NCC233403_FRO Submitted_20231116

Check if this project is ARPA-funded ❑
Attach a copy of the Letter of Intent to Fund
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, including any
activity under a common plan of development of this size as covered by the NCG01 permit, 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 51 ota1 .ki 4"'
*If this project involves American Rescue Plan Act(ARPA) funds, list the Project Name or Project
Number(e.g., SRP-D-ARP-0121) below under which you were approved for funding through the
Division of Water Infrastructure (DWI).
2. Location of land-disturbing activity: County I'bit-SYy' City or Township KfarktteaVi
Highway/Street LAz'i c",a UW Latitude(decimaldegrees) Long itude(declmal degrees)
3. Approximate date land-disturbing activity will commence: 7// Jzoz1
4. Purpose of development (residential, commercial, industrial, institutional, etc.): TSIOSP- 11AL
5. Total acreage disturbed or uncovered (including off-site borrow and waste areas):
6. Amount of fee enclosed: $ . The application fee of$100.00 per acre (rounded
up to the next acre) is assessed without a ceiling amount (Example: 8.10-acre application fee is$900).
Checks should be addressed to NCDEQ.
7. Has an erosion and sediment control plan been filed? Yes ❑ Enclosed No ❑
8. Person to contact should erosion and sediment control issues arise during land-disturbing activity:
Name '{FOR LJU ' P E-mail Address—go yA-c.s4io 5oF c G.4'.M L.(Ara
Phone: Office# 3510-02-8i00 Mobile# ✓%-LIZA'" 09
9. Landowner(s)of Record (attach accompanied page to list additional owners):
7-45 . flOrl*S DP(46MA agtocAPJA -31l 6SZ- IS&--1f2o-"104
Name Phone: Office# Mobile#
ro �72 /4l48 LitacyidAANK"frThOreE flto t
Current Mailing Address Current Street Address
614" ; 14c. 2721,,t GR :/%15 c z 9
City State Zip City State Zip
10. Deed Book No. 77 Page No. 113 Provide a copy of the most current deed.

2023021861 00147
FORSYTH COUNTY NC FEE$26.00
STATE OF NC REAL ESTATE EXTX
$584.00
PRESENTED&RECORDED
06/28/2023 02:58:31 PM
LYNNE JOHNSON
REGISTER OF DEEDS
BY: OLIVIA DOYLE,ASST
BK: RE 3761
PG: 679-680
{
' 3
NORTH CAROLINA GENERAL WARRANTY DEED
Excise Tax:$584.00
Parcel Identifier No. OUT OF 6896-28-0337
Mail/Box to:Grantee:PO Box 16168,High Point,NC 27261
This instrument was prepared by: Moss Woods PLLC(Jason Moss)
Brief description for the Index: {I{
THIS DEED made this eV' day of June ,2023 by and between
GRANTOR ` GRANTEE
CLSH Partners,LLC Royal Homes of North Carolina,
LLC
PO Box 16168 1089 Luna Creek Court
High Point,NC 27261 Kernersville,NC 27284
Enter in appropriate block for each Grantor and Grantee: name,mailing address,and, if appropriate,character of
entity,e.g.corporation oryartnership.
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.
WI'I'19ESSETH, 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 the City of Kernersville Township,
Forsyth .County,North Carolina and more particularly described as follows:
Being all of Lots 18,20,25 and 44 of Stonehaven,as shown on the plat recorded in Plat Book 77,Page 43,
in the Office of the Register of Deeds of Forsyth County,North Carolina.
The property hereinabove described was acquired by Grantor by instrument recorded in Book 3575 page 3598.
All or a portion of the property herein conveyed includes or does not include the primary residence of
a Grantor.
A map showing the above described property is recorded in Plat Book 77 page 43 .
submitted electronically by "Moss Woods PLLc"
in compliance with North Carolina statutes governing recordable documents
and the terms of the submitter agreement with the Forsyth County Register of Deeds.

