NCC223331_FRO Submitted_20220923

FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
EROSION & SEDIMENTATION CONTROL
No person may initiate any land -disturbing activity on one or more acres, '/2 acre or more inside a
watershed, as covered by the Sedimentation Pollution Control Act and the Iredell County Land
Development Code, before an acceptable erosion and sedimentation control plan has been submitted
and approved by the Iredell County Planning & Development, Erosion Control Section.
(Please type or print.)
Part A.
1. Project Name Harris Farms - Master Infrastructure & Residential
2. Location of land -disturbing activity: County Iredell City or Township Mooresville
Coddle Creek Highway
Highway/Street Kistler Farm Road Latitude 35 33' 46.33" N Longitude 80 47' 29.22" W
3. Approximate date land -disturbing activity will commence: July 30th, 2022
4. Purpose of development (residential, commercial, industrial, institutional, etc.): Residential & Commercial
5. Total acreage disturbed or uncovered (including off -site borrow and waste areas): 93 acres
6. Amount of fee enclosed: $ 16,275 . An application fee of $175.00 per acre (rounded up to the next acre) is
assessed without a ceiling amount (Example: a 9-acre application fee is $1575). For projects > than 0.5 acres but no
greater than 0.99 acres in a water supply watershed, a flat fee of $135.00 is assessed.
7. Has an erosion and sediment control plan been filed? Yes No Enclosed X
8. Person to contact should erosion and sediment control issues arise during land -disturbing activity:
Name Barrett Blackburn E-mail Address [e-mail]
Telephone [phone] Cell # 704-661-1893 Fax # N/A
9. Landowner(s) of Record (attach accompanied page to list additional owners): PINs: 466-664-8318, 466-665-6517,
466-655-6172
Harris Brothers Family Limited Partnership 704-664-2060 N/A
Name Telephone Fax Number
1271 Coddle Creek Highway 1271 Coddle Creek Highway
Current Mailing Address Current Street Address
Mooresville NC 28115 Mooresville NC 28115
City State Zip City State Zip
10. Deed Book No. 1177 Page No. 1416 Provide a copy of the most current deed.
1365 2239
Part B. 2182 687
1. Person(s) or firm(s) who are financially responsible for the land -disturbing activity (Provide a comprehensive list of all
responsible parties on an attached sheet):
Cambridge -Harris Farms, LLC
Name
831 E Morehead Street, Suite 245
Current Mailing Address
Charlotte NC 28202
City State Zip
Telephone [phone]
[e-mail]
E-mail Address
831 E Morehead Street, Suite 245
Current Street Address
Charlotte NC 28202
City State Zip
Fax Number N/A
Page 1 of 2

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
Current Mailing Address
E-mail Address
Current Street Address
City State Zip City
Telephone Fax Number.
State Zip
(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:
Cambridge - Harris Farm LLC [e-mail]
Name of Registered Agent E-mail Address
831 E. Morehead Street, Suite 245
Current Mailing Address Current Street Address
Charlotte NC 28202
City State Zip City State Zip
Telephone [phone] 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 by any change in the information provided herein.
George L. Maloomian
Type Zorname
ignatu
Manager
Title or Authority
5 1121ZZ
Date
a Notary Public of the County of
State of North Carolina, hereby certify that . "0 [__ It 8W1VV2.i1. appeared personally before me this day
and being duly sworn acknowledged that the above f*ff was executed by him. ��}}
Witness my hand and notarial seal, this day of , 20 ZL
Notary
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Page 2 of 2

Continued - Financial Responsibility/Ownership Form
9 (cont). Landowner(s) of Record:
Name: Mary Q. Harris
PIN: 466-675-3266
1212 Coddle Creek Highway,
Mooresville, NC, 28115
Current Mailing Address: 1212 Coddle Creek Highway,
Mooresville. NC 28115
Deed Book No. 121 Page No. 203