NCC232830_FRO Submitted_20230920

Town
FINANCIAL RESPONSIBILITY OWNERSHIP (FRO) FORM irkntersville
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Soil Erosion and Sedimentation Control Ordinance N o R r H CAR 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 items on this form must be
filled out accurately and completely.
PART A - PROJECT AND LANDOWNER INFORMATION
1. Project name Bryton Woodfield Apartments
2. Address of land-disturbing activity (number, street) 12554 Hambright Road
3. Approximate date land-disturbing activity will begin 9/18/23
4. Purpose of development (Commercial, Residential, Multi Family
Industrial, etc.)
5. Total acreage of land to be disturbed or uncovered 17.40
6. Total site acreage 21.79
7. Landowner(s) of Record. The names listed below must match the Deed(s).Attach a list of additional owners, if
applicable.
Note: If the landowner of record is not the person(s)firm(s),or Company's Financially Responsible Party,
as listed in Part B, item 1, a separate Letter of Consent, signed and dated by the Landowner of
Record, or their Authorized Agent,is required.
Landowner 1 of Record
Company Name Hambright Road Apartments Contact Name Chad Hagler
If applicable Owner, LLC
Mailing Address 8045 Arco Coporate Drive, Suite 108, Raleigh
Physical Address
If PO Box listed above
Phone [phone] Email [e-mail]
Landowner 2 of Record
Company Name Contact Name
If applicable
Mailing Address
Physical Address
If PO Box listed above
Phone Email
8. Indicate the Deed Book and Page number the deed or instrument is filed. Attach a list of additional deeds if
applicable.
Deed Book Page I. Deed Book Page Deed Book Page
25520 147
Rev. 8/2022 TOH Staff Reviewer Ownership/Agent: Verified at Pre-Con Meeting By: Page 1 of 3

FINANCIAL RESPONSIBILITY OWNERSHIP (FRO) FORM
TMT �. e
Soil Erosion and Sedimentation Control Ordinance NORTH C A R O L I N A
PART B — FRO AND NC REGISTERED AGENT
1. Person(s),firm(s)or Company who is/are financially responsible for this land-disturbing activity.
.1111.1.11.1111111111111111111111111111.111.11111111.010111 Financially Responsible Party
Company Name(if applicable) Woodfield Acquisitions, Contact Name Chad Hagler
LLC
Mailing Address 7804 C Fairview Road
Physical Address Charlotte, NC 28226
If PO Box listed above
Phone [phone] Email [e-mail]
2. If the Financially Responsible Party listed above does not reside in the state of North Carolina, they must
provide a designated North Carolina agent below. This agent must be registered with the NC Secretary of State.
VI ' .1 Ins IeP•rt
NC Registered Agent Name Contact Name
Mailing Address
Physical Address
If PO Box listed above
Phone Email
3. (Optional)Additional contact familiar with the site,who understands the plans,and may represent the company.
Site Contact's Name _ Jason Fosselman Email [e-mail]
Phone: Office Phone: Mobile [phone]
PART C — SIGNATURE WITNESSED BY A NOTARY PUBLIC
ADO NOT SIGN THIS FORMAT `:t 1 1 KSSMAI.Fi A NOTARYPUBLICw IiIIIIIIMIO
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 Chad M. Hagler
Title or Authority Vice President
Wet-Ink Signature at/w, Date 9-18-23
I Cynthia Kirby , a Notary Public of the County of Mecklenburg
State of North Carolina , hereby certify that Chad M. Hagler personally
appeared beforgoleceki`e9 y and being duly sworn acknowledged that the above form was executed by him/her.
��� 1��1�Kl ''1, 18th September 23
Witness►` an no li s�al, this day of p , Zp
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m Pt)d��rs Z Notary Signatur 1�l
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F '��•` My Commission Expires 5-30-2027
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Rev. 8/2022 Page 2 of 3

Town
FINANCIAL RESPONSIBILITY OWNERSHIP (FRO) FORM T v..�Ilte of• e
Soil Erosion and Sedimentation Control Ordinance N o R r H CAR O L I N A
My Commission Expires
Rev. 8/2022 Page 3 of 3