NCC242043_FRO Submitted_20240708

City of Charlotte & Mecklenburg County
Soil Erosion and Sedimentation
Control Ordinance
Financial Responsibility/Ownership Form
No person shall initiate any land-disturbing activity covered by Chapter 17, Article 2 of the Charlotte City Code or
Section 6 of the Mecklenburg County Sedimentation and Erosion Control Ordinance prior to completing and filing this
form with the City of Charlotte Engineering and Property Management Department,Land Development Services Division
or Mecklenburg County Land Development Services. The financial responsibility 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.
Please Type or Print
PART A
1. Project where land-disturbing activity is to be undertaken: Bainbridge-Harmony
2. Address of land—disturbing activity: North-east corner of Beard Road and Ridge Road
2610 Beard Road, Charlotte, NC 28269
3. Approximate date land-disturbing activity will commence:
Month Day Year
4. Purpose of Development(Residential, Commercial,Industrial, etc.): Multifamily Residential
5. Approximate acreage of land to be disturbed or uncovered: 14.83 AC
6. List total site acreage: 14.83 AC
7. Landowners of Record (Use blank page to list additional owners):
Name: Mary Beard
Address: 2610 Beard Road
Charlotte, NC 28269
Telephone: [phone] Fax:
(Area Code) (Area Code)
Email Address: [e-mail]
Signature: '
Name:
Daniel S. &Vi ' n B. Robbins
Address: 2700 Beard Road Charlotte, NC 28269
Telephone: [phone] Fax:
(Area Code) (Area Code)
Email Address: [e-mail]
Signature: 11-1-ejj 1 fe(
eif,..A4v1)
8. Indicate Book and Page where deed or instrument is filed(Use blank page to list additional deeds or
instruments) Book 03482 page 007 Book Page
Book 03482 Page 010 Book Page
Page 1

Continue - Financial Responsibility/Ownership Form
PART B
1. Person(s) or firm(s) financially responsible for this land-disturbing activity (Note:If the financially responsible
person(s)or firm(s)has an out-of-state address, a North Carolina agent must be designated in item 2 below):
Person or Firm: Bainbridge Communities Acquisition Ill LLC
Address: /p77(S L✓ 6&rHI[L r1'ie01 S /7i73C)7
W�o?J/ 33'1f/
Telephone: 6/ -3?J 3f'/ f' Fax: 5 i/.- 17q3 -ado
(Area Code) �7 (Area Code)
Email Address: 9,0 /4101 l I2t'riet •e c. Born
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: Zach Spencer
Address: 555 Fayetteville Street,Suite 300,Raleigh,NC 27601
Telephone: [phone] Fax:
(Area Code) (Area Code)
Email Address: [e-mail]
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.)
Printed Nam Title �.o�&mime
_774 .. z
Signature Date
CVI 5 f 1(/111�/�--� _ a Notary Public of the County
of /6t 0 f}a414l' , l , State of 0✓l(�`�`, , hereby
certify that (3 t"V( 1/L 0 .5 personally
appeared before me this day and under oath acknowledge that this for was executed bym/her. /
Witness my hand and not sea, t is ( day of , 20 3-I
Notary Signature: 4
My Commission expires: I
•
5.��"' %•; ,• CRISTIN MIHAN
*1 t; *= MY COMMISSION#HH 336019 ((p)
.�''��`''O EXPIRES:March 28,2027
aMINIMMEND
charlottenc.gov
Storm Water Services-Land Development
600 East Fourth Street,Charlotte,North Carolina 28202-2844
Telephone:[phone]
http://charlottenc.gov/developmentcenter
Rev.09/2021 Page 2