NCC223870_FRO Submitted_20221118

Gaston County
*� Gaston Natural Resources Department
+ 1303 Cherryville Highway, Dallas, NC 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 NIA in blank)
PART A:
1. Project Name Oaks Commerce Center
2. Location of land -disturbing activity Hickory Grove Rd
City Belmont Highway/Street ry
3. Approximate date land -disturbing activity will commence October 2022
4. Purpose of development (residential, commercial, industrial, etc.) warehouse industrial
5. Total acreage disturbed or uncovered (including off -site borrow and waste areas) 41 acres
6. Amount of fee enclosed $ 12,300
7. Soil Erosion & Sedimentation Plan Filed? Yes x No
8. Landowner(s) of Record (Use blank page to list additional owners) See Attached Sheet
F''
10.
Name
Mailing Address
City State Zip
Telephone Number
Name
Mailing Address
City State Zip
Telephone Number
Indicate Deed Book and Page where deed(s) or instrument(s) are recorded See Attached Sheet
Deed Book Page
Deed Book Page
Tax Map No. See Attached Sheet Block
Lot No.
Page 1

PART B:
1. Person(s) or firm(s) who are financially responsible for this land-disturbinq activitV
CRP/CHI Oaks Commerce Center Owner, LL
Name
4064 Colony Road, Suite 405
Mailing Address
Charlotte, NC 28211
City State Zip
704-258-9147
Telephone Number
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Name
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Mailing Address
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City State Zip
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Telephone Number
If the Financially Responsible Party is not a resident of North Carolina, give name and street
GRAM WOO VI Q 17VI LI1 VQI VIII IQ ❑VGI It.
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 Part is a Corporation give name and street address of the Registered Agent.
Mailing Address Street Address
Raleigh, NC 27615-6417 704-258-9147
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.
Matt Cochrane
Type or Print Name
9, th 1,
Signature
Vice President
Title or Authority
09/13/2022
Date
I, Christina L. Conkle , a Notary Public of the County of Gaston , State of North
Carolina, hereby certify that Matt Cochrane appeared personally before me this day
and being duly sworn acknowledged that the above form was executed by him.
�WZ���ta�na eal, this 13th day of September _ .2022
° CHRISTINA L CONKLE SEAL WY—Comm'issioli Expires
Notary Public North Carolina I File: Financial Responsibility -Ownership Form.mw
Gaston County
My Commission Expires
August 07, 2027
Page 2

Owner Name/Address
Parcel #
Deed Book Page PIN # Plat Book Plat Page
DMG Road Works, LLC
183196
4837 0477 3585394271 006 003
183195
4837 0477 3585394271 006 003
Kevin Carmichael
306477
3585394271
Quarles & Brady, LLP
1395 Panter Lane
Suite 300
Naples, FL 34109