HomeMy WebLinkAboutNCC230484_FRO Submitted_20230227FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
SEDIMENTATION POLLUTION CONTROL ACT
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. Submit the completed form to the
appropriate Regional Office. (Please type or print and, if the question is not applicable or the e-mail and/
or fax information unavailable, place N/A in the blank.)
Part A. Concord Elevation Multifamily
1. Project Name
2. Location of land -disturbing activity: County CabarruS City or Township Concord
3
0
5
Highway/Street Cliffwood St Latitude 35.412124 Longitude-80.616756
Approximate date land -disturbing activity will commence: 5/1 /21
Purpose of development (residential, commercial, industrial, institutional, etc.): Multifamily Housing
Total acreage disturbed or uncovered (including off -site borrow and waste areas): 2.59
6. Amount of fee enclosed: $ 300 . The application fee of $100.00 per acre
(rounded up to the next acre) is assessed without a ceiling amount (Example: 8.10 ac = $900.00).
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 Andrew McDonald E-mail Address amcdonald@truehomesusa.com
Telephone 704-288-7256
Cell # Fax #
9. Landowner(s) of Record (attach accompanied page to list additional owners):
Concord Retail Investment Group, LLC
Name
Telephone Fax Number
545 CONCORD PKWY N STE 40
545 CONCORD PKWY N STE 40
Current Mailing Address
Current Street Address
CONCORD NC 28027
CONCORD NC 28027
City State Zip
City State Zip
10. Deed Book No. 13537 Page No. 0227 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.
True Homes, LLC
amcdonald@truehomesusa.com
Name
E-mail Address
2649 Brekonridge Centre Dr
2649 Brekonridge Centre Dr
Current Mailing Address
Current Street Address
Monroe, NC 28110
Monroe, NC 28110
City State Zip
City State Zip
704-288-7256
Telephone
Fax Number
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:
Andrew McDonald amcdonaldC@truehomesusa.com
Name of Registered Agent E-mail Address
2649 Brekonridge Centre Dr 2649 Brekonridge Centre Dr
Current Mailing Address Current Street Address
Monroe, NC 28110 Monroe, NC 28110
City State Zip City State Zip
Telephone 704-288-7256
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.
Andrew J. McDonald Market Partner - Land Development
T Lname
Title or Authority
I! z /ZoZ^Z_
Date
I, klk(.• (iAVIVA 1 aVVI , a Notary Public of the County of f ��aral• 2 �2 i;1
State of North Carolina, hereby certify that Ai tilt' mi 1 1 CAE - d 4� appeared
personally before me this day and being duly sworn acknowledged that the above form was
executed by him.
Witness m hand and notarial seal, this ��da of
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