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HomeMy WebLinkAboutNCC240638_FRO Submitted_20240307 FINANCIAL RESPONSIBILITY/OWNERSHIP FORM EROSION & SEDIMENTATION CONTROL IREDELL No person may initiate any land-disturbing activity on one or more acres, Y. acre or more inside a o i_r N Tv x C watershed, as covered by the Sedimentation Pollution Control Act and the Iredell County Land Development Code, before an acceptable erosion and sedimentation control plan has been submitted and approved by the Iredell County Planning&Development,Erosion Control Section. (Please type or print) Part A. 1. Project Name Quail Ridge Dr Subdivision Erosion & Sediment Control Plan 2. Location of land-disturbing activity: County Iredell City or Township Mooresville Highway/Street Quail Ridge Dr Latitude 35-32-46 Longitude —80-52-06 3. Approximate date land-disturbing activity will commence: March 4, 2024 4. Purpose of development(residential,commercial, industrial, institutional,etc.): Residential 5. Total acreage disturbed or uncovered(including off-site borrow and waste areas): 4.2 6. Amount of fee enclosed:$ 875.00 . An application fee of$175.00 per acre(rounded up to the next acre)is assessed without a ceiling amount (Example: a 8.10-acre application fee is $1575)_ For projects >than 0.5 acres but no greater than 0.99 acres in a water supply watershed,a flat fee of$100.00 is assessed. �[ 7. Has an erosion and sediment control plan• been filed? Yes No Enclosed X 8. Person to contact should erosion and sediment control issues arise during land-disturbing activity: Name Gabriel Barnhardt E-mail Address gabeb@teambellalago.com Telephone Cell# 704-506-0566 Fax# 9. Landowner(s)of Record(attach accompanied page to list additional owners): Southern Alliance II, LLC 704-506-0566 Name Telephone Fax Number 18124 Nantz Rd 18124 Nantz Rd Current Mailing Address Current Street Address Cornelius, NC 28031 Cornelius, NC 28031 City State Zip City State Zip 10. Deed Book No. 301 8 Page No. 1 397 Provide a copy of the most current deed. Part B. 1. Person(s)or firm(s)who are financially responsible for the land-disturbing activity(Provide a comprehensive list of all responsible panties on an attached sheet): Southern Alliance II, LLC Name E-mail Address 18124 Nantz Rd Current Mailing Address Current Street Address Cornelius, NC 28031 City State Zip City State Zip Telephone 704-506-0566 Fax Number • ram" Page of 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 E-mail Address Current Mailing Address Current Street Address City State Zip City State Zip Telephone Fax Number (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 name and street address of the Registered Agent: Name of Registered Agent E-mail Address Current Mailing Address Current Street Address City State Zip City State Zip Telephone • Fax 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 the authority to execute instruments for the Financially Responsible Person). I agree to provide corrected information should there by any change in the information provided herein. abrel mhar President Type ri Title or Authority t , 2/Z/ ' a Date I, t iv, ni./Z i- L!4_,C( / L /Ibf,allotaPublicoftheCountyof l /7 State of North Carolina, hereby certify that (j7�/2v _ �,`ef 4't I l ii_CL'� appeared personally before me this day and being duly sworn acknowledged that the above form wal;executed by him. Witness my hand and notarial seal,this day of r- va_e;/.1 ,20 , . V_ - u--v -a/e-. �}'h.�G^Ii/V--(..--YLAj2 ,i N Seal ] My commission expires ` ✓' Bruni Trinidad Melius Notary Public lredell County,NC My Commission Expires 11/22/2026 Page 2 of 2