NCC232923_FRO Submitted_20230927

City of Charlotte Soil Erosion and
Sedimentation
Control Ordinance
7 Financial Responsibility/Ownership Form
No person shall initiate any land-disturbing activity on one or more acres as covered by Chapter 17 of the Charlotte
City Code of Ordinances before this form and an acceptable erosion and sedimentation control plan have been completed
and approved by the City of Charlotte.The financially responsible 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. All relevant
items on this form must be filled out accurately and completely
Please Type or Print
PART A
1. Project name: The McAlpines Soccer Field - Site 2
2. Address of land—disturbing activity: 8330 McAlpine Park Drive
1, 2023ust
3. Approximate date land-disturbing activity will commence: August Year
Month Day
4. Purpose of Development(Residential, Commercial, Industrial, etc.): Commercial
5. Total acreage of land to be disturbed or uncovered: 4.93ac
6. List total site acreage: 12.53ac
7. Landowners of Record (attach accompanied page to list additional owners). If the landowner of record is not
the person(s) or firm(s) financially responsible as listed in Part B, item 1, a separate letter of consent signed
by the landowner of record or their authorized agent is required:
Name: The McAlpines LLC
Address: PO Box 2439, Matthews, NC 28106
Telephone: [phone] Fax: (Area Code)
(Area Code)
Email Address: dsmith levine ro erties.com
Name:
Address:
Fax:
Telephone: (Area Code)
(Area Code)
Email Address:
Indicate Book and Page where deed or instrument is filed(Use blank page to list additional deeds or
8. Book Page
instruments) Book 9169 Page 181
Book Page
Book Page Page 1

Continue - Financial Responsibility/Ownership Form
PART B
I. Pcrson(s)or firm(s)financially responsiblc for this land-disturbing activity(Note:If the financially responsible
persons)or firms)has an out-of-state address,a North Carolina agent must he designated in item 2 below):
Person or Firm: DT Soccer, LLC
Address: 800 S. Mint Street
Charlotte. NC 28202
Telephone: [phone] Fax:
(Arca Code) (Area Code)
Email Address: [e-mail]
2. If the Financially Responsible Party is not a resident of North Carolina,give name and street address of the
designated North Carolina agent:
Person or Firm:
Address:
Telephone: Fax:
(Area Code) (Area Code)
Email Address:
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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! N _ , a NotaryPublic of the County
1 hereby
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certify that
appeared before me this day and under oath acknowledge that this form was executed by him/her. 70
Witness my han n otaria
day of
Notary Signature: ,,
My Commission expires:
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Storm Water Services—Land Development
92
600 East Fourth Street,Charlotte,
tte,North 6th Carolina 28202-2844
h ://charlottenc. ov/develo mentcenter
Page'-
Rev.09/2021