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HomeMy WebLinkAboutNCC241315_FRO Submitted_20240506 ( { FINANCIAL RESPONSIBILITY/OWNERSHIP FORM EROSION & SEDIMENTATION CONTROL IR C U E L L No person may initiate any land-disturbing activity on one or more acres, % acre or more inside a " ` watershed, as covered by the Sedimentation Pollution Control Act and the Iredell Coun�+ Land Development Code, before an acceptable erosion and sedimenta jai �•n' .' .I• , =�be subTrtitted and approved by the Iredell County Planning&Development, Eros,•n L. (Please type or print) Part A. MAR 2 7 2024 Project Name Langtrcc Manor,LLC 1 2 Location of land-disturbing activity County In ilea City or Townships. . Davidson Highway/Street Langtree Rd Latitude 35.524725 Longitude -80.882637 3. Approximate date land-disturbing activity will commence: April 2024 4 Purpose of development(residential,commercial, industrial,institutional, etc.)- residential 5 Total acreage disturbed or uncovered(including off-site borrow and waste areas) 7.896 6. Amount of fee enclosed $ 1400 . 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 0 5 acres but no greater than 0 99 acres in a water supply watershed, a fiat 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 Brian McManus E-mail Address brion@spivcyinc.com Telephone 704-746—i7o9 Cell# Fax# 9. Landowner(s)of Record(attach accompanied page to list additional owners) Langtree Manor,LLC 260-414-4448 Name Telephone Fax Number 662 Langtree Rd 662 Longtime Rd Current Mailing Address Current Street Address Mooresville,NC 28117 Mooresville,NC 28117 City State Zip City State Zip 10. Deed Book No 2896 Page No. 282 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) Langtrce Manor,LLC stevc.bcrincs@gmail.com Name E-mail Address 662 Langtree Manor,LLC 662 Langircc Rd Current Mailing Address Current Street Address Mooresville,NC 28117 Mooresville,NC 28117 City State Zip City State Zip Telephone 260-414-4448 Fax Number Page 1 of 2 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. Steve Bermes Manager Type or print name Title or Authority 03/24/2024 Signature Date I, ‘ �(Q' C. n‘C, , a Notary Public of the County of R1,rc1 +2tn‘Duy3 State of North Carolina, hereby certify that s_rQ qec) (me S 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,this25 day of �Q 1CY) , 20 a,y 011/2A Notary U Seal My commission expires /0/0VcW6078- Christy Knlgtits Palmer r- NOTARY PUBLIC Mecklenburg County North Carolina\ My Commission Expires 10/2/2028 Page 2 of 2