NCC232095_FRO Submitted_20230712

PLAN REVIEW/FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
CATAWBA COUNTY CODE OF ORDINANCES, CHAPTER 16 ARTICLE V
SOIL EROSION AND SEDIMENTATION CONTROL
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 Catawba County
Utilities and Engineering Department. (Please type or print, and if question is not applicable,please N/A in the blank)
PART A
1. Job Name Spring Farms Subdivision
2. PIN or 911 Address (See attached)
3. Purpose of development (residential, commercial, industrial, institutional,etc.) Residential
4. Approximate soil disturbance date (June 1,2023
5. Total acreage disturbed or uncovered (including off-site borrow and waste areas) I7.51
6. Has an erosion and sedimentation control been filed? r Yes f No r: Attached
7. If you have an Erosion Control billing account, would you like this to be billed? r Yes Pi No
Account Number
PEOPLE
8. Person to contact should erosion and sediment control issues arise during land-disturbing activity
Name (Katie Dyess E-mail address [e-mail]
Telephone [phone] Cell# 1704-488-1100 Fax# I
9. Landowner(s) of Record (attach accompanied page to list additional owners)
Name Martinray Holdings LLC Telephone Fax# I
Current Mailing Address 114 Morlake Drive;Suite 103
City (Mooresville State INC Zip 28117
Current Street Address Same
City State I_ Zip I
10. Deed Book No. 13736 Page No. 1782
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 attached sheet):
Name IWJH LLC E-mail address [e-mail]
Current Mailing Address 9325 Center Lake Drive Ste 160
City Charlotte State INC Zip 128216

Current Street Address 19325 Center Lake Drive Ste 160
City (Charlotte State INC Zip 128216
Telephone [phone] Fax#
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:
Name (Katie Dyess E-mail address [e-mail]
Current Mailing Address 19325 Center Lake Drive Ste 160
City [Charlotte State INC Zip 128216
Current Street Address I
City I State I Zip I
Telephone J980-488-1100 Fax#
2. (b) If the financially responsible party is a Partnership or other person engaging in business under 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:
Name CT Corporation Systems E-mail address
Current Mailing Address 1160 Mine Lake Ct;Suite 200
City (Raleigh State INC Zip 127615
Current Street Address I
City I State I Zip I
Telephone I Fax# I
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 be any change in the information provided herein.
Kurt Stawarz Regional President
Type of Print Name Title of Authority
4/26/23
Signatur Date
I, A „ t,t' ,a Notary Public of the County of C4 State of North
Carolina,hereby certify hat � ,¢- S ,°�z appeared personally before me this day and being duly
sworn ackn`mledg9,that the above form was executed by him.
\ A WR7i,/o
Witnp*hy hand andcrbarayy seal,this ZC. day of 7 Z ,2077
Seal I ARY /1//
P U g L\G Notary
09 4) My Commission expires 5'3o-Z�
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