NCC231283_FRO Submitted_20230502

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F=va Mecklenburg County Soil Erosion and
. } �1. , Sedimentation Control Ordinance
02 •
• Financial Responsibility/Ownership Form
No person shall initiate any land-disturbing activity covered by Section 6 of the Mecklenburg
County, Mint Hill or Davidson Sedimentation and Erosion Control Ordinances prior to
completing and filing this form with Mecklenburg County Land Use and Environmental
Services. The financially responsible party will be on record as the party to accept any Notices
of Violation or related documents for any non-compliance with the above Ordinances. If the
financially responsible party is out of State, a North Carolina agent must be assigned.
Please Type or Print
PART A
1. Project where land-disturbing activity is to be undertaken: North Chase at the Park
PATTERSON RD,HUNTERSVILLE,NC 28078
2. Address of land-disturbing activity:
PIN#:01723316, 01723317, 01723318, 01723319, 01723398, 01723399, 01722106
3. lApproximate date land-disturbing activity will commence: April 20 2023
Month Day Year
4. Purpose of development (Residential, Commercial, Industrial, etc.): Industrial
5. Approximate acreage of land to be disturbed or uncovered: 38 AC
6. Total site acreage: 46.66 AC
7. Landowners of record (use blank pages to list additional owners as necessary):
Owner#1 Name: ADE 859, LLC & ADE 872, LLC
Address: 3715 NORTHSIDE PARKWAY NW, BUILDING 200, SUITE 700,ATLANTA, GEORGIA 30327
Telephone: [phone] Fax: N/A
Email Address: [e-mail]
Owner#2 Name: ADE 872, LLC
Address: 3715 NORTHSIDE PARKWAY NW, BUILDING 200, SUITE 700,ATLANTA, GEORGIA 30327
Telephone: [phone] Fax: N/A
Email Address: [e-mail]
8. Indicate Book and Page where the deed or instrument is filed (use blank pages to list
additional deeds or instruments as necessary):
Book 34310 Page 139 Book 30373 Page 29
Book 34310 Page 135 Book 19652 Page 36
DEED INFO ON THIS PG. IS FOR PARCEL ID 01723302 ONLY
(continue on back or separate pages as necessary)
Form Revised 12-2016

Continue - Financial Responsibility/Ownership Form
PART B
1. Person(s) or firm(s) financially responsible for this land-disturbing activity:
Person or Firm: McDonald Development Company
Address: 3715 NORTHSIDE PARKWAY NW, BUILDING 200, SUITE 700,ATLANTA, GEORGIA 30327
Telephone: [phone] Fax: N/A
Email Address: [e-mail]
2. North Carolina agent for the person or firm who is financially responsible:
Person or Firm: Bohler Engineering NC, PLLC - Daniel R. Hines
Address: 1927 South Tryon Street, Suite 310
Charlotte, NC 28203
Telephone: [phone] Fax: n/a
Email Address: [e-mail]
3. The above information is true and correct to the best of my knowledge and belief and was
provided by me while under oath. (This form must be signed by the financially responsible
person if an individual or by an officer, director, partner, attorney-in-fact, or other person
with authority to execute instruments for the financially responsible company or entity, if not
an individual.)
John R. McDonald Manager
Printed Name Title
� f✓� c�� L f l 1812.023
Sig ature Date
LL K • N 012W 001) , a Notary Public of the
County of Co to , State of Cfo`. , hereby ANEW
r. R . t lC� .Q d
certify that personallyappeared
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before me this day and under oath acknowledged that this form was executed by him/her.
Witness my hand and notarial seal, this \VA day - Q.. . 20 2 3 .
Notary Signature:
My Commission expi es: S I t I-2-024 ME t K NORWOOD
�ao�<
.�y.•••• Notary Public,Georgia
Cobb County
%p ��`` My Commission Expires
rrrma August 11, 2026
Mecklenburg County Land Use and Environmental Servic4t pp Ry
2145 Suttle Ave.
Charlotte,NC 28208-5237
Phone[phone]

ADDITIONAL DEED FILINGS (CONTINUED FROM PAGE 1)
PARCEL ID 01723319
BOOK 33931, PAGE 22
PARCEL ID 01723318
BOOK 33931, PAGE 22
PARCEL ID 01723317
BOOK 34310, PAGE 139
PARCEL ID 01723316
BOOK 34310, PAGE 139
PARCEL ID 01723399
BOOK 33931, PAGE 22
PARCEL ID 01723398
BOOK 34310, PAGE 139
PARCEL ID 01722106
BOOK 33931, PAGE 22
BOOK 33931, PAGE 18
BOOK 29338, PAGE 976
BOOK 02460, PAGE 045
PARCEL ID 01740105
BOOK 29690, PAGE 610