NCC240114_FRO Submitted_20240129

Check if this project is ARPA-funded ❑
Attach a copy of the Letter of Intent to Fund
FINANCIAL 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, including any
activity under a common plan of development of this size as covered by the NCG01 permit, 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 address or phone
number is unavailable, place N/A in the blank.)
Part A.
1. Project Name Col Francis Beatty Park Baseball Improvements
*If this project involves American Rescue Plan Act(ARPA) funds, list the Project Name or Project
Number(e.g., SRP-D-ARP-0121) below under which you were approved for funding through the
Division of Water Infrastructure (DWI).
2. Location of land disturbing activity: County Mecklenburg City or Township Matthews
Weddington Rd 35.06695 -80.73855
Highway/Street Latltude(decimal degrees) Longitude(decimal degrees)
3. Approximate date land-disturbing activity will commence: 12/26/23
4. Purpose of development(residential, commercial, industrial, institutional, etc.): Recreation
5. Total acreage disturbed or uncovered (including off-site borrow and waste areas): 19.00
6. Amount of fee enclosed: $ 1900 . The application fee of$100.00 per acre (rounded
up to the next acre) is assessed without a ceiling amount (Example: 8.10-acre application fee is $900).
Checks should be addressed to NCDEQ.
7. Has an erosion and sediment control plan been filed? Yes ❑✓ Enclosed El No ❑
8. Person to contact should erosion and sediment control issues arise during land-disturbing activity:
Name Dan Putman E-mail Address [e-mail]
Phone: Office# 980-433-2352 Mobile# [phone]
9. Landowner(s) of Record (attach accompanied page to list additional owners):
Mecklenburg County
Name Phone: Office# Mobile#
600 E 4th St 11th Floor
Current Mailing Address Current Street Address
Charlotte, NC 28202
City State Zip City State Zip
10. Deed Book No. 06080 Page No. 693 He 695 Provide a copy of the most current deed.

Part B.
1. Company(ies)who are financially responsible for the land-disturbing activity(Provide a comprehensive list
of all responsible parties on accompanied page.) If the company is a sole proprietorship or if the landowner(s)is
an individual(s), the name(s) of the owner(s)may be listed as the financially responsible party(ies).
Mecklenburg County [e-mail]
Company Name E-mail Address
600 E 4th St 11th Floor
Current Mailing Address Current Street Address
Charlotte, NC 28202
City State Zip City State Zip
Phone: Office# Mobile#[phone]
Note: If the Financially Responsible Party is not the owner of the land to be disturbed, include with this form
the landowner's signed and dated written consent for the applicant to submit a draft erosion and sedimentation
control plan and to conduct the anticipated land disturbing activity.
2. (a) If the Financially Responsible Party is a domestic company registered on the NC Secretary of State
business registry, give name and street address of the Registered Agent:
Name of Registered Agent E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Phone: Office# Mobile#
Name of Individual to Contact(if Registered Agent is a company)
(b) If the Financially Responsible Party is not a resident of North Carolina, give name and street address
of the designated North Carolina agent who is registered on the NC Secretary of State business registry:
Name of Registered Agent E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Phone: Office# Mobile#
Name of Individual to Contact(if Registered Agent is a company)

(c) If the Financially Responsible Party is engaging in business under an assumed name, give name under
which the company is Doing Business As. If the Financially Responsible Party is an individual, General
Partnership, or other company not registered and doing business under an assumed name, attach a copy
of the Certificate of Assumed Name.
Company DBA Name
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(s)
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 Party). I agree to provide
corrected information should there be any change in the information provided herein.
Daniel S. Putman Construction Project Manager II
T jyor pri t nam Title or Authority
11/14/23
Signature Date
I, KkgM + 7A,2 •s. , a Notary PublicP.f e County of M E(', E4c3)1
State of North Carolina, hereby certify that----PM I S fJ7 A.J1 appeared personally
before me this day and being duly sworn acknowledged that the above form was executed by him/her.
i
Witness my hand and notarial seal, this I day of , 20 c 5
•
•
it- Oita
No ry ,�f �/ /� ,
Sep l My c mission expires/V AK-Ct-I a(p �l,b22

