NCC222010_FRO Submitted_20220531

FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
SEDIMENTATION POLLUTION CONTROL ACT
EXPRESS PERMITTING OPTION
No person may initiate any land -disturbing activity on one or more acres as covered by the Act before this
form and an acceptable erosion and sedimentation control plan have been completed and approved by the
Land Quality Section, N.C. Department of Environmental Quality. (Please type or print and, if the question is
not applicable or the e-mail and/or fax information unavailable, place NIA in the blank.)
Part A.
1. Project Name Coldwater Ridge Apartments II
2. Location of land -disturbing activity: County Cabarrus City or Township Kannaplis
Highway/Street 2328 Coldwater Ridge Rd Latitude 35.468345 Longitude -80.593989
3. Approximate date land -disturbing activity will commence: July 1, 2021
4. Purpose of development (residential, commercial, industrial, institutional, etc.): Residential
5. Total acreage disturbed or uncovered (including off -site borrow and waste areas): 5.90 ac
6. Amount of fee enclosed: $ 1890 . The Express Permitting application fee is a dual
charge. The normal fee of $65.00 per acre (rounded up to the next acre) is assessed without a ceiling
amount. In addition, the Express Permitting supplement is $250.00 per acre up to eight acres, after
which the Express Permitting supplemental fee is a fixed $2,000.00 (Example: 9 acres total is $2,585).
7. Has an erosion and sediment control plan been filed? Yes X No Enclosed
8. Person to contact should erosion and sediment control issues arise during land -disturbing activity:
Name Dj Montgomery E-mail Address dj.montgomeryowynnefieldproperties.com
Telephone [phone]
,Cell # 336-215-5426 Fax # [phone]
9. Landowner(s) of Record (attach accompanied page to list additional owners):
Coldwater Ridge Apartments
II LLC 919-270-0121 NA
Name
Telephone Fax Number
309 N Bloodworth Street
309 N Bloodworth Street
Current Mailing Address
Current Street Address
Raleigh NC 27601-1107
Raleigh NC 27601-1107
City State
Zip City State Zip
10. Deed Book No. 14906
Page No. 0196 Provide a copy of the most current deed.
Part B.
1. Company (ies) or firm(s) who
are financially responsible for the land -disturbing activity (Provide a
comprehensive list of all responsible parties on an attached sheet.) If the company or firm is a sole
proprietorship, the name of the owner or manager may be listed as the financially responsible party.
Urquhart Development LLC
[e-mail]
Name
E-mail Address
309 N Bloodworth Street
309 N Bloodworth Street
Current Mailing Address
Current Street Address
Raleigh NC 27601-1107
Raleigh NC 27601-1107
City State
Zip City State Zip
Telephone [phone]
Fax Number NA

2. (a) If the Financially Responsible Party is not a resident of North Carolina, give name and street address
of the designated North Carolina Agent:
Name E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Telephone Fax 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 name and street address of the Registered Agent:
Name of Registered Agent E-mail Address
Current Mailing Address Current Street Address
City
Telephone
State Zip City
Fax Number
State Zip
(c) In order to facilitate Express Permitting, it is necessary to be able to contact the Engineer or other
consultant who can assist in providing any necessary information regarding the plan and its preparation,
Hagen Engineering, PA
Engineering Firm or other consultant
Tim Shaw, P.E.
Individual contact person (type or print)
[e-mail]
E-mail Address
336-286-3350
Telephone
NA
Fax Number
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 the 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.
Thomas W. Urquhart
Ty`" UtWmeWVI V
Signature
Manager
Title or Authority
.'-
©ate
a Notary Public of the County of E2eA
State of ' ' " ` rreby certify that U1 appeared personally
before me this day and being duly sworn acknowledged that the a ve form was executed by him.
,`�`+irerrrrrrrr�r�
itgtarial seal, this day of ftr , 20r�
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Coldwater Ridge Apartments LLC
309 N. Bloodworth Street
Raleigh, NC 27601
April 5, 2021
Thomas W. Urquhart
Urquhart Development, LLC
309 N. Bloodworth Street
Raleigh, NC 27601
RE: Coldwater Ridge Apartments IIC
Kannapolis, NC
Urquhart Development LLC;
This letter is to confirm that Urquhart Development LLC has accepted the financial
responsibility for the compliance with the Sedimentation Pollution Control Act. Urquhart
Development LLC has authority to cause land disturbance activities to be completed on the site
for Coldwater Ridge Apartments II in Kannapolis, NC.
Sincerely
Coldwater Ridge Apartments Il
By: Thomas W. Urquhart, manager
Coldwater Ridge Management II, Managing Member