NCC215560_FRO Submitted_20211007

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: Reames Road Townhomes
2. Address of land -disturbing activity: Reames Road between North Park Blvd and Lawnmeadow Road
Charlotte NC 28216
3. Approximate date land -disturbing activity will commence: 1 2021
Month Day Year
4. Purpose of Development (Residential, Commercial, Industrial, etc.): Residential
5. Approximate acreage of land to be disturbed or uncovered: 7 AC
6. List total site acreage: 9.1 AC
7. Landowners of Record (Use blank page to list additional owners):
Name: Stuart D Ross
Address: 6510 North Park Blvd Charlotte NC 28216
Telephone:_ '�4 4 _ cl o 4
(Area Code)
Email Address: !Z4 s
Signature:
Name:
Address:
Telephone: _ _
(Area Code)
Email Address:
Signature:
+-IT Fax:
c_L_';, P^�-
Fax:
(Area Code)
(Area Code)
8. Indicate Book and Page where deed or instrument is filed (Use blank page to list additional deeds or
instruments) Book 30956 Page 549 Book Page
Book 32875 Page 915 Book Page _
Page

Continue - Financial Responsibility/Ownership Form
PART B
1. Person(s) or firm(s) financially responsible for this land -disturbing activity:
Person or Firm: Bart Carroll (D.R. Horton, Inc.)
Address: 8 0 0 1
Arrowridge Blvd, Charlotte, NC 28273
Telephone: [phone] Fax:
(Area Code) (Area Code)
Email Address: [e-mail]
2. North Carolina agent, for the person or firm who is financially responsible:
Person or Firm: CT Corp System
Address: 150 Fayetteville Street 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.)
Bart Carroll
Printed
Signature
NPDES Manager
Title
�j ZUZ�
ate
a Notary Public of the County
of ' t 4,S 4 n , State of AJO ►-4-k C _ U Pt -t , hereby
certify that C ✓a I I personally
appeared before me this day and under oath acknowledge that this form was executed by him/her.
Witness my hand and notarial seal, this day of-20 2 1
Notary Signature: Y V [ qK
My Commission expires: 27, Z1)1-7
w Rachel Martin Hayes
NOTARY PUBLIC
Gaston County
North Carolina
CHAP"TTE. My Commission Expires May 27, 2025
ENGINEERING & PROPERTY
MANAGEMENT
Land Development Division
600 East Fourth Street, Charlotte, North Carolina 28202-2844
Telephone: [phone] Fax: [phone]
http://Iandpermits.chartneck.org
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