NCC232653_FRO Submitted_20230901

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 party is out of State,a North Carolina agent must be assigned.
Please Type or Print
PART A
1. Project where land-disturbing activity is to be undertaken: Dillon Lakes Phase 2 (ACCELA Project No.
SDRMF-2021-00164)
2. Address of land—disturbing activity: 5000 Stevedore Way, Lots 225-229&262-265(Bldks 1002& 1010)
3. Approximate date land-disturbing activity will commence: Oct. 2023
Month Day Year
4. Purpose of Development(Residential, Commercial,Industrial, etc.): Townhome Construction
5. Approximate acreage of land to be disturbed or uncovered: 0.36 ac.
6. List total site acreage: 19.3 ac.
7. Landowners of Record(Use blank page to list additional owners):
Name (1) : Cardinal Development Group (aka,Dillon Lakes, LLC)
Address: 8320 Judy Witt Lane
Vienna, VA 22183
Telephone: [phone] Fax: N/A
(Area Code) (Area Code)
Email Address: ckieler(a�cardinaldevvrp.com (Charles Kieler)
Signature: See Authorization Letter from Owner
Name(2):
Address:
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 37017 Page 706 Book Page
Book Page Book Page
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Continue - Financial Responsibility/Ownership Form
PART B
1. Person(s) or firm(s)financially responsible for this land-disturbing activity:
Person or Firm: NVR,Inc. (dba Ryan Homes)
Address: 13924 Professional Center Drive, Suite 100
Huntersville,NC 28078
Telephone: [phone] Fax: [phone]
(Area Code) (Area Code)
Email Address: lhuthei'e?a nvriuc.coin (Luke Huther)
2. North Carolina agent, for the person or firm who is financially responsible:
Person or Firm: Corporation Service Company
Address: 2626 Glenwood Avenue, Suite 550
Raleigh,NC 27608
Telephone: [phone] Fax: N/A
(Area Code) (Area Code)
Email Address: N/A
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.)
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Printed Name U Title
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Signature / / //IL/)
Date
I /'/Vd / li , a Notary Public of the County
of Li Aitea( , State of ! V eita i`. ItrarizAJ , hereby
certi.6)that E tve/ve- f e . personally
appeared before me this day and under oath acknowledge that this for was executed by him/her.
Witness my hand and notarial seal, this / q 4_- day of 11�t�( L1-67 , 20 .4
Notary Signature: a2m 7 }
My Commission expires: oRh?f C1a
D:1 NEW HE PROJECTS122321-DILLON LAKES PH 21DOCS\FRO DILLON LAKES PH2.DOCX
ANNETTE N GALLUP
Notary Public, North Carolina
Lincoln County
My Commission Expires
Me February 29,2024
CHARLOrFTE.
ENGINEERING&PROPERTY
MANAGEMENT
Land Development Division
600 East Fourth Street,Charlotte,North Carolina 28202-2844
Telephone:[phone] Fax:[phone]
http://landperrnits.charmeek.org
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