NCC232578_FRO Submitted_20230825

FINANCIAL RESPONSIBILITY OWNERSHIP (FRO) FORM I jte,,,,,f. e
Soil Erosion and Sedimentation Control Ordinance \;,,,Z r„ , :"t o i
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 Hamlet Huntersville
2. Address of land-disturbing activity (number, street) 12349 Old Statesville Rd
3. Approximate date land-disturbing activity will begin Feburary 2023
4. Purpose of development (Commercial, Residential, Single Family For-Rent
Industrial, etc.)
5. Total acreage of land to be disturbed or uncovered 41.80
6. Total site acreage 43.91
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 Contact Name Donna Stancil Abbott
If applicable
Mailing Address 108 Nanesemond Turn,Yorktown,VA 23693
Physical Address
If PO Box listed above
Phone [phone] Email [e-mail]
Landowner 2 of Record
Company Name Contact Name Daniel C Whitener& Linda L.
If applicable Whitener
Mailing Address PO BOX 3144 HUNTERSVILLE NC 28070
Physical Address 12335 OLD STATESVILLE RD HUNTERSVILLE NC 28078
If PO Box listed above
Phone l 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 s 1 Deed Book Page
6983 162
27267 684
28802 119
Rev.8/2022 TOII Staff Reviewer Ownership/Agent: Verified at Pre-Con Meeting By: Page 1 of 2

FINANCIAL RESPONSIBILITY OWNERSHIP (FRO) FORM ce Iunt1em,
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Soil Erosion and Sedimentation Control Ordinance ,tit,If ( :\,;,,, I.,
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
Company Name(if applicable) Hamlet Huntersville LLC Contact Name Steve Farmartino
Mailing Address 1921 Gallows Rd Suite 700 Vienna VA 22182
Physical Address
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.
North Carolina Agent for Financially Responsible Party
NC Registered Agent Name CT Corporation System Contact Name
Mailing Address 160 Mine Lake Court,Ste 200 Raleigh, NC 27615
Physical Address
If PO Box listed above
Phone [phone] Email
3. (Optional)Additional contact familiar with the site, who understands the plans, and may represent the company.
Site Contact's Name Steve Farmartino Email [e-mail]
Phone: Office 7578025149 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 floe/ C'e4 e Title or Authority /ifik`^ 14/ .Cy4-t
Wet-Ink Signature Date 0! ZZ
I, IVO NNE 0OV , a Notary Public of the County of 1f'1 1E69-X
State of V 112GI NI , hereby certify that kal.Y Ct EAn1S personally
appeared before me this day and being duly sworn acknowledged that the above form was executed by hint/her.
Witness my hand and notarial seal. this Wt. day of S6P-rC,M 136(L , 20 ZZ.
01°w"4* (seal)
6Ru' F;9.% Notary Signature
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