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,other than the following exceptions:
IN WITNESS WHEREOF,the Grantor has duly executed the foregoing as of the day and year first above written.
,lagli partners.1,1,
(Entity Name)
Print/Type Name&Title: 7 v
State of\\C72A-. 1ti
County of ' ; ,,pk,
1 , a Notary Public of the above state and
co nty, certify that ta`� in his/her capacity as duly
authorized r � c LSH Partners,LLC ,personally appeared before
me this day�t the 3 tme time and place all of the following occurred: (a) the aforesaid
individual appeared in person before me; (b)the aforesaid individual was personally known to
me, or identified by my through satisfactory evidence; and(c) the aforesaid individual either
indicated and acknowledged to me that the signature on the above document was his/hers or
signed the above document while in my physical presence,and while being personally observed
by me doing so.
Date:
tart'Public
Dawn M Otremba
.rkfv;),,. NOTARY PUBLIC My Commission Expires: -`-.��'7szC
Guilford county,NC
M Commission k ires Au est 21,2026

Part B.
1. Company(ies)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(les).
/ .,t+d,015.16 stC @ 0441L. af-+.
Company Name E-mail Address
3bic /IA8 !j1f 5 Mo.J.Jft —( an/6
Current Mailing Address Current Street Address
/-hb I-F ?1/Jr tI 2724,1 (R sa N'- 27/a ff
City State Zip City State Zip
Phone: Office# 33‘-IO2m890 Mobile# 3i4 /Z0.-3410`�
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
To 3034 14148 W25"MtAVM✓vi—racE, f/0 7
Current Mailing Address Current Street Address
thr w ?d trri ge- 27 21.( 6�cx.. wz 27Yo7
City State Zip City State Zip
Phone: Office# 33Z_03zi ao 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)

{
(a) 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 k
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.
743 -- IJO.) /144i4
Type or print n .e Title or Authority
/ 7/Z5/21
Signatur Date
I,� � , --•\ ,k, , a Notary Public of the County of C-16�.Ssc�,
State of North Carolina, hereby certify that c S- Is*�\. appeared personally
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 a1 day of `.` , 20n
J
Notary
��: D wn,. Otremba �
C
;,, N A Y PUBLIC My commission expires A-zA2s. .t„
Guilford County, NC
My Commission Expiroo AU not 21,2026

Continued from Items 9 & ID 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:
1 L k-I p r jJEg$ 554 -02-84100
Name Phone: Office# Mobile#
Po Px /O/Ga 'MZ5 Mdr1Up t #/a7
Current Mailing Address Current Street Address
/i6/4 t'[Trinti` IJG 2726 ( aiG, 53c1 /46 27/16
City State Zip City State Zip
Deed Book No. n ?%t( Page No. ; 51313 -3854Provide 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 9 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.
etOt rniZ r4-e5 ,t .-
Company 2 Name E-mail Address
(� �o= I6,11.8 ynz.5"NAld�. "7 4r. 1047
Current Mailing Address Current Street Address
City State Zip City State Zip
Phone: Office# 3/6- 63Z—8900 Mobile#
1
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#

2021027204 00281
FORSYTH CO. NC FEE$26.00
• NO TAXABLE CONSIDERATION
PRESENTED&RECORDED
• 05/21/2021 04:29:41 PM
LYNNE JOHNSON
REGISTER OF DEEDS
BY:OLIVIA DOYLE
ASST
• BK: RE 3611
PG: 3893-3896
•
.
Mail deed and tax bills to Grantee:4425 Monument Trace,Suite 107,Greensboro,NC 27409
Prepared by: Raymond D Thomas(Thomas and Bennett)
116 S.Cherry Street, Suite C,Kernersville,NC 27284
(No title search or closing requested or performed by Drafting Attorney)
Excise Tax: NTC
Brief description: 35.963 acres on County Line Road
QUITCLAIM DEED
THIS DEED made this 18th day of May,2021,by and between:
GRANTOR: GRANTEE:
JENNIFER WALLS WATSON, wife of PHILIP CLSIIi PARTNERS, LLC, a North Carolina limited
GREGORY WATSON liability company
•
Grantor address: Grantee address:
4017 Loch Lorien Road,Kernersville,NC 27284 4425 Monument Trace, Suite 107, Greensboro, NC
27409
The ro erty conveyed does X ,does not include the primary residence of the Grantor.
WITNESSETH
WHEREAS,the Grantee acquired the real estate herein described by a deed recorded on Book 3575 at page 3598 in
the Office of the Register of Deeds of Forsyth County,North Carolina;and
WHEREAS,one of the grantors in said deed was PHILIP GREGORY WATSON who was noted as being
unmarried,but,in fact was married to JENNIFER WALLS WATSON and the said JENNIFER WALLS WATSON
did in fact execute the aforesaid deed,but her signature was not notarized,and in order to convey her interest in the
real estate hereinafter describe, she executes this quitclaim deed to the Grantee.
That the Grantor, for a valuable consideration paid by the'Grantee, the receipt of which is hereby acknowledged,
has and by these presents does remise,release,convey and forever quitclaim unto the Grantee,all of the right,title,
claim and interest of the Grantor in and to that certain lot or parcel of land situated in Forsyth County,;North
Carolina,and more particularly described on Exhibit A attached hereto and made a part hereof.
TO HAVE AND TO HOLD the aforesaid lot or parcel of land and all privileges and appurtenances thereto
Submitted electronically by "Thomas and Bennett"
in compliance with North Carolina statutes governing recordable documents
and the terms of the submitter agreement with the Forsyth County Register of Deeds.

