NCC233230_FRO Submitted_20231030

FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
% EROSION & SEDIMENTATION CONTROL
IR E D E L L No person may initial,- any land-disturbing activity on one or more acres, '/z acre or more inside a
r•, c watershed, as covered by the Sedimentation Pollution Control Act and the Iredell County Land
L~ - _ -- 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 River Rock Storage -Troutman
2. Location of land-disturbing activity: County Iredell City or Township Troutman
Highway/Street 782 South Main Street Latitude 35-682925 Longitude -80.862277
3. Approximate date land-disturbing activity will commence Dec 1, 2023
4, Purpose of development(residential, commercial, industrial, institutional,etc.): Commercial
5. Total acreage disturbed or uncovered(including off-site borrow and waste areas) 4.64
6. Amount of fee enclosed $ $1225.00 An application fee of$175.00 per acre(rounded up to the next acre)is
assessed without a ceiling 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 Austin Hughes E-mail Address [e-mail]
Telephone Cell# 704-682-1625 Fax#
9. Landowner(s)of Record(attach accompanied page to list additional owners):
River Rock Storage -Troutman LLC 704-682-1625
Name Telephone Fax Number
Alcove Road, Suite 301
Current Mailing Address Current Street Address
Mooresville, NC 28117
City State Zip City State Zip
10. Deed Book No, 5969 -Page No 1734 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):
Austin Hughes, River Rock Storage - Troutman LLC [e-mail]
Name E--rmm�l Address
1
- 4Alcove Road, Suite 301 uf-5•7tAlcove Road, Suite 301
Current Mailing Address Current Street Address
Mooresville, NC 28117 Mooresville, NC 28117
City State Zip City State Zip
Telephone [phone] Fax Number
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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:
River Rock Capital Partners, LLC [e-mail]
Name E-mail Address
571 Alcove Road. Suite 301 571 Alcove Road, Suite 301
Current Mailing Address Current Street Address
Mooresville, NC 28117 Mooresville, NC 28117
City State Zip City State Zip
Telephone [phone] Fax Number
the Financially Responsible Party is a Partnership or other person engaging in business under an assumed name .
a co•• .• Certificate of Assumed Name. If the Financially Responsible Party is a Corporation, give = a street
address of th- -red Agent:
Name of Registered Agent E-mail Address
Current Mailing Address Current a; • ress
City " - Zip City State Zip
.ne 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 by any change in the information provided herein.
,' St;,n 14-nkks A,k+horittd s ;511l +ofn
Type or print name Title or Authority
S/a
Signature Date
1, 1_1Au..r d1 V- r 1/41-r-1- ,a Notary Public of the County of I rye,c.urt.t
State of North Carolina, hereby certify that Au SS►r1 appeared personally before me this day
and being duly sworn acknowledged that the above form was execut d by him.
Witness my hand and notarial seal,this 23 day of Pi && .ii4k' ,20 7.-3 'l
liti ,i, f N;u
Notary
Seal ,M& ` S��
My commission expires r' ( 1 `
Lauren E Hutt
NOTARY PUBLIC
Iredell County
North Carolina
My Commission Expires May 15 2027
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