NCC242244_FRO Submitted (2)_20240729

Rowan County
Financial Responsibility/Ownership Form Sedimentation Pollution Control Ordinance
No person may initiate any land-disturbing activity on one or more acres as covered by the ordinance before this
form and an acceptable erosion and sedimentation control plan have been completed and approved by the
Rowan County Environmental Management Department.
Parcel ID Number
Lot 51: 326H065
Lot 96: 3261006
1. Project Name*
Crescent Golf(Lots 51 &96)
2. Location of land-disturbing activity(Highway/Street)*
Lot 51: 3214 Player Court
Lot 96: 414 Laurel Valley Way
3. Latitude Longitude
Lot 51: 35.704860 Lot 51: -80.490474
Lot 96: 35.700176 Lot 96: -80.494544
4. Approximate date land-disturbing activity will be commenced
06/07/2024
5. Purpose of development(residential, commercial, industrial, etc.)
Residential Homebuilding
6. Approximate acreage of land to be disturbed or uncovered*
0.87 Acres
*this information will be made available on the Rowan County Planning&Development website.
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Rowan County
7. Person to contact should sediment control issues arise during land-disturbing Cell Phone Number*
activities*
Henry Kirchner 704-754-5460
Email Address
[e-mail]
8. Landowner of Record Landowner of Record
Century Communities Southeast, LLC
Name Name
Current Mailing Address Current Mailing Address
7401 Carmel Executive Park Drive
Charlotte, NC 28226
9. Recorded in Deed Book Number Page Number
Lot 51: 1389 Lot 51: 52
Lot 96: 1402 Lot 96: 954
1. Person or Firm who are financially responsible for Person or Firm who are financially responsible for this
this land-disturbing activity land-disturbing activity
Century Communities Southeast, LLC
Name of Person(s)or Firm(s) Name of Person(s)or Firm(s)
Current Mailing Address Current Mailing Address
7401 Carmel Executive Park Drive
Charlotte, NC 28226
Phone Number Phone Number
704-754-5460
*this information will be made available on the Rowan County Planning&Development website.
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Rowan County
a. If the Financially Responsible Party is not a resident of North Carolina, give name and street address of a North
Carolina Agent.
Name of Agent Name of Agent
Current Mailing Address Current Mailing Address
Phone Number Phone 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 the name and street address of the Registered Agent.
Name of Agent Name of Agent
National Registered Agents, Inc.
Current Mailing Address Current Mailing Address
160 Mine Lake Ct. Ste. 200
Raleigh, NC 27615
Phone Number Phone Number
*this information will be made available on the Rowan County Planning&Development website.
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Rowan County
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 instrument s for the
Financially Responsible Person). I agree to provide correctional information should there be any change in the
information provided herein.
Name Title or Authority
Andrew Rouzer Division President
Signature Date
6/12/2024
Pruy-
1,F ht Ay r1-n ee , a Notary Public of the County of lify\b)t`CQ
State o North Carolina, hereby certify that Qockep_*..) R-t )2.Lg-. appeared personally before me this
day and being duly sworn acknowledged that the above form was executed by him/her. Witness my hand and seal of
Notary,this 1 a, _day of Trtk_ . 20 3,4
Notary My commission expires
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Checklist
Download a copy of the Erosion and Sedimentation
Control Plan Checklist (PDF)
*this information will be made available on the Rowan County Planning&Development website.
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