NCC231914_FRO Submitted_20230707

FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
SEDIMENTATION POLLUTION CONTROL ACT
EXPRESS PERMITTING OPTION
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 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 Forrest Creek Phase 5
2. Location of land-disturbing activity: County Stanly City or Township Red Cross
Highway/Street Hartley Burris Rd Latitude(dectmatdegrees)35.247214 Longitude(decimaIdegreest"80.365986
SR 1131 October, 2022
3. Approximate date land-disturbing activity will commence:
4. Purpose of development(residential,commercial, industrial, institutional,etc.)_Residential
5. Total acreage disturbed or uncovered (including off-site borrow and waste areas):37.5 acres
6. Amount of fee enclosed $5,800.00 . The Express Permitting application fee is a dual charge.
The normal fee of$100.00 per acre(rounded up to the next acre) is assessed without a ceiling amount.
In addition,the Express Permitting supplement is$250 per acre up to eight acres,after which the Express
Permitting supplemental fee is a fixed$2,000.00 (Example:8.10-acre application fee is$2,900). Checks
should be addressed to NCDEQ.
7. Has an erosion and sediment control plan been filed? Yes ❑ Enclosed 571 No ❑
8. Person to contact should erosion and sediment control issues arise during land-disturbing activity:
Name Joseph Burleson E-mail Address [e-mail]
Phone: Office# [phone] Mobile# [phone]
9. Landowner(s)of Record (attach accompanied page to list additional owners):
Burleson Development Group, LLC [phone] [phone]
Name Phone: Office# Mobile#
248 Market St. 248 Market St.
Current Mailing Address Current Street Address
Locust NC 28097 Locust NC 28097
City State Zip City State Zip
10. Deed Book No. 1755 Page No. 698 Provide a copy of the most current deed.
1755 1007

Part B.
1. Company(les)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).
Burleson Development Group, LLC [e-mail]
Company Name E-mail Address
248 Market St. 248 Market St.
Current Mailing Address Current Street Address
Locust NC 28097 Locust NC 28097
City State Zip City State Zip
Phone: Office# [phone] 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:
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)
(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
•
(d) If order to facilitate Express Permitting, it is necessary to be able to contact the engineer or other
consultant who can assist in providing any necessary information regarding the plan and its preparation:
American Engineering Associates - Southeast, PA [e-mail]
Engineering firm or other consultant E-mail Address
Barry M. Fay, PE [phone] [phone]
Individual contact person (type or print) Phone: Office# Mobile#
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.
1;0pr C ieSeD.i Ma114 i�
Type or print name Title or Authority
Signs re Date
1, ?_ L)tecl, a Notary Public of the County of rt a I,
State of North Carolina, hereby certify that os i.p s D9 appeared personally
before me this day and being duly sworn acknowledged that the above form was executed by him/her.
G
Witness my hand and notarial seal, this 3 day of Lx.(1 , 20 a a
\, rr 000, Notary
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- e a, 'R Y \ e My commission expires
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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 I 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#

BK 1755 PG 698(3) DOC#437150
This Document eRecorded: 09/01/2021 03:42:30 PM
Fee: $26.00
Stanly County, North Carolina
Suzanne Lowder, Register of Deeds
Received By: KAYLAN ROLAND
NORTH CAROLINA GENERAL WARRANTY DEED
Excise Tax$0.00
Parcel Identifier No.559401078780 Verified by Stanly County on the day of .20
By:
Mail/Box to: HINSON FAULK,PA.,309 POST OFFICE DRIVE,INDIAN TRAIL NC 28079
This instrument was prepared by: HINSON FAULK,P.A. / FILE NO. 2021085929
Brief description for the index: Hatley Burris Road
Title Insurance Company:Investors
THIS DEED made this the 31st day of August,2021,by and between
GRANTOR GRANTEE
BURLESON SQUARE,LLC BURLESON DEVELOPMENT GROUP,LLC
A North Carolina Limited Liability Company A North Carolina Limited Liability Company
Mailing Address: Mailing Address:
248 Market Street 248 Market Street
Locust,NC 28097 Locust,NC 28097
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.
WITNESSETTH,that the Grantor,for a valuable consideration paid by the Grantee,the receipt of which is hereby acknowledged,has
and by these presents does grant,bargain,sell and convey unto the Grantee in fee simple,all that certain lot or parcel of land situated
in Stanly County,North Carolina and more particularly described as follows:
See Exhibit"A"attached hereto and incorporated herein.
The property hereinabove described was acquired by Grantor by instrument recorded in Book 1724,Page 933.
A map showing the above described property is recorded in Plat Book 20,Page 102,
This instrument prepared by,Hinson Faulk,PA,a licensed North
Carolina attorney.Delinquent taxes,if any,to be paid by the closing
attorney to the Stanly County,NC Tax Collector
upon disbursement of closing proceedings.
Submitted electronically by "Hinson Faulk, P.A."
in compliance With North Carolina statutes governing recordable documents
and the terms of the submitter agreement with the stanly county Register of Deeds.

