NCC231067_FRO Submitted_20230418

O1°'"''A Gaston County
Gaston Natural Resources Department
- i n o 1303 Cherryville Highway, Dallas NC 28034 Telephone: [phone]
.IJ�1., � P
eSoil Erosion & Sedimentation Control
a,,
. Financial Responsibility/Ownership
No person may initiate any land-disturbing activity on one (1) or more acres of property in all portions of
Gaston County, except for that property within the city limits of the incorporated municipalities of Gaston
County who have not adopted the Gaston County Soil Erosion & Sedimentation Control Ordinance,
before this form and an acceptable Soil Erosion & Sedimentation Control Plan have been completed and
approved by the Gaston County Natural Resources Department's staff.
(Please type or print and, if question is not applicable, place NIA in blank)
PART A:
1. Project Name Cramer Woods Phase 2
2. Location of land-disturbing activity
City Gastonia, NC Highway/Street McDade Lane _
3. Approximate date land-disturbing activity will commence April 2022
4. Purpose of development(residential, commercial, industrial, etc.) Residential
5. Total acreage disturbed or uncovered (including off-site borrow and waste areas) 18.6
6. Amount of fee enclosed $ 5,700
7. Soil Erosion & Sedimentation Plan Filed? Yes X No
8. Landowner(s)of Record (Use blank page to list additional owners)
Horsley Forests, LLC
Name Name
1919 Chestnut Street
Mailing Address Mailing Address
Wilmington, NC 28405
City State Zip City State Zip
Telephone Number Telephone Number
9. Indicate Deed Book and Page where deed(s)or instrument(s)are recorded
Deed Book 4699 _ Page 990-998
Deed Book Page
10. Tax Map No. _ Block Lot No.
Page I

PART B:
1. Person(s)or firm(s)who are financially responsible for this land-disturbing activity
AMH NC DEVELOPMENT, LP
Name Name
16905 Northcross Drive, Ste 200
Mailing Address Mailing Address
Huntersville. NC 28078
City State Zip City State Zip
704-650-1936
Telephone Number Telephone Number
2. If the Financially Responsible Party is not a resident of North Carolina, give name and street
address of a North Carolina aaent.
Name
Mailing Address Street Address
City State Zip Telephone Number
3. 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 Part is a Corporation give name and street address of the Registered Agent.
Name
Mailing Address Street Address
City State Zip Telephone Number
4. 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 authority to execute instruments for the financially responsible person).
agree to provide corrected information should there be any change in the information provided
herein.
Type or Pri ame Title or Authority
7/3) 202.2-
Sig ature Date
I,(I Gbe oJ-%. S Mea Cr- , a Notary Public of the County of ic'r , , State of North
Carolina, hereby certify that fh—arleA I1 �'c i'c_, appeared personally before me this day
and being duly sworn acknowledged io was executed by him.
Witness my hand and notarial seaF
....4 e , 2022 .
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