NCC231836_FRO Submitted_20230613

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 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 Environment and Natural Resources. (Please type or print and, if
the question is not applicable or the e-mail and/or fax information unavailable, place N/A in the blank.)
Part A.
1. Project Name Corvian Elementary School
2. Location of land-disturbing activity: County Mecklenburg City or Township Charlotte
Highway/Street Johnston Oehler Rd. Latitude 35.3650 Longitude -80.7730
3. Approximate date land-disturbing activity will commence: 6.12 .23
4. Purpose of development(residential,commercial,industrial, institutional, etc.): Institutional
5. Total acreage disturbed or uncovered(including off-site borrow and waste areas): 7.7 6
6. Amount of fee enclosed: $ 520 . The application fee of$65.00 per acre (rounded
up to the next acre)is assessed without a ceiling amount (Example: a 9-acre application fee is$585).
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 Kellen Hughes E-mail Address keilert.hughesEtbarringerconstruction.cutt
Telephone [phone] Cell# 704-352--4374 Fax#
9. Landowner(s)of Record (attach accompanied page to list additional owners):
CCSSH, ITC
Name Telephone Fax Number
9501 David Taylor Drive 9501 David Taylor Drive
Current Mailing Address Current Street Address
Charlotte NC 28262 Charlotte NC 28262
City State Zip City State Zip
10. Deed Book No. 3407 6 Page No. 185 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):
CCSSH, ITC Stacey [e-mail]
Name E-mail Address
9501 David Taylor Drive 9501 David Taylor Drive
Current Mailing Address Current Street Address
Charlotte NC 28262 Charlotte NC 28262
City State Zip City State Zip
Telephone [phone] Fax Number 70 ` i q c - I D7

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 be any change in the information provided herein.
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Signature S Date
1, r NAL CTCV hr-N.�� , a Notary Public of the County of seceN-Na i.sr�
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State of North Carolina, hereby certify that Ica CneasEer � S Ncs appeared
personally before me this day and being duly sworn acknowledged that the above form was
executed by him.
Witness my hand and notarial seal, this )2 day of -k. _ , 20 'a3
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Seal
My commission expires - v.x_t_'-1, -aC 3
li EMILY GOEHRING M
,'4 Notary Public-North Carolina $
Mecktenburs County
My Commission Expires Jut 4,2023

B34076 - P185
FOR REGISTRATION
Fredrick Smith
REGISTER OF DEEDS
Mecklenburg County NC
2019 NOV 26 04:25: 9 PM
BK:34076 PG:185-187
FEE:$26.00
INSTRUMENT # 2019162371
TAYLORD
i
2019162371
��cG.'Sz4° NORTH CAROLINA QUIT CLAIM DEED
NO TITLE EXAMINATION PERFORMED BY PREPARER
Parcel Identifier No. 02946194-Verified by Mecklenburg, County on the day of ,20
By:
Mail after recording to: GRANTEE
This instrument was prepared by: SHAW LAW FIRM
Brief description for the Index: 4125 Johnston Oehler Road, Charlotte,NC 28269
THIS DEED MADE THE 22ND DAY OF NOVEMBER,2019 BY AND BETWEEN
GRANTOR GRANTEE
TDR HOLDINGS,LLC CCSSH,LLC
a North Carolina limited liability company a North Carolina limited liability company
MAILING ADDRESS: MAILING ADDRESS:
1428 Crowell Road 4041 Johnston Oehler Road
Vienna,VA 22182 Charlotte,NC 28269
Enter in appropriate block for each party:name,address,and,if appropriate,character of entity,e.g.corporation or partnership.
The designation Grantor and Grantee as used herein shall include said parties,their heirs, successors, and assigns,
and shall include singular,plural,masculine, feminine or neuter as required by context.
WITNESSETH, that the Grantor, does by these presents, remise release and quitclaim to Grantee all right and
title as Grantor has in or to a certain parcel or lot of land, described as follows all that certain lot or parcel of land
situated in the Mecklenburg County,North Carolina and more particularly described as follows:
SEE EXHIBIT"A"ATTACHED HERETO
3

