NCC243221_FRO Submitted_20241018

City of Charlotte Soil Erosion and
Sedimentation
Control Ordinance
Financial Responsibility/Ownership Form
No person shall initiate any land-disturbing activity on one or more acres as covered by Chapter 17 of the Charlotte
City Code of Ordinances before this form and an acceptable erosion and sedimentation control plan have been completed
and approved by the City of Charlotte.The financially responsible 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. All relevant
items on this form must be filled out accurately and completely
Please Type or Print
PART A
1. Project name: CSX CHARLOTTE TRANSFLO TRACK EXPANSION
2. Address of land—disturbing activity: 6 816 CSX WAY, CHARLOTTE, NC 28214
3. Approximate date land-disturbing activity will commence: OCTOBER 15 2024
Month Day Year
4. Purpose of Development(Residential, Commercial, Industrial, etc.): INDUSTRIAL
5. Total acreage of land to be disturbed or uncovered: 2 . 0
6. List total site acreage: 26 . 14
7. Landowners of Record (attach accompanied page to list additional owners). If the landowner of record is not
the person(s) or firm(s) financially responsible as listed in Part B, item 1, a separate letter of consent signed
by the landowner of record or their authorized agent is required:
Name: THE ATLANTIC LAND & IMPROVEMENT COMPANY
Address: 500 WATER STREET, UNIT 1208, JACKSONVILLE, FL 32202
Telephone: Fax:
(Area Code) (Area Code)
Email Address:
Name: ECO-ENERGY DISTRIBUTION - CHARLOTTE LLC
Address:6100 TOWER CIRCLE STE 500, FRANKLIN, TN 37067
Telephone: Fax:
(Area Code) (Area Code)
Email Address:
8. Indicate Book and Page where deed or instrument is filed (Use blank page to list additional deeds or
instruments) Book 3 3 7 8 Page 291 Book Page
Book Page 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: TRANSFLO TERMINAL SERVICES, INC. C/O MATTHEW SAPP
Address: 500 WATER STREET, J975, JACKSONVILLE, FL 32202
Telephone: [phone] Fax:
(Area Code) (Area Code)
Email Address:[e-mail]
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:CT Corporation System
Address: 160 MINE LAKE CT. STE 200, RALEIGH, NORTH CAROLINA 27615
Telephone: [phone] Fax:
(Area Code) (Area Code)
Email Address: CT-STATECOMMUNI CAT [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
financiall esponsibleJ companyC or entity, if not an individual.) tal fALit✓ --�G , � 1�& ,___ llU��� t(/EI,CiP Gi
Printed Name �� Title
Aidc.4,,, / )6�'1-1
Signature Date
I, Y1V.AYX_I '• WM t , a Notary Public of the County
of al ,�,,`.r t1 r • State of D�4O&. hereby
e- ►' V certify that tV P ersonally
appeared before me this day and under oath ac•-nowledge that this form was executed by him/her. �.�•
Witness my hand and notarial se . this - c .of , 20 .
Notary Signature: •My Commission expires: \o lg I•
•
/0"0., Notary Public State of Florida
MY commission HH 054357
(a)) ?of n Expires 10/18/2024
sw
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