolina, give name and street address of the
designated North Carolina agent:
Person or Firm: CT Corporation System
Address: 160 Mine Lake Court Suite 00 Raleigh, North Carolina 27615
Telephone:
(Area Code)
Email Address:
Fax:
(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.)
Noam Magence Secretary
Ity��
Date
1, FA r 11 - ws JAUra Notary Public of the County
Of
State of hereb
Y
cert that ersonally
appeared before me this day and under oath acknowledge that this form was executed by him/her.
Witness my hand an�otarial seal, this day �of b d 20
Notary Signature;
My Commission expires:
charlottenc.gov
Storm Water Services — Land Development
600 East Fourth Street, Charlotte, North Carolina 28202-2844
Telephone: [phone]
Rev. 09/2021 http://chat-lottenc.gov/develoi2mentcenter
Emma Samuels
Notary Public, State of Ohio
My Commission Expires:
June 30,2026
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