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Home My WebLink AboutNCC230706_FRO Submitted_20230316FINANCIAL 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. CDIA - Taxiway F Extension, Deicing Pad, South Cross -Field Taxiway, and Yorkmont Realignment Project - Package 2 1. Project Name 2. Location of land -disturbing activity: County Mecklenburg City or Township Charlotte Highway/Street Piney Top Dr and Hangar Rd Latitude 35.204 Longitude-80.947 3. Approximate date land -disturbing activity will commence: March 11 2023 4. Purpose of development (residential, commercial, industrial, institutional, etc.): Airport Expansion 5. Total acreage disturbed or uncovered (including off -site borrow and waste areas): 135 6. Amount of fee enclosed: $ $8, 775.00 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 No Enclosed x 8. Person to contact should erosion and sediment control issues arise during land -disturbing activity Name Ryan Fairchild, Chief Construction Inspector E-mail Address ryan.fairchild@cltairport.com Telephone 704-574-9866 Cell # Fax # 9. Landowner(s) of Record (attach accompanied page to list additional owners): City of Charlotte- Aviation Name Telephone Fax Number 600 E 4th Street Current Mailing Address Current Street Address Charlotte NC 28202 City State Zip City State Zip 10. Deed Book No. 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. City of Charlotte- Aviation jeffrey.mcswain@cltairport.com Name E-mail Address 5601 Wilkinson Blvd 5601 Wilkinson Blvd Current Mailing Address Current Street Address Charlotte NC 28208 Charlotte NC 28208 City State Zip City State Zip Telephone 704-622-1303 Fax Number. 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 Current Mailing Address City Telephone E-mail Address Current Street Address State Zip City State Zip 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: Name of Registered Agent Current Mailing Address City State Zip E-mail Address Current Street Address City Telephone Fax Number, State Zip 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 McSwain, PE Airport Development Manager Type or print name Title or Au hor'ty Sig u Date I,Terre nee- 3Uoej a Notary Public of the County of boa - State of North Carolina, hereby certify that L �c Ewa �" 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 G E' V I ✓� ��'�. �v : psa q y • : N Seal~ �= �� • jOUB\_NC' z" .,� -/ NB 'R `;; day of /1/Ol_e_On k>°1__ 20 La -- Notary My commission expires / Name Telephone Fax Mailing Address Cft State Zip Street Address City State Zip DB No. Pe No. Parcel ID City of Charlotte 600 E Trade St Charlotte NC 28202 4939 Hangar Rd Charlotte NC 28208 3612 4 14102318 City of Charlotte 600 E Trade St Charlotte NC 28202 4733 Hangar Rd Charlotte NC 28208 6638 218 14119101 City of Charlotte 600 E Trade St Charlotte NC 28202 3628 Yorkmont Rd Charlotte NC 28208 2669 228 14119206 City of Charlotte 600 E Trade St Charlotte NC 28202 4417 Yorkmount Rd Charlotte NC 28208 6636 691 14119204 City of Charlotte 600 E Trade St Charlotte NC 28202 4501 Hangar Rd Charlotte NC 28208 6650 346 14119203 City of Charlotte 600 ETrade St Charlotte NC 28202 4020 Yorkmont Charlotte NC 28208 6367 873 14119202 City of Charlotte 600 E Trade St Charlotte NC 28202 NA NA NA NA 2085 244 14102319 City of Charlotte 600 E Trade St Charlotte NC 28202 5631 West By Charlotte NC 1 28208 3423 1 567 1 14120201 City of Charlotte 600 E Trade St Charlotte NC 28202 NA NA NA NA 14108 460 14101104 City of Charlotte 600 E Trade St Charlotte NC 28202 4906 Piney Top Dr Charlotte NC 28208 3799 702 14101106 City of Charlotte 600 E Trade St Charlotte NC 28202 8200 Byrum Dr Charlotte NC 28208 8605 40 14101113 City of Charlotte 600 E Trade St Charlotte NC 28202 8116 Byrum Dr Charlotte NC 28208 6176 301 14101114 City of Charlotte 600 E Trade St Charlotte NC 28202 8200 Byrum Dr Charlotte NC 28208 8605 40 14101113 City of Charlotte 600 E Trade St Charlotte NC 28202 8000 Byrum Dr Charlotte NC 28208 8965 557 14101116 City of Charlotte 600 E Trade St Charlotte NC 28202 NA NA NA NA 8605 37 14101112 City of Charlotte 600 E Trade St Charlotte NC 28202 4923 Larkmoore Ct Charlotte NC 28208 1 17034 326 14101142 City of Charlotte 600 E Trade St Charlotte NC 28202 4923 Larkmoore Ct Charlotte NC 28208 11081 881 1 14101142 City of Charlotte 600 E Trade St Charlotte NC 28202 4926 Larkmoore Ct Charlotte NC 28208 8116 251 14101143 City of Charlotte 600 E Trade St Charlotte NC 28202 4200 Yorkmont Rd Charlotte NC 28208 11423 345 11521109 City of Charlotte 600 E Trade St Charlotte NC 28202 5205 Hangar Rd Charlotte NC 28208 6158 996 14102313 City of Charlotte 600 E Trade St Charlotte NC 28202 8216 Byrum Dr Charlotte NC 28208 6084 546 14101111 AFB-TWO LP PO BOX 286 Hasbrouck Heights NJ 7604 4815 Sirus Ln Charlotte NC 28208 7951 313 14101138 Colonial Fuel and Lubricant Services Inc 101 North Lathrop Ave Savannah GA 31415 4901 Sirus Ln Charlotte NC 28208 33470 678 14101146 AubreyJJRElam 5017 Sirus Ln Charlotte NC 28208 5017 Sirus Ln Charlotte NC 28208 10634 721 14101148 Griffin & Griffin Prime Investment 4801 West By Charlotte NC 28208 4801 West By Charlotte NC 28208 5383 408 14101402 International Express Holdings INC 141 Robin St Lowell NC 28098 4749 West By Charlotte NC 28208 32237 175 14101401 Carolina Printwear & Sports Equipment 11512 Winding Way rd Charlotte NC 282226 4920 Larkmoore Ct Chaelotte NC 28208 11313 881 14101144 Sun Enterprises LLC PO Box 12658 Charlotte NC 28220 NA NA NA NA 33095 858 14101141 Hans Joachim Nocher 5001 Sirus Ln Charlotte NC 28208 5001 Sirus Ln Charlotte NC 28208 22285 105 14101147 Brown Craig INC 250 N Trade St Charlotte NC 28105 4800 Sirus Ln Charlotte NC 28208 9152 574 14101407 D+F Realty Lite 3020 Bridgewick Rd Waxhaw NC 28173 4816 Sirus Ln Charlotte NC 28208 34005 98 14101406 Felton Family Partnership LLP 259 Bobby Jones Expressway Augusta GA 30907 4916 Sirus Ln Charlotte NC 28208 31259 675 14101418