NCC232978_FRO Submitted_20231013

DURHAM JCN
COUNTY Durham City/County (Office Use Only)
Sedimentation and Erosion Control
FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
O\1881 •
WITH LANDOWNER CONSENT FORM
No person may initiate any land-disturbing activity covered by the Durham City-County Unified Development Ordinance before a
Land Disturbing Permit is issued by the Sedimentation and Erosion Control Office. Issuance of a Land Disturbing Permit does not
relieve the permittee of the obligation to obtain any other licenses, permits and approvals as may be required by Federal, State,
County or Municipal governments. This office must be notified in writing of any change to the information on this form.
PLEASE TYPE OR PRINT
1. Project name: OAK CHARTER ACADEMY Extension: Yes or No X
2. Road location of land-disturbing activity: 2523 E.CLUB BLVD.
Tax Map-Block-Parcel: 169714; 169719 PIN: 0842-58-43-9931; 0842-58-85-7625
3. square footage of land to be disturbed or uncovered: 444,780 SF (10.211 AC)
4. List below the landowner of record. Each landowner must complete Item 8.
(If there are multiple owners,please list on a separate page):
JAMES R.GROVES
Name
2523 E.CLUB BLVD.
Address
DURHAM NC 27704
City State Zip
Telephone Fax Email
5. List the person or entity financially responsible for this land-disturbing activity: The financially responsible party shall
be (1) the developer or other person who has or holds themselves as having financial or operational control over the land-
disturbing activity and/or (2) the land owner or person in possession or control of the land when they have directly or
indirectly allowed the land-disturbing activity or have benefited from it and (3) the named party on the Land Disturbing
Permit.
CHARTER DEVELOPMENT COMPANY,LLC
Name
3850 BROADMOOR . AVE.SE
Street Address
GRAND RAPIDS MI 49512
City State r_Zip
616-299-6611 `e0.1 e s-t e @ Y141a5 c.he ,\ IS . COnyi
Telephone Fax Email
The Sedimentation and Pollution Control Act (Act) and the Durham City-County Unified Development Ordinance
(Ordinance)includes,but is not limited to,the following legal obligations of the financially responsible party:
• Maintain a set of approved sedimentation and erosion control plans,if required,on site.
• Display permit on site.
• Understand and implement any required plan,including the construction sequence and details.
• Inspect,maintain and repair sedimentation and erosion control measures,especially after rainfall events.
• Provided adequate ground cover or otherwise stabilize all areas that have not been actively graded within 21 calendar
days.
201 E.Main St,5th Floor,Durham,N.C.27701 •[phone]•Fax[phone]
www.co.durham.nc.us/ceng

• Plan and conduct all land-disturbing activity so as to prevent off-site sedimentation.
6. For business applicants,list below the North Carolina registered agent for the financially responsible entity:
BUSINESS FILINGS INTERNATIONAL,INC
Name
160 MINE LAKE CT STE.200
Street Address
RALEIGH NC 27615
City State Zip
Telephone Fax Email
7. The above information is true and correct to the best of my knowledge and belief and was provided by me while under oath. I
understand that the person or entity listed on Line 5 above will be: (I) the owner of the Land Disturbing Permit when issued;
(2)responsible for ensuring compliance with the Act and Ordinance; and,(3)will be the only person or entity with standing to
appeal any action taken or decision made by the Sedimentation and Erosion Control Office.
Alpei` t11.ZoZ.'3 Je CJ'?a.m her lain
Date Type or Print Name
( /6. 485-aaoa c e
Telephone Fax Title • ut rit
re. a.\ -Ica. s . C.
Email Signature
B mess Appluapt`(Provide "orporate resolution on signatory authority)
I, llrr Jit(jUlfi Kt, ,a Notary Public of the County of
State of l ( Ilk( ,hereby certify that C212/L hG1 )/ --1
per nally came bef re me this day and ac led d that he is _
0 4_
o 4 (, nd ac ledged,on behalf o � (/.
,the ue execution of the foregoi •n ment.
Witness my hand and official seal,this / day of ,20
(f,
`----7
NotaryPublic CARRIE M GULLIFORD
My commission expires ,�� ,20 �� NOTARY PUBLIC-STATE OF MICHIGAN
**********************************************************■*************************** „*,�;OUNTY O OTT WA
** 'omm
Gi tiission expires` y2, 0* ** *.***
f
Acting in the County of
Individual Applicant
I, ,a Notary Public of the County of
State of ,hereby certify that
personally appeared before me this date and under oath acknowledged that the above form was executed by them.
Witness my hand and official seal,this day of ,20
Notary Public
My commission expires 20
LAND DISTURBING PERMITS ARE NON-TRANSFERABLE

