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HomeMy WebLinkAboutNCC232334_FRO Submitted_20230804 Tovm 11 FINANCIAL RESPONSIBILITY OWNERSHIP (FRO) FORM cttmfffiffle Soil Erosion and Sedimentation Control Ordinance NORTH C A R O L I N A Instructions: No person shall initiate any land-disturbing activity on one or more acres, as covered in the Town of Huntersville Soil Erosion and Sedimentation Control Ordinance,before this form and an acceptable erosion and sedimentation control plan have been completed and approved by the Town of Huntersville. The Financially Responsible Party will be on record as the party to accept any Notices of Violation or related documents for any non- compliance of the Town of Huntersville Soil Erosion and Sedimentation Control Ordinance. If the Financially Responsible Party resides out of state, a North Carolina agent must be assigned. All items on this form must be filled out accurately and completely. PART A -PROJECT AND LANDOWNER INFORMATION 1. Project name Birkdale GC MXU -Solis Birkdale 2. Address of land-disturbing activity(number, street) 16580 Birkdale Commons Parkway 3. Approximate date land-disturbing activity will begin March 2023 4. Purpose of development(Commercial, Residential, Commercial, Residential Industrial, etc.) 5. Total acreage of land to be disturbed or uncovered 5.86 6. Total site acreage 4.59 7. Landowner(s) of Record. The names listed below must match the Deed(s).Attach a list of additional owners, if applicable. Note: If the landowner of record is not the person(s)firm(s),or Company's Financially Responsible Party, as listed in Part B, item 1, a separate Letter of Consent, signed and dated by the Landowner of Record,or their Authorized Agent,is required. LandownerRecord Company Name Lake Norman Real Estate Contact Name Trent Gustafson Ifapplicable Investors, LLC Mailing Address 5960 Fairview Rd,Ste 327,Charlotte 28210 Physical Address 16580 Birkdale Commons Prkwy,Huntersville28078 I PO Box listed above Phone 7049533104 Email Tgustafson@gpartnerscre.com Landowner i Company Name Lake Norman Real Estate Contact Name Trent Gustafson Ifapplicable Investors, LLC Mailing Address 5960 Fairview Rd,Ste 327, Charlotte 28210 Physical Address 16500 Birkdale Commons Prkwy,Huntersville28078 I PO Box listed above Phone 7049533104 Email Tgustafson@gpartnerscre.com 8. Indicate the Deed Book and Page number the deed or instrument is filed. Attach a list of additional deeds if applicable. Deed Book Page Deed Book Page Deed Book Page 37334 653 0 37331 924 37334 642 37331 936 Rev. 8/2022 TOH Staff Reviewer Ownership/Agent: Verified at Pre-Con Meeting By: Page 1 of 3 jj FINANCIAL RESPONSIBILITY OWNERSHIP (FRO) FORM j*;Mte of� e Soil Erosion and Sedimentation Control Ordinance N o R T x C A R O L I N A PART B -FRO AND NC REGISTERED AGENT 1. Person(s), firm(s) or Company who is/are financially responsible for this land-disturbing activity. Financially Responsible Party Company Name(ifapplicable) Terwilliger Pappas Contact Name Jeff Smith Multifamily Partners, LLC Mailing Address 4777 Sharon Rd,Ste. 550, Charlotte, NC 28210 Physical Address I PO Box listed above Phone 7047163906 Email jsmith@terwilligerpappas.com 2. If the Financially Responsible Party listed above does not reside in the state of North Carolina,they must provide a designated North Carolina agent below. This agent must be registered with the NC Secretary of State. North Carolina Agent for Financially Responsible Party NC Registered Agent Name Contact Name Mailing Address Physical Address I PO Box listed above Phone Email 3. (Optional)Additional contact familiar with the site,who understands the plans, and may represent the company. Site Contact's Name Sean Paone Email sean.paone@bolton-menk.com Phone: Office 7043761555 Phone:Mobile 7042936338 PART C - SIGNATURE WITNESSED BY A NOTARY PUBLIC DO NOT SIGN THIS FORM UNTIL YOU ARE IN THE PRESENCE OF A NOTARY PUBLIC 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. If the Financially Responsible Owner is not an individual,this form must be signed by an officer,director,partner,or registered agent with the authority to execute instruments for the Financially Responsible Party). I agree to provide corrected information should there be any change in the information provided herein. Printed Name T-r-4 Title or Authority Ex ec v4,,ie V 1(-e Wet-Ink Signature r j Date a I, L.01;_h e- a.►.,s.•, , a Notary Public of the County of i2A,- ,Lv,� State of r,/o�tw �.v.i��., hereby certify that J�r� 5.,,:r� personally appeared before me this day and being duly sworn acknowledged that the above form was executed by hhn1her. Witness my han¢ ZaZ�t ,j��aj, this day of mac•^-w 20 Z2- o�� ,p U B L\L Notary Signature Rev. 8/2022 burg `��,.�`�,` Page 2 of 3 wn FINANCIAL RESPONSIBILITY OWNERSHIP (FRO) FORM �� oof� e Soil Erosion and Sedimentation Control Ordinance NORTH C A R O L I N A My Commission Expires I Z ti �I I �I I i Rev. 8/2022 Page 3 of 3