NCC230948_FRO Submitted_20230404

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FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
SEDIMENTATION POLLUTION CONTROL ACT
No person may initiate any land-disturbing activity on one or more acres as covered by the Act, including any
activity under a common plan of development of this size as covered by the NCGO1 permit, before this form
and an acceptable erosion and sedimentation control plan have been completed and approved by the Land
Quality Section, N.C. Department of Environmental Quality. Submit the completed form to the appropriate
Regional Office. (Please type or print and, if the question is not applicable or the e-mail address or phone
number is unavailable, place N/A in the blank.)
Part A.
1. Project Name Fernhill Apartments Comm Bld-New Bld
`li [i7i3 project involves Amer/Ca/7 Rescue Plan Act (ARRA) funds, list the Project Name belol-v
under which you applied for funding through the Division of Water Infrastructure ('DWI).
2. Location of land-disturbing activity: County Catawba City or Township Conover
Emmanuel Church Road 35.70123 -81.19831
Highway/Street Latitude(decimal degrees) Longitude(decimal degrees)
3. Approximate date land-disturbing activity will commence: March 15, 2023
4. Purpose of development (residential, commercial, industrial, institutional, etc.):
Multi-family Residential
5. Total acreage disturbed or uncovered (including off-site borrow and waste areas): 6.00
6. Amount of fee enclosed: $600.00 . The application fee of$100.00 per acre (rounded
up to the next acre) is assessed without a ceiling amount (Example: 8.10-acre application fee is$900).
Checks should be addressed to NCDEQ.
7. Has an erosion and sediment control plan been filed? Yes x❑ Enclosed ❑ No ❑
8. Person to contact should erosion and sediment control issues arise during land-disturbing activity:
Name James Royster E-mail Address [e-mail]
Phone: Office# 704-763-1727 Mobile# [phone]
9. Landowner(s) of Record (attach accompanied page to list additional owners):
Fernhill Housing, LLC 704-763-1727 704-763-1727
Name Phone: Office# Mobile#
4600 Park Road, Suite 390 4600 Park Road, Suite 390
Current Mailing Address Current Street Address
Charlotte, NC 28209-3670 Charlotte, NC 28209-3670
City State Zip City State Zip
10. Deed Book No. 3774 Page No. 1005 Provide a copy of the most current deed.

Part B.
1. Company(ies)who are financially responsible for the land-disturbing activity(Provide a comprehensive list
of all responsible parties on accompanied page.) If the company is a sole proprietorship or if the landowner(s)is
an individual(s), the name(s) of the owner(s)may be listed as the financially responsible party(ies).
Fernhill Housing, LLC [e-mail]
Company Name E-mail Address
4600 Park Road, Suite 390 4600 Park Road, Suite 390
Current Mailing Address Current Street Address
Charlotte, NC 28209-3670 Charlotte, NC 28209-3670
City State Zip City State Zip
Phone: Office# 704-763-1727 Mobile# [phone]
Note: If the Financially Responsible Party is not the owner of the land to be disturbed, include with this form
the landowner's signed and dated written consent for the applicant to submit a draft erosion and sedimentation
control plan and to conduct the anticipated land disturbing activity.
2. (a) If the Financially Responsible Party is a domestic company registered on the NC Secretary of State
business registry, give name and street address of the Registered Agent:
James Royster [e-mail]
Name of Registered Agent E-mail Address
4600 Park Road, Suite 390 4600 Park Road, Suite 390
Current Mailing Address Current Street Address
Charlotte, NC 28209-3670 Charlotte, NC 28209-3670
City State Zip City State Zip
Phone: Office# 704-763-1727 Mobile# [phone]
Name of Individual to Contact(if Registered Agent is a company)
(b) If the Financially Responsible Party is not a resident of North Carolina, give name and street address
of the designated North Carolina agent who is registered on the NC Secretary of State business registry:
Name of Registered Agent E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Phone: Office# Mobile#
Name of Individual to Contact(if Registered Agent is a company)

