NCC233667_FRO Submitted_20231213

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 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 Steele Creek- Goodwill
2. Location of land-disturbing activity: County Mecklendburg City or Township Charlotte
Highway/Street 4835 Shopton Road Latitude(decimaidegrees)35.172478LongitUde(decimai degrees)-80.963483
3. Approximate date land-disturbing activity will commence: 4/1/2023
4. Purpose of development(residential, commercial, industrial, institutional, etc.): Commercial
5. Total acreage disturbed or uncovered (including off-site borrow and waste areas): 1 . 5
6. Amount of fee enclosed: $ 200 . 00 . 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 El No ❑
8. Person to contact should erosion and sediment control issues arise during land-disturbing activity:
Name Tripp Davis E-mail Address [e-mail]
Phone: Office# 828-324-1284 Mobile# [phone]
9. Landowner(s)of Record (attach accompanied page to list additional owners):
Boos-GW Shopton, LLC 727-669-2900 954-825-8335
Name Phone: Office# Mobile#
410 Park Place Blvd Suite 100
Current Mailing Address Current Street Address
Clearwater FL 33759
City State Zip City State Zip
10. Deed Book No. 38078 Page No. 546 Provide a copy of the most current deed.

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(ies).
Boos- GW Shopton, LLC sdavignon@boosdevelopment .com
Company Name E-mail Address
410 Park Place Blvd Suite 100 (Same)
Current Mailing Address Current Street Address
Clearwater FL 33759 (Same)
City State Zip City State Zip
Phone: Office# 727-669-2900 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:
Christopher Moore cmoore@boosdevelopment .corn
Name of Registered Agent E-mail Address
6919 Windyrush Rd
Current Mailing Address Current Street Address
Charlotte NC 28226-7560
City State Zip City State Zip
P eye : Office# Mobile# [phone]
X
me of dividua 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
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.
Robert D.Boos
/Ack nor
Ty e or rin naj "7S Title or Auth ity
$, 2oz 3
Signature Date
Maureen Walla , a Notary Public of the County oft tYW ALts
Flov1�i o► r
State , hereby certify that I c(±e 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 2 day of'l',eFjc)i1 , 201,
.4!•"'"4. ; MAUREEN WOLFE
otar
; ' Commission#HH 405496
.,.„..., Expires October 1,2027 My commission expires 10 I 17:1

B38078 - P 546
For Registration •
Fredrick Smith
• Register of Deeds •
Mecklenburg County, NC
Electronically Recorded •
2023 Apr 25 04:40 PM RE Excise Tax: $ 1190.00
Book: 38078 Page: 546 - 550 Fee: $ 26.00
• Instrument Number: 2023037581 •
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£ kL *��yy
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NORTH CAROLINA SPECIAL WARRANTY DEED
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• Excise Tax: $1,190.00
PIN: 19959106 •
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Mail after recording to: Grantee
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This instrument was prepared by: Hunton Andrews Kurth LLP
1445 Ross Avenue, Suite 3700
Dallas,TX 75202
Attention: Jimmy N. Bui
THIS DEED made effective as of the 20th day of April,2023,by and between
GRANTOR GRANTEE
FOOD LION, LLC, BOOS—GW SHOPTON,LLC,
a North Carolina limited liability company a Florida limited liability company
2110 Executive Drive do David R. Phillips,Esq.,Phillips,Hayden&
Salisbury,NC 28147 Labbee,LLP •
19321 US Highway 19 North, Suite 301
Clearwater, FL 33764
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 those certain lots or parcels of land situated in Steele Creek Township,
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Submitted electronically by "South Durham Law"
in compliance with North Carolina statutes governing recordable documents
and the terms of the submitter agreement with the Mecklenburg county Register of Deeds.

