NCC240972_FRO Submitted_20240404

IREDELL
O U N T v NC
FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
EROSION & SEDIMENTATION CONTROL
No person may initiate any land-disturbing activity on one or more acres, '/z acre or more inside a watershed, as covered by the
Sedimentation Pollution Control Act and the Iredell County Land Development Code, before this form and an acceptable erosion
and sedimentation control plan have been submitted and approved by the Iredell County Development Services, Planning Division-
Erosion Control Section. (Please type or print.)
Part A.
1. Project Name The Overlook
2. Location of land-disturbing activity: County Iredell City or Township Mooresville
Highway/Street Alcove Road Latitude 35 32' 11" N 80 51' 44" W
Longitude
3. Approximate date land-disturbing activity will commence: Fall 2024
4. Purpose of development(residential, commercial, industrial, institutional, etc.): Residential
5. Total acreage disturbed or uncovered (including off-site borrow and waste areas): 10.00 AC.
6. Amount of fee enclosed: $ 1,750.00 . An application fee of$175.00 per acre(rounded up to the next acre)is
assessed without a ceiling amount (Example: a 9-acre application fee is $1575). For projects > than .5 acre but < 1.0 acre
in a water supply watershed, a flat fee of$135.00 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 Zach Wolf E-mail Address [e-mail]
Telephone [phone] Cell# Fax#
9. Landowner(s)of Record (attach accompanied page to list additional owners):
Alcove Holdings, LLC 704-902-3835
Name Telephone Fax Number
PO Box 42
Current Mailing Address Current Street Address
Mt. Mourne NC 28123
City State Zip City State Zip
10. Deed Book No. Page No. 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 parties on an attached sheet):
Overlook at the Osprey, LLC [e-mail]
Name E-mail Address
5710 LBJ Freeway, Suite 225 5710 LBJ Freeway, Suite 225
Current Mailing Address Current Street Address
Dallas TX 75240 Dallas TX 75240
City State Zip City State Zip
Telephone [phone] Fax Number
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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:
Rick Howard [e-mail]
Name E-mail Address
PO Box 42
Current Mailing Address Current Street Address
Mt. Mourne
City State Zip City State Zip
Telephone [phone] 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.
Zach Wolf President
Type or print name Title or Authority
03/18/2024
Signature Date
Stephanie Dunbar , a Notary Public of the County of Bowie
Texas
State of"Nbrth-Carblina Tiereby certify that Zach Wolf appeared personally before me this day
and being duly sworn acknowledged that the above form was executed by him.
Witness my hand and notarial seal,this 18th day of March nn 20 24
,4444gA2te
Notary
Seal
My commission expires 08/11/2026
\��\\\�\�\ vI iPbbi�/
\(,Sp _ 4e �i� Stephanie Dunbar
2 ,, %.% Electronically signed and notarized online using the Proof platform.
'�S '* ID NUMBER
A 4) P I 133904337
1) �IOIIIF�1 4 August+`\\ COMMISSION
ll,EXPIRES
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