NCC232596_FRO Submitted_20230828

5/9/23,3:09 PM Rowan County
Financial Responsibility/Ownership Form Sedimentation Pollution Control Ordinance
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 Rowan County
Environmental Management Department.
Part A Parcel ID Number
0520470001,
0520470101, 052204
1.Project Name*
Rusher Farms Industrial Center
2.Location of land-disturbing activity(Highway/Street)*
721 Andrews Street
Latitude Longitude
35.682755° -80.414926°
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3.Approximate date land-disturbing activity will be commenced
7/1/2023
4.Purpose of development(residential,commercial,industrial,etc.)
Industrial Warehouse&Gas Station
5.Approximate acreage of land to be disturbed or uncovered*
6a
4
6.Person to contact should sediment control issues arise during land-disturbing Cell Phone Number*
activity* 9193392371
Tim Wipperman
*this information will be made available on the Rowan County Planning 8 Development website.
Email Address
[e-mail]
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5/9/23,3:09 PM Rowan County
7.Landowner of Record Landowner of Record
Rusher, Robert James Sr. Clayton,Ashley S
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Name Name
Current Mailing Address Current Mailing Address
1060 Choate Road 2222 Westdale Drive
Salisbury, NC 28146 Fayetteville, NC 28303
4
8.Recorded in Deed Book Number Page Number
08-E 1207
Part B
1.Person or Firm who are financially responsible for this Person or Firm who are financially responsible for this land-
land-disturbing activity disturbing activity
Tectonic, LLC
Name of Person(s)or Firms) Name of Person(s)or Firm(s)
Current Mailing Address Current Mailing Address
416 Hermitage Court
Charlotte, NC 28207
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Phone Number Phone Number
a.If the Financially Responsible Party is not a resident of North Carolina,give name and street address of a North Carolina
Agent.
Name of Agent Name of Agent
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Current Mailing Address Current Mailing Address
4
Phone Number Phone Number
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5/9/23,3:09 PM Rowan County
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
Wake Hamilton
Current Mailing Address Current Street Address
416 Hermitage Court
Charlotte, NC 28207
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Telephone Number Telephone 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 authority to execute instruments for the Financially Responsible Person).
I agree to provide correctional information should there be any change in the information provided herein.
Name Title or Authority
Wake Hamilton President
Signature Date
_ ®,9 a
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X
I, A5 f Dye. # J a
Not y Public of the County of ��,k�(A'tb State of North Carolina,
hereby certify that s.4(/ ytT;i 0 appeared personally before me this da t being duly sworn acknowledged
that the above form was executed by him/her.Witness my hand and seal of Notary,this Ss-day of Afhty ,203.
Notary My commission expires
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Checklist = 'OUBOO ; Z
Download a copy of the Erosion and Sedimentation % ;•,`1'
Control Plan Checklist(PDF) 1. C�%.j;11 2;°••s i`q
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ii,https://www.rowancountync.gov/FormCenter/Print?formID=96&Preview=YES&Save=False&savedProgressID=810 3/3