B34076 - P186
IN WITNESS WHEREOF, the Grantor has hereunto set their hand and seal, the day and year first above
written.
SELLER:
TDR HOLDINGS, LLC
a North Carolina 1" i d liability company
By:
Ken Sharp, anaging Member
SEAL—STAMP STATE OF J)a" ;�-;g,, -COUNTY OF rrti;r,1et
I,the undersigned Notary Public of the County and State aforesaid, certify that Ken Sharp,
.�6V .. S personally appeared before me this day, and acknowledged that he is the Managing
4ri• p 1��:•� ? Member of TDR HOLDINGS, LLC and that by authority duly given and as the act of such
p ? 1.1 Z entity, he signed the foregoing instrument in its name on its behalf and its act and deed.
-'?'O •• :#768�'R'��/ WITNESS my hand and official stamp or seal, this 9-9—da of ovember, 2019.
'''oALTH Oda
My Commission Expires: efi 314-20 Notary Public
The foregoing Certificate(s)of
is/are certified to be correct. This instrument and this certificate are duly registered at the date and time and in the
Book and Page shown on the first page hereof.
REGISTER OF DEEDS FOR MECKLENBURG COUNTY
By Deputy/Assistant-Register of Deeds

B34076 - P187
EXHIBIT "A"
PROPERTY DESCRIPTION
Lying and being in the City of Charlotte, Mecklenburg County, North Carolina, and lying on the
southern side of Johnston Oehler Road (public right of way, variable width - Deed Book 28602 at Page
621), and being the property of TDR Holdings (Deed Book 29887 at Page 151) and being more
particularly described as follows:
BEGINNING at a set#5 rebar with cap in the southern right of way line of Johnston Oehler Road (public
right of way, variable width - Deed Book 28602 at Page 621), said set #5 rebar with cap being the
northwest corner of CCSSH, LLC (Deed Book 32260 at Page 414); thence from the POINT OF
BEGINNING with the line of said CCSSH, LLC (Deed Book 32260 at Page 414) S 05°03'30" E 492.47
feet to a set#5 rebar with cap; thence continuing with the said CCSSH,LLC (Deed Book 32260 at Page
414) and with CCSSH, LLC (Deed Book 33569 at Page 34) S 25°50'20" W (passing an existing#5 rebar
on line at 481.01 feet) a total distance of 1250.94 feet to an existing #4 rebar; thence with the property of
Daniel Ray Lubresky and Melanie Marie Lubresky (Deed Book 33287 at Page 483) N 62°17'27" W
(passing an existing #4 rebar on line at 104.77 feet) a total distance of 237.18 feet to an existing #4
rebar; thence N 30°47'23" W 34.52 feet to an existing #4 rebar; thence N 44°08'39" W 219.09 feet to an
existing #4 rebar inside 3/4" pipe beside stone; thence with the property of Harvey W. Johnston and wife,
Roberta O. Johnston (Deed Book 3236 at Page 373) the following four courses and distances:
1) N 18°45'33" E 737.25 feet to an existing 1" pipe; 2) N 18°40'49" E 150.14 feet to an existing
#6 rebar; 3) N 89°52'12" E 328.58 feet to an existing #4 rebar; and 4) N 04°55'17" W 564.10 feet to an
existing nail at bend in #5 rebar in the southern right of way line of Johnston Oehler Road (public right
of way, variable width - Deed Book 28602 at Page 621); thence with the said southern right of way line
of Johnston Oehler Road the following four courses and distances: 1) S 81°05'46" E 102.99 feet to a set
#5 rebar with cap; 2) with the arc of a circular curve to the right having a radius of 460.00 feet, an arc
length of 17.75 feet and a chord bearing and distance of S 71°46'13" E 17.75 feet to a set #5 rebar with
cap; 3) S 70°37'53" E 76.93 feet to a set #5 rebar with cap; and 4) with the arc of a circular curve to the
left having a radius of 1240.00 feet, an arc length of 130.82 feet and a chord bearing and distance of
S 73°39'13" E130.76 feet to the POINT OF BEGINNING containing 17.024 acres.
TAX PARCEL NO. 02946194