belonging to the Grantee free and discharged from all right, title, claim or interest of the Grantor or anyone
claiming by,through or under Grantor.
IN Wffl flSS WHBREOF, the Grantor has hereunto set their hand and seal or if corporate, has caused this
instrufnent h be signed in its rp rate name by its duly authorized officer by authority of its Board of.Directors. . .
1";17.
"' (Seal)
A NN `:R W LLS ATSO
North Carolina, County
[certify that the following pc ' (s)personally appeared before me this day, each acknowledging to me that he or
she voluntarily signed the foregoing document for the purpose stated therein and in the capacity indicated;
JENNIFER WALLS WATSON,wife of PHILIP GREGORY WATSON.
May i , 2021. . P ace notary seal below this.lire.
Notary Public SUSAN
(Votary p 8EAINerr
Print/Type Nagle: W; n Qttflford�p n aratina
ly
14114
My Commission Expires: `->0
•
Ji

EXHIBIT A
LEGAL DESCRIPTION
That certain tract or parcel of land lying and being in or near the Town of Kemersville,
Ken ersvillo Township, Forsyth County, North Carolina and more particularly described as
follows:
BEGINNING at an existing iron pipe-bent marking the common northeast corner of the
property now or formerly claimed by Carolina Telephone & Telegraph (TM 6896.19.-
5016; D.B. 1326.1770)and the southeast corner of the property now or formerly claimed
by United Telephone Company Carolina (TM 6896-19-5397) and thence from such
beginning point and with the east line of the property now or formerly claimed by United
Telephone N24°56'53"E 238.05' to a non-monumeanted point in the pavement of County
Line Road in the approximate center of the 60' wide public right of way of County Line
Road; thence within the right of way of County Line Road 872 18 05 E 285.18' to a
another non-ronuinented point in the pavement of County Line Road within the right of
way of County Line Road; thence S0l°45'30"W a total distance of 436,03' (and passing
• through an existing iron rod in the southern margin of the right of way of County Line
Road at 37,89' on that line and an existing iron rod at 219,66' on that line)and, from the
southern margin of the right of way of County Line Road, with the west line of the
property now or formerly claimed by Robert D, and Anettia M. Curtis (TM 6896.29µ
1.111; D.B, 0919-0272; D.H. 1024-0365 and D.B. 1173-1112) to an existing iron rod at
the southwest corner of the property now or formerly claimed by the Curtises; thence
with the south line of the property now or formerly claimed by the Curtises S83"34'37"E
223,20' to an existing iron rod at the southeast corner of the property now or formerly
claimed by the Curtises and in the western margin of an Access.Easement that varies in
width ftom 45' to 60'; thence with the western margin of the Access Easement
SO1°46'25"W 184.83' to an existing iron rod in the western margin of the Access
Easement; thence continuing with the western margin of'the Access Baseineiit
S01°46'11"W 174,70'to an nott monumented point at the southwest corner of the Access
.Easement; thence with the southern terminus of the Access Easaroent S87°57'16"E
60.00' to an existing iron rod in the west line of the property now or formerly Claimed by.
David L: and Lynette Stack (TM 6896.28-4529; D.B. 1173-1127; D.B."14734)025; •
thence with 'the west line the property now or formerly claimed .by the Stacks
SOI'°46'23"W 54,79' to an existing iron pipe at the southwest corner of the property now
oir''forrnerly'claimed by the Stacks; thence with the south line of the property now`or
formerly claimed by the Stacks S87°57'16"E 300,08' to an existing iron pipe at the
southeast corner ofthe property now or formerly claimed by the Stacks in the west line of
the property now or formerly claimed by Thomas M, Moore (TM 6896.28.6597; D.B.
2181-3551);thence with the west line of the property now or formerly claimed by Moore
S36°34'48"'W 59,37' to an existing iron pipe at the southwest corner of the property now
or formerly claimed by Moore; thence the south line of the property now or formerly
olaimed by Moore S31°36'01"E 107,31' to an existing iron pipe in the southeast corner
of the property now or formerly claimed by Moore and at a corner of the property no*or
4sts-a1tolop4.ul

