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HomeMy WebLinkAboutNCC231445_FRO Submitted_20230517 FINANCIAL RESPONSIBILITY/OWNERSHIP FORM EROSION & SEDIMENTATION CONTROL IREDELL No person may initiate any land-disturbing activity on one or more acres, 1/2 acre or more inside a I COUNTY • N C watershed, as covered by the Sedimentation Pollution Control Act and the Iredell County Land �✓ Development Code, before an acceptable erosion and sedimentation control plan has been submitted and approved by the Iredell County Planning & Development, Erosion Control Section. (Please type or print) Part A. 1. Project Name WINDSTONE AT WEATHERS CREEK 2. Location of land-disturbing activity: County IREDELL City or Township BARRINGER WEATHERS Highway/Street CREEK ROAD Latitude 35.6793 N Longitude 80.8140 W 3. Approximate date land-disturbing activity will commence: FEB.2023 4. Purpose of development(residential,commercial, industrial, institutional, etc.): RESIDENTIAL 5. Total acreage disturbed or uncovered (including off-site borrow and waste areas): 10.00 ACRES 6. Amount of fee enclosed: $ 1750 . An application fee of$175.00 per acre(rounded up to the next acre)is assessed without a ceiling amount (Example: a 8.10-acre application fee is $1575). For projects > than 0.5 acres but no greater than 0.99 acres in a water supply watershed, a flat fee of$100.00 is assessed. 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 ED BELANGER E-mail Address edbcbhomes@aol.com Telephone 631-831-1461 Cell# 631-831-1461 Fax# 9. Landowner(s)of Record (attach accompanied page to list additional owners): WINDSTONE CONSTRUCTION INC. 631-831-1461 Name Telephone Fax Number 15 FROWEIN ROAD, STE G-2 15 FROWEIN ROAD, STE G-2 Current Mailing Address Current Street Address CENTER MORICHES, NY 11934 CENTER MORICHES, NY 11934 City State Zip City State Zip 10. Deed Book No. 2934 Page No. 256 Provide a copy of the most current deed. Part B. 1. Person(s)or firm(s)who are financially responsible for the land-disturbing activity(Provide a comprehensive list of all responsible parties on an attached sheet): WINDSTONE CONSTRUCTION INC. edbcbhomes@aol.com Name E-mail Address 15 FROWEIN ROAD, STE G-2 15 FROWEIN ROAD, STE G-2 Current Mailing Address Current Street Address CENTER MORICHES, NY 11934 CENTER MORICHES, NY 11934 City State Zip City State Zip Telephone 631-831-1461 _ Fax Number Page 1 of 2 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: RICHARD J. LUTZEL rlutzel@lutzelgandy.com Name E-mail Address 542 WILLIAMSON ROAD, STE 1 542 WILLIAMSON ROAD, STE 1 Current Mailing Address Current Street Address MOORESVILLE, NC 28117-8193 MOORESVILLE, NC 281 1 7-81 93 City State Zip City State Zip Telephone 704-799-3570 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: RICHARD J. LUTZEL rlutzel@lutzelgandy.com Name of Registered Agent E-mail Address 542 WILLIAMSON ROAD, STE 1 542 WILLIAMSON ROAD, STE 1 Current Mailing Address Current Street Address MOORESVILLE, NC 28117-8193 MOORESVILLE, NC 28117-8193 City State Zip City State Zip Telephone 704-799-3570 Fax Number 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 by any change in the information provided herein. Type or prin Titl or Authority :)-P9/2?- Signature Date I, .J 7G F ,4,,QA✓ , a Notary Public of the County of ��e,,ael/ State of North Carolina, hereby certify that V.��e,t sg(Z2n/ 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 day of ' 'a���� �� ��� p ! -/ a_2°Q commission ex ite s 9 m ><1&t1.e • r 4�^•0°• 4.1 •''Q�' „ COUta it1t!s� Page 2 of 2