BK 1755 PG 699 DOC#437150
TO HAVE AND TO HOLD the aforesaid lot or parcel of land and all privileges and appurtenances thereto belonging to the Grantee in
fee simple.
And the Grantor covenants with the Grantee,that Grantor is seized of the premises in fee simple,has the right to convey the same in
fee simple,that title is marketable and free and clear of all encumbrances,and that Grantor will warrant and defend the title against
the lawful claims of all persons whomsoever except for the exceptions hereinafter stated.
Title to the property hereinabove described is subject to the following exceptions:
All such valid and enforceable easements,restrictions and rights of way of record and the lien of ad valorem taxes
for the current year which the grantee herein assumes and agrees to pay.
All or a portion of the property herein conveyed does not include the primary residence of a Grantor.
IN WITNESS WHEREOF,the Grantor duly executed the foregoing as of the day and year first above written.
Burleson Square,LLC
A North Carolina Limited Liability Company
By 1, /� (SEAL)
Jerry L.Burleson,Member
P '^'By � `y _(SEAL)
Jose L.
Burleson,Member
SEAL-STAMP State ofNorth Carolina,County of Union ll����ff��
I,ShoihnDf fjtVCS a Notary Public for frle . b g
,, rP �,,' County, State of North Carolina, certify that the following person(s), either
`��=o Butte�y�� personally known to me or proven by satisfactory evidence,personally appeared
4` �O' RY s before me this day and acknowledged to me that they voluntarily signed the
�X71F�8 c foregoing document for the purpose stated therein and in the capacity indicated:
a� 1551�
5Lto a' Jerry L.Burleson and Joseph L.Burleson. Witness my hand and official stamp or
t�JJ µp�lSy5. �a seal,this ;I day of August,2021.
• ( 4(\cr1 ?alth U
Notary Public --
My Commission Expires:3L)'s OWE
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 County
By Deputy/Assistant-Register of Deeds

BK 1755 PG 1007 (4) DOC#437196
This Document eRecorded: 09/02/2021 03:44:03 PM
Fee: $26.00
Stanly County, North Carolina
Suzanne Lowder, Register of Deeds
Received By: DEBBIE WHITLEY
Return to:
Hinson Faulk, P,A.
309 Post Office Drive
Indian Trail NC 28079
File#2021085930
This instrument prepared by, Hinson Faulk, P.A.,a licensed North
Carolina attorney.Delinquent taxes, if any,to be paid by the closing
attorney to the Stanly County, NC Tax Collector
upon disbursement of closing proceedings.
North Carolina General Warranty Deed
by and between
Richard D Bray and Cheryel H. Bray,
and
Burleson Development Group, LLC
Brief description for the index:
VAC Hatley Burris Road
submitted electronically by "Hinson Faulk, p.A."
in compliance with North Carolina statutes governing recordable documents
and the terms of the submitter agreement with the stanly county Register of ❑eeds.

