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HomeMy WebLinkAboutNCC240532_FRO Submitted_20240223 C,*.RY A NORTH CAROLINA Stormwater Division FINANCIAL RESPONSIBILITY - OWNERSHIP FORM No person may initiate any land-disturbing activity covered by Cary's Sedimentation and Erosion Control Ordinance before completing and filing this form with the Cary Stormwater Division. Indicate N/A if a question is not applicable. Section 1 PROJECT NAME: Alston Town Center-Phase 1B Infrastructure PROJECT DEVELOPMENT PLAN #: 20-DP-2085-B PROJECT LOCATION: 0735395493,0735490086,0735383886,0735493416 Property Tax ID#/PIN 0 NC-55 Hwy, Cary, North Carolina 27519 Street Address APPROXIMATE DATE OF PROJECT INITIATION: 01/02/2024 ACREAGE OF LAND TO BE DISTURBED: 16.4 acres APPLICANT SUBMITTING PLAN: (must match the financially responsible party named in Section 2 of the Financial Responsibility/Ownership (FR/O) Form.) Cary Creek Land, LLC Name(Person or Firm) Section 2 PERSON(S) OR FIRM(S) FINANCIALLY RESPONSIBLE FOR THIS LAND-DISTURBING ACTIVITY: (If out of state, a registered agent in North Carolina must be used.) Cary Creek Land, LLC Name(Person or Firm) 5950 Fairview Road,Suite 800 Street Address(No PO Box) Charlotte, NC 28210 City State Zip Cary 316 North Academy Street, Cary, NC 27513 PO Box 8005, Cary, NC 27512-8005 Tel: 311 or 919-469-4000 outside Cary limits www.carync.gov updated:04/2023 704.295.4005 Telephone Number 704.295.4059 Fax Number djarrett@aacusa.com E-Mail Address REGISTERED AGENT FOR THE PERSON OR FIRM WHO IS FINANCIALLY RESPONSIBLE: (If out of state, a registered agent in North Carolina must be used.) Chuck Handy Name 5950 Fairview Road,Suite 800 Street Address(No PO Box) Charlotte, NC 28210 City State Zip 704.295.4000 Telephone Number 704.295.4059 Fax Number chandy@aacusa.com E-Mail Address The Town reserves the right to contact either the financially responsible person or registered agent listed below in case of violation. Please indicate your preference below. Chuck Handy OR Financially Responsible Person Registered Agent Section 3 LANDOWNER OF RECORD: Cary Creek Land, LLC Name(Person or Firm) 0735395493,0735490086,0735383886,0735493416 Property Tax ID#/PIN 5950 Fairview Road,Suite 800 Street Address(No PO Box) Charlotte, NC 28210 City State Zip Cary 316 North Academy Street, Cary, NC 27513 PO Box 8005, Cary, NC 27512-8005 Tel: 311 or 919-469-4000 outside Cary limits www.carync.gov Page 2 of 3 updated:04/2023 STATEMENT OF LANDOWNER CONSENT: In accordance with NCGS 113A-54.1(a), I hereby declare that I am the owner or legally authorized representative of the owner of the property described above and provide my consent for the applicant cited in Section 1 above to submit an erosion control plan to the Town of Cary Stormwater Division and to conduct the planned land-disturbing activities on the property listed in Section 1 above. Chuck Handy V P Name Title or Authority December 15, 2023 Signature Date chandy@aacusa.com 704.295.4000 Email Telephone Number THE ABOVE INFORMATION is true and correct to the best of my knowledge and belief and as provided by me while under oath.(This form must be signed by the financially responsible person, if an individual or by an officer,director, partner, attorney-in-fact, or other person with authority to execute instruments for the financially responsible person if not an individual.) eI A-a c_ -'S M, � .._ V ,P Type or Print Name Title orAuthonty Signature � Date ,a Notary Public of the County of State of North Carolina, hereby certifies that l personally appeared before me this day and under oath acknowledged that the above form was executed by him/her. `` Witness my hand and notarial seal,this, l`:1T\f) day of NCP..Y1h2•�' , 2023 1.rd11111drS1i, , y NO * lwar M. Noa h ,, U: Notary Public •.,�e Pkg.‘" My commission expires 1� X-s. dfe -toNGov%% into- Cary 316 North Academy Street, Cary, NC 27513 PO Box 8005, Cary, NC 27512-8005 Tel: 311 or 919-469-4000 outside Cary limits www.carync.gov Page 3 of 3 updated:04/2023