NCC231348_FRO Submitted_20230508

ii.,„ Gaston County
(�
c1 Gaston Natural Resources Department
d 1303 Cherryville Highway, Dallas, NC 28034 Telephone: [phone]
so
;511 4--e., Soil Erosion & Sedimentation Control
In Financial Responsibility/Ownership
4,
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 N/A in blank)
PART A:
1. Project Name Derry Phase 1
2. Location of land-disturbing activity
City Gastonia Highway/Street Howe Dairy Road
3. Approximate date land-disturbing activity will commence January 2023
4. Purpose of development(residential, commercial, industrial, etc.) Residential
5. Total acreage disturbed or uncovered (including off-site borrow and waste areas) 89 ac
6. Amount of fee enclosed $26,700
7. Soil Erosion & Sedimentation Plan Filed? Yes X No
8. Landowner(s) of Record (Use blank page to list additional owners)
Name Name
Mailing Address *SEE ATTACHED SHEET FOR PROPERTY INFORMATION*
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 Pana
Deed Book *SEE ATTACHED SHEET FOR
PROPERTY INFORMATION*
10. Tax Map No. Lot No.
Page 1

PART B:
1. Person(s)or firm(s)who are financially responsible for this land-disturbing activity
TriGate Suncrest Howe Landing LLC
Name Name
2701 E Camelback Road, Suite 180
Mailing Address Mailing Address
Phoenix AZ 85016
City State Zip City State Zip
704.995.3290
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 agent.
CT Corp
Name
150 Fayetteville Street
Mailing Address Street Address
Raleigh NC 27601 919-821-7139
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). I
agree to provide corrected information should there be any change in the information provided
herein.
.SEAVA \NIG y C1P•NaEi 69-
Type or P int Title or
Authority
jl l LiZo'L'L
Signature Date �/ _
I, G/ , a Notary Public of the County of ti('i oo ct , State f hi
, hereby rtify that an ogle- appeared persohally before me this day
and being duly sworn acknowledged that the abo e form as exe uted by him.
Witness my hand and notarial seal,this 6 day of__ , 2 O 24..
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Notary 0 .NE .., GAQWN+NER r Ily Commission Expires
Notary Public-Arizona ` File:Financial Responsibility-Ownership Form.mw
` l Maricopa County `
' \`'c Commission#574473
My Comm.Expires Nov 7,2023 M Page 2
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1. TriGate-Suncrest Howe Landing LLC
2701 East Camelback Road, Suite 180,
Phoenix, AZ 85016
DB: 5340
PG: 1616
Tax Parcel: 141615
PIN: 3544932510
2. TriGate-Suncrest Howe Landing LLC
2701 East Camelback Road, Suite 180,
Phoenix,AZ 85016
DB: 5340
PG: 1406
Tax Parcel: 307554
PIN: 3544932510
3. TriGate-Suncrest Howe Landing LLC
2701 East Camelback Road, Suite 180,
Phoenix, AZ 85016
DB: 5340
PG: 1375
Tax Parcel: 220216
PIN: 3544932510
4. TriGate-Suncrest Howe Landing LLC
2701 East Camelback Road, Suite 180,
Phoenix, AZ 85016
DB: 5340
PG: 1526
Tax Parcel: 305081
PIN: 3544932510