BK 1755 PG 1008 DOC# 437196
NORTH CAROLINA GENERAL WARRANTY Y DEED
Excise Tax$1586.00
Parcel Identifier No.559401289118 Ve_1fied by Stanly County on the day of ,20
By:
Mail/Box to: HINSON FAULIC,P.A.,309 POST OFFICE DRIVE,INDIAN TRAIL NC 28079
This instrument was prepared by: HINSON FAULK,P.A. /FILE NO. 2021085930
Brief description for the index: VAC Halley Burris Road
Title Insurance Company:Investors
THIS DEED made this the 31st day of August,2021,by and between
GRANTOR GRANTEE
Richard D.Bray and spouse, Burleson Development Group,LLC
Cheryel H.Bray A North Carolina Limited Liability Company
Mailing Address: Mailing Address:
1421 Ashfield Drive 248 Market Street
Lewisville,NC 27023 Locust,NC 28097
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,for a valuable consideration paid by the Grantee,the receipt of which is hereby acknowledged,has
and by these presents does grant,bargain,sell and convey unto the Grantee in fee simple,all that certain lot or parcel of land situated
in Stanly County,North Carolina and more particularly described as follows:
BEGINNING at a rebar found at the Southernmost corner of the property of Dustin McIntyre(now or formerly)
described in Deed Book 1667,Page 1343,and shown a plat recorded in Map Book 26,Page 196,all in the Stanly
County Registry(the'Registry),said point also lying in a line of the property of Burleson Square,LLC(now or
formerly)described in deed recorded in Deed Book 1742,Page 933 in the Registry;thence along a line of the
McIntyre property,North 52°08'37°East 1259.27 feet to a bent pipe found(NCSPC coordinates:N:548,410.36;
E;1,592,371.85);thence proceeding North 52°12'00"East 1291.23 feet to a bent pipe found,a corner of the property
of Ora Lee H.Smith and Dwight David Smith(now or formerly)described in deed recorded in Deed Book 1608,
Page 1403 in the Registry;thence proceeding along a line of the Smith property,South 35°12'58'East 986.59 feet
to a pipe found,a corner of the property of LTC Development LLC(now or formerly)described in deed recorded in
Deed Book 1716,Page 1525 in the Registry;thence proceeding along the LTC property,South 36°13'34"East
450.37 feet to a spike found in the right of way of Halley Burris Road(S.R.1131)(a 60'public right of way);thence
proceeding along the road for the following eighteen(18)courses and distances:(1)South 77°56'44"West 49.61
feet to a point;(2)South 76°43'35"West 298.46 feet to a point;(2)South 76°02'50"West 120.61 feet to a point;(3)
South 75°58'34"West 92.25 feet to a point;(4)South 75°46'30"West 61.46 feet to a point;(5)South 74°40'01"
West 124.55 feet to a point;(6)South 73°39'13"West 56.69 feet to a point;(7)South 72°27'08"West 61.74 feet to
a point;(8)South 70°11'46"West 58.92 feet to a point; (9)South 69°56'28'West 46.30 feet to a point;(10)South
68°23'15"West 58.45 feet to a point;(11)South 66°17'36"West 48.68 feet to a point;(12)South 65°35'58"West
66.66 feet to a point;(13)South 64°08'35"West 64.38 feet to a point;(14)South 62°58'31"West 58.99 feet to a
point;(15)133.52 feet along the arc of a circular curve to the left,said curve having a radius 9363.55 feet and a
chord bearing and distance of S 62°33'36'West 133.52 feet;(16)452.21 feet along the arc of a circular curve to the
N.C.Bar Assoc.Form No.3 01976,Revised @ 1977,2002

BK 1755 PG 1009 DOC# 437196
right,said curve having a radius of 6330.66 feet and a chord bearing and distance of South 64°12'14"West 452.11
feet;(17)South 66°17'50"West 550.60 feet;and(18)219.06 feet along the arc of a circular curve to the left,said
curve having a radius of 1368.11 feet and a chord bearing and distance of South 61°42'37"West 218.82 feet,to a
spike found in a line of the aforementioned Burleson Square property;thence along a line of the Burleson Square
property,North 36°48'47"West 700.41 feet to the POINT AND PLACE OF BEGINNING;containing 58.584 acres,
more or less,as shown on a survey by Carolina Surveyors,Inc.entitled Harley Burris Road,prepared for Burleson
Square,LLC.
The property hereinabove described was acquired by Grantor by instrument recorded in Book 332,Page 708 and Book 332,Page 888.
A map showing the above described property is recorded in Plat Book,Page.
N.C.Bar Assoc.Form No.3 01976,Revised 0 1977,2002

BK 1755 PG 1010 DOC# 437196
TO HAVE AND TO HOLD the aforesaid lot or parcel of land and all privileges and appurtenances thereto belonging to the Grantee in
fee simple.
And the Grantor covenants with the Grantee,that Grantor is seized of the premises in fee simple,has the right to convey the same in
fee simple,that title is marketable and free and clear of all encumbrances,and that Grantor will warrant and defend the title against
the lawful claims of all persons whomsoever except for the exceptions hereinafter stated.
Title to the property hereinabove described is subject to the following exceptions:
All such valid and enforceable easements,restrictions and rights of way of record and the lien of ad valorem taxes
for the current year which the grantee herein assumes and agrees to pay.
All or a portion of the property herein conveyed includes or X does not include the primary residence of a Grantor.
IN WITNESS WHEREOF,the Grantor duly executed the foregoing as of the and year first above • n.
®✓:52 (seal)
'chard D.Bray
/.e..t. ' "' (seal)
Cheryel H,Br y
SEAL-STAMP State of North Carolina's.�'ts('-�County� of Union
� 6 •
1, . vt+ a Notary Public for
County, State of North Carolina, certify that the following person(s), either
41 B. C.� ���, personallyknown to me orproven bysatisfactoryevidence,personallyappeared
z'S.(x Pp
pii before me this day and acknowledged to me that they voluntarily signed the
�ytic
i.'fozT col
foregoing document for the purpose stated therein and in the capacity indicated:
MY G 2o.7Gn; ���` Richard D.Bray and Cheryel H.Bray.Witness my hand and official stamp or
q,. ea 6+� seal,this the 31st day of August,2021.
rti
Notary Public f�
My Commission Expires: g'2-6"24
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 _County
By Deputy/Assistant-Register of Deeds
N.C.Bar Assoc.Form No.3®1976,Revised 01977,2(02