Provide a Notarized Item 8 for each landowner listed in Item 4.
8. Land Owner Consent. As a landowner,I provide my consent for land-disturbing activities to occur on the property listed in
Item 2 by the person or entity listed in Item 5.
57f'8�Z3 JAMES R.GROVES
Date Type or Print Name
?if 9`370YO1 f/ F1�/8"0S Individual Landowner
Telephone Fax itle r rit
Email Signature ueer►.e$ R Gro�S
***************.************************************** *******►********..********************#Mir**************************Y#ski YIY#
Business Landowner(Provide corporate resolution on signatory authority)
I, ,a Notary Public of the County of
State of ,hereby certify that
personally came before me this day and acknowledged that he is
of and acknowledged,on behalf of
,the due execution of the foregoing instrument.
Witness my hand and official seal,this day of ,20
Notary Public
My commission expires ,20
Individual Landowner
I, . Q,,,,pl eil4r r.era Notary Public of the County f
State of .C ,hereby certify that ✓ ]A P_u/C P !AI
personally appeared before me this date and under oath acknowledged that th-above form was executed by them.
Witness my hand and official seal,this t (4 day of ,20
V�a
• , P Elie
My commission expires C I 70 3 20 Z ,,,,,, J Cy �'''',,,
JOL „ ;qq,9
SE-03 -Q: �� Rev.07/06
to I My Comm.Exp. 1=
01-03-2026

NORTH CAROLINA
LIMITED POWER OF ATTORNEY FOR REAL PROPERTY
I, James R. Groves of 11 Bedford Court, Cartersville,GA 30120-6453, name the following
person as my agent:
Name of Agent: Matthew P. Ceradini, Ceradini Law, PLLC, 8480 Honeycutt Rd., Ste. 200,
Raleigh,NC 27615
For purposes of this power of attorney,the "Properties" are all of that real property located in
Durham County,North Carolina, and known or identified as follows:
Legal Description: 2523 East Club Blvd, Durham,NC 27704
BEGINNING at an iron pin situated at the intersection of the northwestern right-of-way of
Geer Street with the northern right-of-way line of Club Boulevard;thence with the
northwestern right-of-way line of Geer Street North 47 deg. 19' 58"East 195.36 feet to an
iron stake;then North 13 deg.40' 00"West 522.88 feet to a concrete monument;thence
North 82 deg. 18' 40" West 435.92 feet to another concrete monument;thence South 06 deg.
59' 07"West 76.88 feet to a concrete monument;thence South 76 deg. 48' 07"East 139.59
feet to an iron stake; thence South 11 deg. 46' 27"West 500.07 feet to an iron stake on the
northern right-of-way line of Club Boulevard;thence with the northern right-of-way line of
Club Boulevard South 75 deg.22' 37"East 400.35 feet to an iron stake, the point and place
of BEGINNING, containing 6.129 acres, more or less, and being all of that property shown
on a survey entitled"Property of Robert Groves, DB, 1395, pg 441(Portion of Markham
Farm and Lots 226, 227,228 Markham Land PB 18 pgs 16 & 17,"dated December 21, 1989,
and drawn by Norman A. Beaver, Registered Land Surveyor.
Legal Description: 2201 East Geer Street, Durham,NC 27704
BEING all of Parcel 1 consisting of 4.714 acres according to plat and survey recorded in Plat
Book 146, Page 69, Durham County Registry, to which reference is hereby made for a more
particular description of same.
GRANT OF AUTHORITY
I grant my agent general authority to act for me with respect to the Property, all tangible personal
property related to the Property, and all financial transactions relating to the Property. The
authority granted to my agent pursuant to this power of attorney expressly includes the
following:
(1) The authority to act with respect to real property as set forth in Section 32C-2-204 of the
North Carolina General Statutes;
(2) The authority to act with respect to tangible personal property as set forth in Section
32C-2-205 of the North Carolina General Statutes;and
•
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(3) The authority to act with respect to banks and other financial institutions as set forth in
Section 32C-2-208 of the North Carolina General Statutes.
The authority granted to my agent pursuant to this power of attorney may be exercised by my
agent even though the exercise of that authority may benefit the agent or a person to whom the
agent owes an obligation of support.
EFFECTIVE DATE; AUTOMATIC EXPIRATION
This power of attorney is effective immediately. The authority of my agent to act on my behalf
pursuant to this power of attorney will automatically expire on January 31, 2025. Actions taken
by my agent on my behalf pursuant to this power of attorney while this power of attorney
remains in effect shall continue to bind me even after my agent's authority expires.
RELIANCE ON THIS POWER OF ATTORNEY
Any person, including my agent, may rely upon the validity of this power of attorney or a copy
of it unless that person knows it has terminated or is invalid.
MEANING AND EFFECT
The meaning and effect of this power of attorney shall for all purposes be determined by the law
of the State of North Carolina.
SIGNATURE AND ACKNOWLEDGMENT
9))14fre4--- 4dP jj 026026
ur Signature Date
James R. Groves
Your Name Printed
STATE OF C >°D/' to, , COUNTY OF ,f- cJ
/
I certify that the following person personally ap eared befo e me this da , acknowledging to me
that he or she signed the foregoing document: siatte,
Date: v3/5 Ad of
Signat re of Notary Public
(Official Seal)
i „fr. ,Notary Public
• ALEX GARCIA (Printed or typed name)
ier Notary Public•State of Georgia
Cobb County
M Comm.Ex sires June 25,2023 My commission expires:
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