UEEOaOOK PAGE 000351
, ,STATE OF NORTH CAROLINA 6080 0693 CIVIL ACTION
IN THE GENERAL COURT OF JUSTICE
COUNTY OF MECKLENBURG SUPERIOR COURT DIVISION
89-CVS- /do R I-
MECKLENBU Y, NORTH CAROLINA, )
.t ao
w
Plaintiff, ) r-,;, %-3
V. ) '..� 'c'7 J� .Tl
rn 1
) MEMORANDUM OF ACTION %`_-'..'. ^� „Orin
J.P. SIMPSONAND WIFE, EULENE :uo
(CONDEMNATION) .�-nc, -p A93.-i
WILSON SIMPSON, ) c,oc aC -i rry
. r'i CQ c,
) z x
Defendants. ) :-,v) --
z-
)
TAKE NOTICE: `
1. That on the 1 /r'" day of il A44-- , 1989, Mecklenburg County,
Al
North Carolina, pursuant to the provisions of Chapter 40A of the General Statutes
of North Carolina, instituted the above-captioned civil action in the Superior
Court of Mecklenburg County, North Carolina, to acquire by condemnation the fee
simple absolute interest in and to the real property described in Exhibit A
attached hereto and incorporated herein.
2. That the above-named defendants are the entities which the plaintiff is
informed and believes may have or may claim to have an interest in the property.
3. That the following matters are set forth in Exhibit A attached hereto and
made a part hereof: Section I, a description of the entire tract or tracts of
land affected by the taking; Section II, a statement of the property taken for
public use; and-Section II , a description of the area taken.
This / 1›1day of , 1989.
ames 0. Cobb
RUFF, BOND, COBB, WADE & MCNAIR
Two First Union Plaza, Suite 2100 __
Charlotte, North Carolina 28282 r_
[phone]
• Marvin A. Bethune • : • .• r
RUFF, BOND, COBB,-,)WADE At MCNAIR
Two First Union Plaza, Suite 2100
Charlotte, North Carolina 28282
[phone]
Attorneys for Mecklenburg County,
North Carolina
PRFP!tRED BY f.'Fa RAIL TO:
. 5892p ". .1 ' . .. FSQ.
RUFF, ;. .. �_ AEcNiIR
-. ...,i"/ N. C. 232:12
R2CIS'L..R J? D3 3. BOX 24

000352
STATE OF NORTH CAROLINA CIVIL ACTION
" GEEDB04K PAg! THE GENERAL COURT OF JUSTICE
COUNTY OF MECKLENBURG SUPERIOR COURT DIVISION
6000 0695 89-CVS- add , 9
MECKLENBURG COUNTY, NORTH CAROLINA, )
)
Plaintiff, ) I/ !• `'y
)
1/ ►/ v. )
) MEMORANDUM OF ACTION co
DONALD H. CALDWELL AND WIFE, JOSEPHINE S.) (CONDEMNATION) ma) i°
CALDWELL; GILBERT C. HARTIS AND WIFE, ) "C1 c
:7 "' U
4�
LILLIAN C. HARTIS; JOHN HARTIS AND WIFE, ) " ' m
MARIE L. HARTIS; SOUTHERN NATIONAL BANK; ) cam' --torn
AND JAMES R. BRYANT, III, AS TRUSTEE ) X
iiv ^� y'n Z
UNDER DEED OF TRUST FOR SOUTHERN ) ;ic -{ m
NATIONAL BANK, ) ?pa x o Q
v.•
Z.
C)
Defendants. )
)
)
TAKE NOTICE:
1. That on the / day of , 1989, Mecklenburg County, North
Carolina, pursuant to the provisions of apter 40A of the General Statutes of North
Carolina, instituted the above-captioned civil action in the Superior Court of
Mecklenburg County, North Carolina, to acquire by condemnation the fee simple absolute
interest in and to the real property described in Exhibit A attached hereto and
incorporated herein.
2. That the above-named defendants are the entities which the plaintiff is
informed and believes may have or may claim to have an interest in the property.
3. That the following matters are set forth in Exhibit A attached hereto and
made a part hereof: Section I, a description of the entire tract or tracts of land
affected by the taking; Section II, a statement of the property taken for public use;
and Section III, a description of the area taken.
This /n day of S/1/01)AA - , 1989.
d P' • 60 -
- gm116/446
es 0. Cobb
RUFF, BOND, COBB, WADE & MCNAIR ' ;
Two First Union Plaza, Suite 2100
Charlotte, North Carolina 28282
(704) 377-1634' -
•
Marvin A. Bethune- - • -
RUFF, BOND, COBB, WADE & MCNAIR
Two First Union Plaza, Suite 2100
Charlotte, North Carolina 28282
RUFF. . ':1;N (704) 377-1634
Attorneys for Mecklenburg County,
. +. ::t North Carolina