NCC231191_FRO Submitted_20230426

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
330-119, 329-050,
329-049
1.Project Name
Winecoff Subdivision
2.Location of land-disturbing activity(Highway/Street)
North side of Statesville Blvd, approximately 650 feet west of intersection of Statesville Blvd and Wilton Ln.
Latitude Longitude
35.70271 -80.535992
3.Approximate date land-disturbing activity will be commenced
03/01/2023
4.Purpose of development(residential,commercial,industrial,etc.)
74-lot single family residential development
5.Approximate acreage of land to be disturbed or uncovered
21 acres
6.Person to contact should sediment control issues arise during land-disturbing Cell Phone Number
activity -
J urnner �a �e GrSerl �(J04}57573
g'6y- /7/- $'0 9
Email Address
jjbaynerg.smithelouglasmum HM c Mersa.-, 0 S,1,/41°* d"S•low

7.Landowner of Record Landowner of Record
See attached.
Name Name
Current Mailing Address Current Mailing Address
8.Recorded in Deed Book Number Page Number
Part B
1.Person or Firm who are financially responsible for this land- Person or Firm who are financially responsible for this land-
disturbing activity disturbing activity
SDH Charlotte, LLC
Name of Person(s)or Firm(s) Name of Person(s)or Firm(s)
Current Mailing Address Current Mailing Address
4297 H WY 24/27 E
Midland, NC 28107
Phone Number Phone Number
(70 )...57.5- 7//' 6-19
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
Current Mailing Address Current Mailing Address
Phone Number Phone 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 the name and street address of
the Registered Agent.
Name of Registered Agent
Matthew Chisholm
L
Current Mailing Address Current Street Address
4297 HWY 24/27 E
Midland, NC 28107
Telephone Number Telephone Number
(7 any- 99l- con
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
Jotm Bi unit er �a2it AfeA,y5Du Vi men
4,), Pe 0+1"4474 471411' /1/4"42', ,
Signature Date
1 UM
I,gcm -rsr I ,a Notary Public of the County of vn 1on State of North Carolina,hereby
certify that M C?hCeson appeared personally before me this day and b ng duly swornQ,/j acknowled'e I that the
above form was executed by him/her.Witness my hand and seal of Notary,this (('41 day of a I ' 'b ,21)
Notary My commission expires
lachtrkkrb
mm/dd/yyyy
Seal
Rachel Tomlin
NOTARY PUBLIC
Checklist Union County
Download a copy of the Erosion and Sedimentation Control North Carolina
Plan Checklist(PDF), My Commission Expires July 28,2027

Landowners of Record
1. Richard Lee Cooley
203 Cooley Farm Road, Woodleaf, NC 27054
Parcel ID: 330-119
PIN: 5741-03-33-7806
Deed Book/Page: 599/94
2. Donnie A Myers & WF Margaret R Myers '
224 Whispering Woods Dr, Fleming Island, FL 32003
Parcel ID: 329-050
PIN: 5741-03-34-9325
Deed Book/Page: 971/504
2. James Arcus Myers & Donnie A Myers
224 Whispering Woods Dr, Fleming Island, FL 32003
Parcel ID: 329-049
PIN: 5741-03-44-4527
Deed Book/Page: 796/107