Book 3575 Page 36013
formerly claimed by Scott Miller and Karen Quinonez(TM6896.28-8351; Lot 1,P.B.
197-023)thence with the west line of the property now or formerly claimed by Miller and
Quinonez, Jeffrey D, and Laura W. Kennedy (Guilford County TM 6896278560;1)31.
8209.2827; Lot 2, P.B. 197-023) and Aaron W, Snow (Guilford County TM
6896269507; D.R. 5533.1500) SOO°19'35"E a total distance of 1,446,46' (and passing
through an existing iron pipe at a common corner of the properties now or f'omxarly
claimed by Miller and Quinonez and the Konnedys at 398,86'on that line and an existing
iron pipe at the common corner of the properties now or formerly claimed by the
Kennedy;and Snow at 1,234.94'on that line)to an existing Iron pipe in the west line of
the property now or formerly clahned by Snow and at the northeast corner of the property
now or formerly claimed by the Town of Kerneraville(TM 6896-26-1242; D.13, 1038-
1727),which existing iron pipe is Ioeated 886°24'04"E 0.28" from the true corner at a
stone;thence with the north line of the property now or formerly claimed by the Town of
Kerneraville N86°24'04"W 659,20' to a large nail in a tree root in the north line of the
property now or formerly claimed by the Town of Kerneraville at the southeast corner of
Lot 13 of the Chelsea Place Subdivision(P,B, 30.138);thence with the east line of Lots
13, 14, 15, 16, 17 and 18 and the eastern terminus of the 60' public right of way of
Hollow Creek Lane(all as shown on the plat of the Chelsea Place Subdivision,P,B,30-
138)and the east lino of the property now or formerly claimed by Carolina Telephone&
Telegraph N07°23'27"W a total distance of 2,522.05' (and passing through en existing
iron pipe at the common corner of Lots 13 and 14 of Chelsea Plane at 616.68'in that line,
an existing iron pipe at the common corner of Lots 14 and 15 of Chelsea Place at 876,57"
in that lino,an existing iron pipe at the common corner of Lot 15.and the southern margin
of the right of way of Hollow Creek Lane at 1,136,61'in that line,an existing iron,pipe at
the common corner of the northern margin of the tight of way of Hollow Creek Lane and
Lot 16 of Chelsea Place at 1,196.88' in that line, an existing,iron pipe at the common
corner of Lota 16 and 17 of Chelsea Place at 1,426,88' in that line and an existing iron
pipe at the common corner of Lots 17 and 18 of Chelsea Place at 1,701.86'In that line)to
the point and place of BEGINNING;such tract or parcel of land to contain 35.963 acres,
more or lass (including 0,248 acres, more or less, in the right of way of County Line
Road) and such tract or parcel of land to comprise all or portions of three tracts now
owned by the heirs of Will) Mae Watson,Tract 1 gm 6896-19-7330; D.B. 1118-63;
Tract 5, P.B, 16.40), Tract 2 (TM 6896.28.0893; D.B. 1456-0024) and Tract 3 (TM
6896-28-2154; I0,B, 1456.1509, Part of Tract 4, P.13, 16-40), all as mom particularly
shown on that"Boundary Survey of Wife Mae Watson Properties"dated, signed and
sealed by Jeity L,Calson,P,L.S,(N.C.Lie,Reg,No.L-4403)of CPT Engineering and
Surveying,1ne,on December 15,2020;such tract or parcel of land having an address of
9336 County Line Road,Kerneraville,North Carolina 27284,
Unless otherwise noted,all Tax Map References in this legal description are to numbers
assigned by the Forsyth County Tax Department and all Deed Book and Plat Book
references are to instruments recorded in the Forsyth County,North Carolina Registry.
4B1a,eu►9.sR54,vi