NCC232332_FRO Submitted_20230804

City of Charlotte & Mecklenburg County
Soil Erosion and Sedimentation
Control Ordinance
Financial Responsibility/Ownership Form
No person shall initiate any land-disturbing activity covered by Chapter 17, Article 2 of the Charlotte City Code or
Section 6 of the Mecklenburg County Sedimentation and Erosion Control Ordinance prior to completing and filing this
form with the City of Charlotte Engineering and Property Management Department, Land Development Services Division
or Mecklenburg County Land Development Services. The financial responsibility party will be on record as the party to
accept any Notices of Violation or related documents for any non-compliance of the City of Charlotte Soil Erosion and
Sedimentation Ordinance. If the financially responsible parry is out of State, a North Carolina agent must be assigned.
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PART A
1. Project where land-disturbing activity is to be undertaken: Galloway Road Subdivision
2. Address of land—disturbing activity: 1901 Galloway Road, Charlotte, NC 28262
3. Approximate date land-disturbing activity will commence: March 1, 2023
Month Day Year
4. Purpose of Development(Residential, Commercial, Industrial, etc.): Residential Development
5. Approximate acreage of land to be disturbed or uncovered: 8.0 Acres
6. List total site acreage: 8.0 Acres
7. Landowners of Record(Use blank page to list additional owners):
Name: Donald and Sherry Henderson
Address: 1901 Galloway Road
Charlotte, NC 28262
Telephone: Fax:
(Area Code) (Area Code)
Email Address:
Signature:
Name: AREP Galloway, LLC
Address: 2820 Selwyn Avenue, Suite 6118
Charlotte, NC 28209
Telephone: Fax:
(Area Code) (Area Code)
Email Address:
Signature:
8. Indicate Book and Page where deed or instrument is filed (Use blank page to list additional deeds or
instruments) Book 10187 Page 230 Book Page
Book 36463 Page 308 Book Page
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Continue - Financial Responsibility/Ownership Form
PART B
1. Person(s) or fin-n(s) financially responsible for this land-disturbing activity:
Person or Finn: Pulte Home Company, LLC
Address: 11121 Carmel Commons Boulevard Suite 450
Charlotte NC 28226
Telephone: [phone] Fax:
(Area Code) (Area Code)
Email Address: [e-mail]
2. North Carolina agent, for the person or firm who is financially responsible:
Person or Finn: Dan Rossi
Address: 11121 Carmel Commons Boulevard, Suite 450
Charlotte NC 28226
Telephone:[phone] Fax:
(Area Code) (Area Code)
Email Address:daniel.rossippultegroup.com
3. The above information is true and correct to the best of my knowledge and belief and was provided by me
while under oath. (This form must be signed by the financially responsible person if an individual or by an
officer, director, partner, attorney-in-fact, or other person with authority to execute instruments for the
financially responsible company or entity, if not an individual.)
Dan Rossi VP Land Planning and Development
Printed Title
` 8/2/2023
Si VRTUre Date
I, YC A)ayt a Notary Public of the County
of -)�n State of- &O (s Cam✓ , hereb3,
certif}�that o�S t personally
appeared before nse this day and under oath acknoivledge that this form was execiefed by hinilher.
Witness nay hand and notarial seal, this _ '� day of _ . 2023
Notary Signatiu•e:
My Commission expires: ©q 2 02g,
Porsha Stewart •
1K.. ;►,�;i � NOTARY PUBLIC
I �t Mecklenburg County, NC
My Commission Expires May 09, 2028
ENGINEERING&PROPEM
MANAGEMENT
Land Development Division
600 East Fourth Street,Charlotte,North Carolina 28202-2844
Telephone: [phone] Fax: [phone]
http://Iaiidpernlits.cliarmeck.org
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