NCC242535_FRO Submitted_20240822

00IIN14, Gaston County
g k Gaston Natural Resources Department
1303 Dallas-Cherryville Hwy. Dallas, N.C. 28034 Telephone:[phone]
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 Hornet Solar Phase 1
2. Location of land-disturbing activity
City Stanley Highway/Street Drew Rd
3. Approximate date land-disturbing activity will commence Summer 2024
4. Purpose of development(residential,commercial, industrial, etc.) Solar
5. Total acreage disturbed or uncovered (including off-site borrow and waste areas) 153
6. Amount of fee enclosed$45900
7. Soil Erosion &Sedimentation Plan Filed? Yes X No
8. Landowner(s) of Record (Use blank page to list additional owners)
LTSM LLC LTSM LLC
Name Name
1418 Nature Preserve Trail 1418 Nature Preserve Trail
Mailing Address Mailing Address
Denver NC 23037 Denver NC 23037
City State Zip City State Zip
Telephone Number Telephone Number
9. Indicate Deed Book and Page where deed(s) or instrument(s) are recorded
Deed Book 465° Page 1486
Deed Book 465° Page 1486
10. Tax Map No. Block Lot No.
Page 1

PART B:
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.
Hornet Solar LLC Emily Brown-Authorized Signatory
Name Contact Name for Inspection Reports
2398 East Camelback Road Suite 940 [e-mail]
Mailing Address Email Address
Phoenix AZ 85016- soot [phone]
City State Zip Telephone Number
Telephone Number Fax Number
2. If the Financially Responsible Party is not a resident of North Carolina, give name and street
address of a North Carolina agent.
CT Corporation System
Name
160 Mine Lake Court,Sutte 200
Mailing Address Email Address
Raleigh NC 27815
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 name and street address of the Registered Agent.
Name
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. t
,1,i l_ ;7 Y ( ,.�`` i�l `
.
Type or Print Name Title or Authority
Signature Date
I,MCl I6S2 T P-r'o-7 {tor-nand ez, a Notary Public of the County of !Ilex Vji yn,Ipvrei , State of North
Carolina, hereby certify that mi ( ?r o w h appeared personally before me this day
and being duly sworn acknow edged`that the above form was executed by him.
Witness my hand and notarial seal, this 6 tl^ day of P g its F , 2 O
Notary EAL My Commission Expires
File:Financial Responsibility-Ownership Form.mw
slA"°F MELISSA PEREZ-HERNANDEZ
Notary Public
115'4,-2.7);.i, Mecklenburg County. NC Page 2
RrH WON> M Commission Expires May 5.2C