(c) If the Financially Responsible Party is engaging in business under an assumed name, give name under
which the company is Doing Business As. If the Financially Responsible Party is an individual, General
Partnership, or other company not registered and doing business under an assumed name, attach a copy
of the Certificate of Assumed Name.
Company DBA Name
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(s)
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 Party). I agree to provide
corrected information should there be any change in the information provided herein.
James Royster Ferrnhill Housing, LLC
y By: Fernhill Housing Manager, Inc
Type or print name Title or Authority Its: Managing Member
James Royster, Vice President
�'rw✓y c' - c,m3 ` 27-Z 3
Signature Date
I, kk \)o z- UJeo . , a Notary Public of the County of A
State of North Carolina, hereby certify that '-'5arfl't 120 c.t (r appeared personally
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 aday of I(Y\Qie.IN , 20 �3
$ , katada
JILL VOLZ WEAVER I Not.''.
Notary Public-North Carolina 0
Mecklenburg County I My commission expires I3 t ( '1
My Commission Expires Jul 31, 2027 `

Continued from Items 9 & 10 in Part A of the Financial Responsibility/Ownership Form for multiple
owners. Attach copies of this page as needed to list all landowners.
Landowner 2 of Record:
Name Phone: Office# Mobile#
Current Mailing Address Current Street Address
City State Zip City State Zip
Deed Book No. Page No. Provide a copy of the most current deed.
Landowner 3 of Record:
Name Phone: Office# Mobile#
Current Mailing Address Current Street Address
City State Zip City State Zip
Deed Book No. Page No. Provide a copy of the most current deed.
Landowner 4 of Record:
Name Phone: Office# Mobile#
Current Mailing Address Current Street Address
City State Zip City State Zip
Deed Book No. Page No. Provide a copy of the most current deed.
Landowner 5 of Record:
Name Phone: Office# Mobile#
Current Mailing Address Current Street Address
City State Zip City State Zip
Deed Book No. Page No. Provide a copy of the most current deed.

Continued from Item 1 in Part B of the Financial Responsibility/Ownership Form for multiple parties.
Attach copies of this page as needed to list all financially responsible parties.
Company 2 Name E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Phone: Office# Mobile#
Company 3 Name E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Phone: Office# Mobile#
Company 4 Name E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Phone: Office# Mobile#
Company 5 Name E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Phone: Office# Mobile#

3774-1005
•
FILED CafavvOs County
on Oct 13, 2022 at 01: :43t1 err?.
Excise Tar $115C.00 (ML)
INST. #22206
DONNA HICKS SPENCER.
Reuter of Deeds
51 03774 Pg 1 5-1007
✓4-16)Tony itnc tri
NORTH CAROLINA SPECIAL WARRANTY DEED
Excise Tax: $856.00
A portion of Parcel Identifier No. 3741-11-77-4474 -LRK(REID): 38260 Verified by County
on the day of ,20
By:
This instrument was prepared by and after recording return to:
Angela D. Sherrill,Esq.,Patrick Harper&Dixon L.L.P., PO Box 218, Hickory,NC 28603
Brief description for the Index: 1312 Conover Blvd.East,Conover,NC 28613
THIS DEED is made on October 11,2022 by,between,and/or among:
GRANTOR GRANTEE
WM Lionheart LLC Fernhill Housing,LLC
a North Carolina limited liability company 9 a North Carolina limited liability company
5282 Hartford Circle ' Ae 4600 Park Road, Suite 390
North Charleston, SC 29405 Charlotte,NC 28209
Enter in the appropriate block for each Grantor and Grantee: the name, mailing address, and, if applicable, the
character of any legal entity identified, e.g. corporation,partnership,etc.
WHEREAS, the designations Grantor and Grantee, as used herein, shall include the Grantor and the
Grantee(collectively)identified above,as well as each such Grantor's and Grantee's respective heirs,successors,
and/or assigns, and shall include singular, plural, masculine, feminine, or neuter, as required by context and
circumstance.
WHEREAS,the Grantor's correct legal name is: WM Lionheart LLC (sometimes also referenced as:
WM Lionheart, LLC).
WHEREAS, the Property,which is more specifically described by the legal description (below), was
previously acquired by Grantor by and through a North Carolina Beneficiary and Executrix's Deed recorded in
Book 3692 at Page 1518 of the Catawba County Public Registry.
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3 s

