NCC241458_FRO Submitted_20240514

Tole RESPONSIBILITY OWNERSHIP (FRO) FORM
Soil Erosion and Sedimentation Control Ordinance NORTH C A R 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 Statesville Stumptown Residential
2. Address of land-disturbing activity(number, street) 15236 Statesville Road
3. Approximate date land-disturbing activity will begin February 1,2024
4. Purpose of development(Commercial, Residential, Residential
Industrial, etc.)
5. Total acreage of land to be disturbed or uncovered 17.72
6. Total site acreage 19.97
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.
Company Name NR Huntersville Property Owner LP Contact Name Kyle Whitaker
It applicable
Mailing Address 929 Jay Street,Ste 100,Charlotte,NC 28206
Physical Address
II PO Box listed above
Phone [phone] Email [e-mail]
Landowner Z of Record
Company Name Contact Name
If applicable
Mailing Address
Physical Address
If PO Box listed above
Phone 1 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
37649 653 37649 s 692
37649 701
37649 698
Rev. 8/2022 TOH Staff Reviewer Ownership/Agent: Verified at Pre-Con Meeting By: Page 1 of 2

i . 'Town of•
FINANCIAL RESPONSIBILITY OWNERSHIP (FRO) FORM ,lam`
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.
Company Name(if applicable) NR Huntersville Contact Name Kyle Whitaker
Property Owner LP
Mailing Address 929 Jay Street,Ste 100,Charlotte, NC 28208
Physical Address
II 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 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 Email
Phone: Office Phone: Mobile
PART C — SIGNATURE WITNESSED BY A NOTARY PUBLIC
DC)NOT SIGN THIS FORM UNTIL YOU ARE 1N 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 Kyle Whitaker Title or Authority Vice President A
Wet-Ink Signature (./; ��(.1� - Date 0-3
I, , a Notary Public of the County of jet)iffit Z — ,
State of I\ANII-4V r,OVIA>�1 v / A-hereby certify that VOMMOr..)-(,/Y.- 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 p " 1 day of ��Y�4l •-1/Y , 20
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Rev. 8/20412, CO U N c ,,•``� Page 2 of 2