NCC224177_FRO Submitted_20230104

FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
EROSION & SEDIMENTATION CONTROL
No person may initiate any land -disturbing activity on one or more acres, Yz 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 NAR Services, Inc.
2. Location of land -disturbing activity: County Iredell City or Township Statesville
Highway/Street Johnson Dr. Latitude 800-54'-40" Longitude 350-46-20"
3, Approximate date land -disturbing activity will commence: September 2022
4. Purpose of development (residential, commercial, industrial, institutional, etc.):
Commercial
5. Total acreage disturbed or uncovered (including off -site borrow and waste areas): 4.8 Ac.
6. Amount of fee enclosed: $ 875,00 . An application fee of $175.00 per acre (rounded up to the next acre) is
assessed without a coiling amount (Example: a 8.10-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 $100.00 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 Marcus Potter E-mail Address [e-mail]
Telephone [phone] Cell # 704-363-9575 Fax # nla
9. Landowner(s) of Record (attach accompanied page to list additional owners):
NAR Services, Inc. 704-655-2250 nla
Name Telephone Fax Number
PO Box 45 6596 Campground Rd
Current Mailing Address Current Street Address
Denver NC 28037 Denver NC 28037
City State Zip City State Zip
10. Deed Book No. 2882 Page No. 1305 Provide a copy of the most current deed.
Part B.
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):
NAR Services, Inc. [e-mail]
Name
PO Box 45
Current Mailing Address
Denver NC 28037
City State Zip
Telephone [phone]
E-mail Address
6596 Campground Rd
Current Street Address
Denver NC 28037
City State Zip
Fax Number nla
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2. (a) If the Financlally 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
Telephone -.- Fax Numbor
(b) If the Financtaily Rosponslble 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:
Marcus Dotter, President [e-mail]
Name of Registered Agent E-mail Address
PO Box 45 6596 Campground Rd
Current Mailing Address Current Street Address
Denver NC 28037 Denver NC 28037
City
Telephone
State
704-655-2260
Zip
City State .Zip
Fax Number nla
The abova 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 offtcer,
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.
Marcus Potter President
Type or print name
-- August 1'I, 2022
Date
I, Aaron Taka , a Notary Public of the County of Lincoln
Stale of North Carolina, hereby certify that Marcus Potter appeared personally before me this day
and being duly sworn acknowledged that the above form was executed by him.
Witness my hand and notarial seal, this 11 day of August 2022
O
Notary
Seat
My commission expires February 21, 2026
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