3774-1006
WHEREAS,the Property that is the subject of this conveyance was described as"Lot 1 (NEW)", on a
Subdivision Plat entitled: Subdivision: WM Lionheart LLC Property (the "Subdivision Plat"), which 1 uuo
Subdivision Plat was recorded in Plat Book 84 at Page 182 of the Catawba County Public Registry.
WITNESSETH,the Grantor, for good and valuable consideration given and paid by the Grantee, the
receipt and sufficiency of which are hereby acknowledged,has and by these presents does hereby grant,bargain,
sell,transfer,and convey unto the Grantee in fee simple,all of that certain lot, parcel of land,and improvements
situated in the City of Conover,Newton Township, Catawba County,North Carolina, which Property is more
particularly described as follows(herein the"Property"):
BEING ALL OF LOT 1 (NEW),AS DEPICTED ON SUBDIVISION PLAT ENTITLED"SUBDIVISION:
WM LIONHEART LLC PROPERTY" PREPARED BY EMH&T FOR FERNHILL HOUSING, LLC
RECORDED IN PLAT BOOK 84 AT PAGE 182, CATAWBA COUNTY PUBLIC REGISTRY.
For further reference to the chain of title, see the North Carolina Beneficiary and Executrix's Deed recorded
in Book 3692 at Page 1518 of the Catawba County Public Registry
The Property conveyed herein does not include the primary residence of Grantor.
[THE PREPARER OF THIS DOCUMENT DID NOT SEARCH OR CERTIFY TITLE.]
TO HAVE AND TO HOLD the aforementioned Property, together with and including all rights,
privileges,and appurtenances appertaining and/or belonging to the Grantee in fee simple. And the Grantor
covenants with the Grantee, that Grantor has done nothing to impair such title as Grantor received, and
Grantor will warrant and defend the title against the lawful claims of all individuals and/or entities claiming
by,under,or through Grantor,other than the following exceptions:
1. Ad valorem taxes and assessments for 2022 and subsequent years, which, for 2022, shall be
prorated between Grantor and Grantee as of the Closing Date.
2. Reciprocal Easement Agreement with Covenants and Restrictions recorded in Book 3139 at Page
475 of the Catawba County Public Registry, as may be amended from time to time.
3. Right(s) of way to Department of Transportation recorded in Book 2149 at Page 1979, Catawba
County Public Registry.
4. Any right, easement, setback, interest, claim, encroachment, encumbrance, violation, variations,
or other adverse circumstances affecting the Title disclosed by Plat(s)recorded in Plat Book 71 at
Pages 119 and 120; Plat Book 63 at Page 36,Catawba County Public Registry.
5. Any and all: easements; covenants; restrictions; conditions; encroachments (including both any
encroachments of improvements located on the Property onto any adjoining property and any
encroachments of any adjoining property improvements onto the Property); encumbrances;
violations of any federal, state, and/or local laws, ordinances, rules, and/or regulations relating to
zoning,environment,subdivision,occupancy,use,construction,or development;other violations;
variations;variances;pipes;setbacks; interests;claims;rights;railroad features;utility easements;
rights-of-way;and any other adverse circumstance(s)or condition(s)affecting the Property and/or
title to the Property that would be disclosed and/or discoverable by a complete and accurate title
search, survey, and/or assessment of the Property.
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3774-1007
1CO7
IN WITNESS WHEREOF,the Grantor has caused this North Carolina Special Warranty Deed to be
duly executed on the date shown below.
WM LIONHEART LLC
By:
Guy P. Scronce
as Manager of
STATE OF NORTH CAROLINA
COUNTY OF CATAWBA
I certify that Guy P. Scronce, as Manager of WM Lionheart LLC, personally appeared before me on
October 11,2022 and acknowledged to me that he signed the foregoing document.
\•" .L Y����,fi,1
NOTARY
Notary Public •
PUBLic
<Q '�� B P,V P.r L.. Cook
Printed Nam f Notary Public
111{1
My Commission Expires: J`� I l ;L Ja 023
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