NCC231650_FRO Submitted_20230530

CITY OF MONROE STANDARD SPECIFICATIONS AND DETAIL MANUAL
07.06 EROSION CONTROL FORMS AND CHECKLISTS
07.06.01 EROSION CONTROL FINANCIAL RESPONSIBILITY FORM
No person may initiate any land-disturbing activity as defined in Chapter 158 of the Monroe City Code prior to
completion of this form,and an applicable and acceptable erosion and sedimentation control plan has been approved by
the City of Monroe Engineering Department. (Please type or print)
Part I
1. Name of Project Riverstone Subdivision - Phase 1
2. Address where land disturbing activity will take place 3908 N. Rocky River Road, Monroe, NC 28110
3. Approximate date disturbing activity will commence 6 / 1 / 2023
4. Purpose of development(residential,commercial, industrial,etc.) Residential
5. Total acreage of land to be disturbed or uncovered 114.5 acres
6. Amount of fee enclosed(fee will be the amount of current policies per acre multiplied by the total number
of acres or any part of an acre from number 5. i.e.7.28 acres equals 8 acres.) $11,900.00
(1 ac x$500) + (114 ac x$100)
7. Agent to contact should sediment control issues arise during land disturbing activity
Name Dan Rossi Phone [phone]
8. Landowner(s)of Record(use blank page to list additional owners)
Name Pulte Home Compnay, LLC Name
Mailing Address Mailing Address
2625 Glenwood Avenue, Suite 550
Raleigh, NC 27608
Street Address Street Address
Phone Phone
Fax Fax
9. Indicate Book and Page where deed of the property where land disturbing activity will take place is recorded
(use blank page to list additional owners)
Book See Attached Book
Page Page
10. Tax Map Parcel Number where land disturbing activity will take place See Attached
07-18 Permits, Checklists, and Forms
Division 07

CITY OF MONROE STANDARD SPECIFICATIONS AND DETAIL MANUAL
Part II
Person(s)or firm(s)who are financially responsible for this land disturbing activity(use blank page to list
additional owners)
Name Pulte Home Company,LLC Name
Mailing Address 2625 Glenwood Avenue, Mailing Address
Suite 550,Raleigh,NC 27608
Street Address 2625 Glenwood Avenue, Street Address
Suite 550,Raleigh,NC 27608
Phone [phone] Phone
Fax Fax
2. A)If the Financially Responsible Party is not a resident of North Carolina, give name and address of a North
Carolina Agent
Name of Registered Agent •
Mailing Address
Street address City State Zip
Phone Email Fax
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
Mailing Address
Street address City State Zip
Phone Email Fax
3. The above information is true and correct to the best of my knowledge and belief and was provided by me
under oath. I agree to provide corrected information should there be any change in the information provided
herein.(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)
Type or Print Nam Dan Rossi Title VP Land Planning and Development
Signature Date
►, V O'e �"t(J�" `� ,a Notary Public of the County of'Ae 1 e" iv ,State of North Carolina,
hereby certify that 0A) 1 �l _o 6t appeared personally before me this d and being dtly sworn acknowledged
that the above form was executed by him.
,. h,-L 315� y 26 23
d notarial seal,this da of
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PUMP My commission expires
.� '�� 07-19 Permits, Checklists, and Forms
t;/Z1 Division 07

Deed
Parcel ID Owner
Book Page
07012007 Pulte Home Company, LLC 8682 338-340
07012010 Pulte Home Company, LLC 8682 298-300
08300033 Pulte Home Company, LLC 8682 304-307
08300035E Pulte Home Company, LLC 8682 311-316
08300040B Pulte Home Company, LLC 8682 311-316
08300054 Pulte Home Company, LLC 8682 301-303
08300054A Pulte Home Company, LLC 8682 308-310
08300054D Pulte Home Company, LLC 8682 298-300
08300054E Pulte Home Company, LLC 8682 301-303