NCC230999_FRO Submitted_20230414

liA
FINANCIAL RESPONSIBILITY OWNERSHIP (FRO) FORM kuitersville
r•
Soil Erosion and Sedimentation Control Ordinance NORTH CA R O L I N A
Instructions: No person shall initiate any land-disturbing activity on one or more acres, as covered in the Town of
Huntersville Soil Erosion and Sedimentation Control Ordinance, before this form and an acceptable erosion and
sedimentation control plan have been completed and approved by the Town of Huntersville. The Financially
Responsible Party will be on record as the party to accept any Notices of Violation or related documents for any non-
compliance of the Town of Huntersville Soil Erosion and Sedimentation Control Ordinance. If the Financially
Responsible Party resides out of state,a North Carolina agent must be assigned. All relevant items on this form
must be filled out accurately and completely.
PART A - Complete All Fillable Fields
1. Project name SafeNest Storage Huntersville
2. Address of land-disturbing activity (number, street) 11600 Hord Drive&509 Seagle Street
3. Approximate date land-disturbing activity will begin 3/1/2023
4. Purpose of development Commercial Other:
5. Total acreage of land to be disturbed or uncovered 5.05 Ac
6. Total site acreage 10.50 Ac
7. Landowner(s)of Record. Names listed must match the deed(s). Attach list of additional owners, if applicable.
Note: If the landowner of record is not the person(s)or firm(s)Financially Responsible Party,as listed in Part
B, item I,a separate letter of consent,signed and dated by the landowner of record, or their authorized agent,
is required
Landowner 1 of Record
Name Town an. Country Mailing 300 S Tryon Street,Suite 2500
Huntersville Owner LLC
Contact Name Cassie A. McCrain Address City: Charlotte
Title Managing Director State: NC Zip: 28202
Phone: Office/Main 980.417.5829 Street
Phone: Mobile Address City:
Email [e-mail] If PO Box listed above State: Zip:
Landowner 2 of Record
Name Mailing
Contact Name Address City:
Title State: Zip:
Phone: Office/Main Street
Phone: Mobile Address City:
Email If PO Box listed above State: Zip:
8. Indicate Book and Page number where the deed or instrument is filed Attach list of addt'l deeds if applicable
Deed Book 37322 Page 883 Deed Book Page
Deed Book 37322 Page 875 Deed Book Page
Rev.6/2022 TOH Staff Reviewer Ownership/Agent: Verified at Pre-Con Meeting By: _ Page 1 of 2

FINANCIAL RESPONSIBILITY OWNERSHIP (FRO) FORM
+knitetsviI1ewn
Soil Erosion and Sedimentation Control Ordinance NOR f I-I CAROL!N A
PART B — Sections 1, 2 and 4 are required
I. Person(s) or firm(s)who are financially responsible for this land-disturbing activity. Note: If the Financially
Responsible Person(s) or Firm(s) has an out-of-state address, a North Carolina agent must be designated in
item 2, below.
Financially Responsible Party
Person or Firm Town and Country Huntersville Owner LLC
If Company or Firm, list name as listed on NC Secretary of State business registry
Mailing Address 300 South Tryon Street,Suite 2500, Charlotte, NC 28202
Street Address City: State: Zip:
Required if PO Box listed as Mailing Address
Contact Name Cassie A. McCrain Email [e-mail]
•
Phone: Office 980.417.5829 Phone: Mobile [phone]
2. If the Financially Responsible Party is not a resident of North Carolina, provide the information of the
designated North Carolina agent who is registered on the NC Secretary of State business registry.
NC Agent for Financially Responsible Party
Registered Agent Name Name as listed on NC Secretary of State business registry
Mailing Address City: State: Zip:
Street Address City: State: Zip:
if PO Box listed above
Email Phone f
3. (Optional)Additional contact familiar with the site, understands the plans, and may represent the company.
Site Contact's Name Daniel Renckens Email [e-mail]
Phone: Office 704.654.7538 Phone: Mobile [phone]
4. 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. If
the Financially Responsible Owner is not an individual,this form must be signed 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.
Printed Name Case A. McCrain �,/,JT.le or Authority Managing Director
Wet-Ink Signature / i1%�"'' Date 02- 23
I, Goldie Q. England , a Notary Public of the County of Lincoln County , State
of North Carolina , hereby certify that Cassie McCrain personally appeared
before me this day and being duly sworn acknowledged that the above form was executed by him/her.
Witness my hand and notarial seal, this 3 day of February , 20 23 .
• — —s.ft=A— ———0" ` —4 Notary Signature m.
GOLDIE Q ENGLAND
Notary Public.North Carolina I Lincoln County My Commission Expires June 6. 2027
' My Commission Expires Jun 6, 2027 «
Rev.6/2022 Page 2 of 2