NCC241560_FRO Submitted_20240528

001:4' Gaston County
.It Gaston Natural Resources Department
U I i o I 1303 Dallas-Cherryville Hwy. Dallas, N.C. 28034 Telephone: [phone]
vt�"� 0 Soil Erosion & Sedimentation Control
) Financial Responsibility/Ownership
No person may initiate any land-disturbing activity on one (1) or more acres of property in all portions of
Gaston County, except for that property within the city limits of the incorporated municipalities of Gaston
County who have not adopted the Gaston County Soil Erosion & Sedimentation Control Ordinance,
before this form and an acceptable Soil Erosion &Sedimentation Control Plan have been completed and
approved by the Gaston County Natural Resources Department's staff.
(Please type or print and, if question is not applicable, place N/A in blank)
PART A:
1. Project Name Millstone
2. Location of land-disturbing activity
City Cramerton Highway/Street Cramerton Village Drive
Latitude 35.24792 Longitude -81.077131
3. Approximate date land-disturbing activity will commence May 1, 2024
4. Purpose of development(residential, commercial, industrial, etc.) Residential
5. Total acreage disturbed or uncovered (including off-site borrow and waste areas) 12.29
6. Amount of fee enclosed$5,200.00 13 acres x$400.00/acre
7. Soil Erosion &Sedimentation Plan Filed? Yes Enclosed No u
8. Landowner(s)of Record(Use blank page to list additional owners)
Tri Pointe Homes Holdings,Inc.
Name Name
6325 Ardrey Kell Rd,Suite 125
Mailing Address Mailing Address
Charlotte NC 28277
City State Zip City State Zip
704-560-4618
Telephone Number Telephone Number
9. Indicate Deed Book and Page where deed(s)or instrument(s)are recorded
Deed Book 5478 Page 7103
Deed Book Page
10. Tax Map No. 214962 Block N/A Lot No. N/A
Page 1

EARLE.
1. Person(s)or firm(s)who are financially responsible for this land-disturbing activity. NOTE:if FRP is not the
Landowner of Record Part A:8., include with this form the landowner's signed and notarized written consent for the
applicant to submit a draft erosion and sedimentation control plan and to conduct the anticipated land disturbing
activity.
Tri Pointe Homes Holdings,Inc. Danny Armstrong
Name Contact Name for Inspection Reports
6325 Ardrey Kell Rd Suite 125 [e-mail]
Street and Mailing Address Email Address
Charlioie NC 28277 704-519-5812
City State Zip Telephone Number
704-560-4618
Telephone Number Fax Number
2. If the Financially Responsible Party is not a resident of North Carolina, give the name and street
address of a North Carolina agent.
N/A
Name
Street and Mailing Address Email Address
City State Zip Telephone Number
3. 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 the name and street address of the Registered Agent.
N/A
Name
Street and Mailing Address Email Address
City State Zip Telephone Number
4. 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 authority to execute instruments for the financially responsible person). I
agree to provide corrected information should there be any change in the information provided
herein.
Margaret Puckett VP of Land
Type or Print Name Title or Authority
A1,4/074— 191/ ✓1/ 511 12o2y
Signature Date ! -
l, A r<r S.e�( -V )LS , a Notary,Public of the County of CIDOIdfui ,State of North
Carolina, hereby certify that Ft re 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 1C day of 1V\G y , 2 62-4 .
a,:_ I/g�/2°2
Notary SEAL My Corn4rtissf6n Expires
Amanda Seward-Chavis
NOTARY PUBLIC
Cabarrus County
North Carolina Page 2
My Commission Expires January 8,2028