NCC230910_FRO Submitted_20230426

7/1/22,12:28 PM Rowan County
Financial Responsibility/Ownership Form Sedimentation Pollution Control Ordinance
No person may initiate any land-disturbing activity on one or more acres as covered by the ordinance before this form
and an acceptable erosion and sedimentation control plan have been completed and approved by the Rowan County
Environmental Management Department.
Part A Parcel ID Number
057174
1.Project Name
Kerns Ridge Subdivision
I
2.Location of land-disturbing activity(Highway/Street)
.0 Bringle Ferry Road, East Spencer, NC (approx. 0.5 mile west of intersection with McCanless Road)
1
Latitude Longitude
35.662910 -80.432999
3.Approximate date land-disturbing activity will be commenced
11/15/2022
4.Purpose of development(residential,commercial,industrial,etc.)
Residential
5.Approximate acreage of land to be disturbed or uncovered
52.0 acres
6.Person to contact should sediment control issues arise during land-disturbing Cell Phone Number
activity
704-363-9760
Greg Williams
—.--._-..__--.-----
Email Address
[e-mail]
https://www.rowancountync.gov/FormCenter/Print?formlD=96&Preview=YES&Save=False&savedProgresslD= 1/3

7/1/22, 12:28 PM Rowan County
7.Landowner of Record Landowner of Record
!Garden Street Communities Southeast, LLC
Name Name
Current Mailing Address Current Mailing Address
100 W. Garden St. 2nd Floor
Pensacola, FL 32502-5696
8.Recorded in Deed Book Number Page Number
1405 811
Part B
1.Person or Firm who are financially responsible for this Person or Firm who are financially responsible for this
land-disturbing activity land-disturbing activity
!Garden Street Communities Southeast, LLC
'Contact Person: Greg Williams
Name of Person(s) or Firm(s) Name of Person(s)or Firm(s)
Current Mailing Address Current Mailing Address
3401 St. Vardell Lane, Suite B
Charlotte, NC 28217
Phone Number Phone Number
704-363-9760
a. If the Financially Responsible Party is not a resident of North Carolina,give name and street address of a North Carolina
Agent.
Name of Agent Name of Agent
National Registered Agents, Inc.
Current Mailing Address Current Mailing Address
160 Mine Lake Ct. Ste. 200
Raleigh, NC 27615
Phone Number Phone Number
919-944-4780
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7/1/22,12:28 PM Rowan County
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.Lithe Financially Responsible Party is a Corporation,give the name and street
address of the Registered Agent.
Name of Registered Agent
!National Registered Agents, Inc.
Current Mailing Address Current Street Address
160 Mine Lake Ct. Ste. 200
Raleigh, NC 27615
Telephone Number Telephone Number
919-944-4780
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).
I agree to provide correctional information should there be any change in the information provided herein.
Name Title or Authority
Carden S Commr> LLC VP of Operations
Michael Patrick Green
Signature Date
C.:1\ • ZGr—.Z
I, iiaphne Fincher a Notary Public of the County of „,, ,,t State of North Carolina,
hereby certify that Michael Patrick Green appeared personally before me this day and being dul x,sw-orn acknowledged
that the above form was executed by him/her.Witness my hand and seal of Notary,this —1 day of ` ,207-2_
Notary My commission expires
� I
:i?•` DAPHNE J.PINCHER
4.- . MY COMMISSION#HH249469
EXPIRES:August 4,2026
Seal
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