NCC240754_FRO Submitted_20240315

Fl L RESPONSIBILITY/0 NERSHI F .
SEDIMENTATION T L
IREDELL
No person may initiate any land-disturbing activity on one or more acres, % acre or more inside a
c o u N T v r c watershed, as covered by the Sedimentation Pollution Control Act and the Iredell County Land
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 Residence at North ate
2. Location of land-disturbing activity: County Iredell City or Township Statesville
1825 Old Wilkesboro Rd. Statesville, NC 28625
Highway/Street Latitude Longitude
3. Approximate date land-disturbing activity will commence:
3/1/24
4. Purpose of development(residential, commercial, industrial, institutional, etc.): Multi-family
5. Total acreage disturbed or uncovered(including off-site borrow and waste areas): 6 acres
6. Amount of fee enclosed: $ 1,356.25 . 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 X No Enclosed
8. Person to contact should erosion and sediment control issues arise during land-disturbing activity:
Name James Pressly E-mail Address [e-mail]
Telephone [phone] Cell# 704-657-2004 Fax#
9. Landowner(s)of Record(attach accompanied page to list additional owners):
Residence Housing Assoc. LLC 704-872-1000
Name Telephone Fax Number
1109 Davie Ave. 1109 Davie Ave.
Current Mailing Address Current Street Address
Statesville, NC 28677 Statesville, NC 28677
City State Zip City State Zip
2594 1470
10. Deed Book No. Page No. 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):
James Pressly [e-mail]
Name E-mail Address
1109 Davie Ave. 1109 Davie Ave.
Current Mailing Address Current Street Address
Statesville, NC 28677 Statesville, NC 28677
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:
Name E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Telephone Fax Number
(b) If the Financially Responsible Party is a Partnership or other person engaging in business under an assumed name, attach
a copy of the Certificate of Assumed Name. If the Financially Responsible Party is a Corporation, 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
Telephone 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.
James Pressly Manager
Type or rint n
Title or Authority
2/1/2024
Signa ure Date
I, M M/1 leaf i&Vt b✓V o 4 , a Notary Public of the County of eitI GtN//OA
State of North Carolina, hereby certify that _qatrier PreG5 appeared personally before me this day
and being duly sworn acknowledged that the above form was execut by him.
Witness my hand and notarial seal, this St day of Rh , 20 a l+
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