NCC233108_FRO Submitted_20231018

Town of
FINANCIAL RESPONSIBILITY OWNERSHIP (FRO) FORM 4 ltee
Soil Erosion and Sedimentation Control Ordinance NORTH cARoLINA
•
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 Trails End Residential Community
2. Address of land-disturbing activity(number, street) 11301 Trails End Lane Huntersville, NC 28078
3. Approximate date land-disturbing activity will begin 1/1/2024
4. Purpose of development(Commercial, Residential, Residential
Industrial, etc)
5. Total acreage of land to be disturbed or uncovered 45.98
b. Total site acreage 58.96
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
.:`CompanyName Shea Homes Carolina, LLC ContactName JC Champion
If applicable.
Mailing Address 10130 Perimeter Parkway,Suite 300
':Physical Address Charlotte, NC 28216
If PO Box listed above
Phone [phone] Email [e-mail]
Landowner I 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 Deed Book Page Deed Book Page
38414 821-825
Rev.8/2022 TO1-1 Staff Reviewer Ownership/Agent: Verified at Pre-Con Meeting By: Page 1 of 3

Town of
FINANCIAL RESPONSIBILITY OWNERSHIP (FRO) FORM to 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.
• Financially Responsible Party
ConxpanyName(if applicable) Shea Homes Carolina, Contact Name Jay Seymoure
U.0
Mailing Address 10130 Perimeter Parkway, Suite 300
• Physical Address Charlotte, NC 28216
• If PO Box listed above
Phone [phone] Entail [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.
North Carolina Agent for•Financially Responsible Party
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 JC Champion Email [e-mail]
Phone: Office 704-917-9009 Phone:Mobile [phone]
PART C -- SIGNATURE WITNESSED BY A NOTARY PUBLIC
DO NOT SIGN THIS FORM UNTIL YOU ARE IN THE PRESENCE Of A NOTARY PUBLIC
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 5:/cY 5E*Ur/2E Title or Authority /114-44k.) 4 e
Wet-Ink Signature — `� � Date /e/03
/,, &kw 0. \1 tb W5 , _, a Notary Public of the County of L1 v cc \Y1
State of Norm Ofivraltnc% , hereby certify that 'Ct SeywtooY.e 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 I\ day of 0c-bb e1 , 20 q3.
F.:.
y Notety Lincoln Notary Signature .
= County n /���,�a�
My Comm.Exp.� ti 0►/
02-14•2028. 4R. •
Rev. rCAao Page 2 of 3

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FINANCIAL RESPONSIBILITY OWNERSHIP (FRO) FORM totem of
e
Soil Erosion and Sedimentation Control Ordinance NORTH CAROLINA
My Commission Expires
Rev. 8/2022 Page 3 of 3