B38078 - P 547
Mecklenburg County,North Carolina and more particularly described on Exhibit A attached hereto
and incorporated herein by reference(the "Property").
TO HAVE AND TO HOLD the aforesaid lots or parcels of land and all privileges and
appurtenances thereto belonging to the Grantee in fee simple,subject to the Permitted Exceptions.
Grantor will warrant and defend the title against the lawful claims of all persons claiming by,under
or through Grantor, but not otherwise, other than the following exceptions (collectively, the
"Permitted Exceptions"):
(a) Ad valorem taxes and assessments for the year 2023 and subsequent years which are
not yet due and payable, zoning ordinances affecting the Property, (b) all matters that an
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accurate survey or a physical.inspection of the Property would reveal, and (c) all matters
of record to the extent valid, subsisting and enforceable, including but not limited to the
restrictions set forth on Exhibit B attached hereto,however,the reference to the foregoing
shall have no intention to reimpose the same to the extent such are invalid, no longer
subsisting or unenforceable.
None of the property conveyed is the primary residence of Grantor.
[Signature Page Follows]
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. B38078 - P 548
IN WITNESS WHEREOF,Grantor has caused this Deed to be duly executed as of the
date first above written.
GRANTOR:
FOOD LION,LLC,
a North Car a limited liability company
By:
Name: J on Wilson
Title: reasurer
STATE OF NORTH CAROLINA
COUNTY OF ROWAN
1, 1201it:e- ,a Notary Public of the County and State aforesaid,
certify that Jason Wilson, as Treasurer of Food Lion,LLC,either being personally known to me
or proven by satisfactory evidence, personally appeared before me this day and acknowledged the
voluntary execution of the foregoing instrument on behalf of said company.
WITNESS my hand and notarial seal,this al day of M MO) ,2023.
Oyu `1 dP. ,
Nota -•':�c
My Commission Expires:
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(Affix 46;•,taritiliS,91)
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B38078 - P 549
EXHIBIT A
Description of the Property
BEING ALL OF Tract 1 as shown on the subdivision plat entitled, "Goodwill-Steele Creek"by
Christopher C. Glosson and recorded in Map Book 72, Page 100, Mecklenburg County Register
of Deeds.
ALSO DESCRIBED AS:
BEING that certain portion of parcel 19959106 (DB 27470, PG 972; MB 66, PG 80), lying and
being situate in Mecklenburg County,North Carolina,bounded on the southwest by that Southwest
Charlotte Stem Academy parcel (DB 33067, PG 627), on,the south by 4841 Shopton Road
(existing retail building on said parcel 19959106) and on the southeast by that Waffle House, Inc
parcel (DB 30877, PG 548), and being more particularly described as follows:
COMMENCING at a stone in the line of said Stem Academy;THENCE N 14°57'54"E 216.60'to
a nail lying within said parcel 19959106, said nail having NC state plane NAD83(2011)
coordinates N 523,442.918', E 1,413,069.634;.THENCE N 61°39'32" E 131.17'to a set 1/2"iron
pipe, the POINT OF BEGINNING.
BEGINNING at said set pipe; THENCE S 54°18'27" E 38.36' to a set 1/2 iron pipe; THENCE N
35°41'33" E 41.73' to a set pk nail; THENCE S.54°39'00" E 167.22' to a set pk naiI; THENCE S
35°41'33"W 237.81'to a set pk nail, said nail also being located S 84°14'36"W 347.60' from a#4
rebar in the line of said Waffle House; THENCE N 54°16'03" W 203.08' to a set 1/2" iron pipe,
passing the corners of the coinciding building face of said 4841 Shopton Road at 17.71'and 78.73';
THENCE N 34°57'24"E 194.96'to the POINT OF BEGINNING,
CONTAINING 46,909 square feet; 1.077 acres of land to be subdivided into a new parcel.

B38078 - P 550
EXHIBIT B
Permitted Encumbrances
1. Covenants,conditions,restrictions,easements,and liens provided for in instrument(s)filed
for record in Book 23812,page 727, as amended in Book 33877,page 954,as amended in
Book 38042, Page 705, and as amended in a Third Amendment to Declaration of
Easements, Restrictions and Maintenance Responsibilities to be recorded on or about the
date hereof,and any related maps,plans,bylaws and other document(s)and amendment(s).
2. Any right, easement, setback, interest, claim, encroachment, encumbrance, violation,
variations or other adverse circumstance affecting the Title disclosed by plat(s) recorded
in Map Book 53,page 927;Map Book 53,page 982;Map Book 50, page 256; Map Book
• 50, page 195; Map Book 48, page 31, as amended by Withdrawal of Implied Dedication
of Rights of Way recorded in Book 23316,page 68;Map Book 1844,page 633;Map Book
59, page 399; Map Book 64, page 619; Map Book 66, page 80; and Map Book 72,.page
100.
3. Storm Water Easement Agreement recorded in Book 30877,page 552.
4. Memorandum of Action recorded in Book 19170, page 453, and corresponding Consent
Judgment recorded in Book 22173,page 424.
5. Notice of Adoption of Roadway Corridor Official Map recorded in Book 7697,page 559.
6. Grant of Easement for Piedmont Natural Gas recorded in Book 25140,page 878.
7. Easement Agreement for the City of Charlotte recorded in Book 25198,page 57.
8. Easement to Duke Power Company recorded in Book 5429,page 5.
9. Terms and conditions of that unrecorded Lease by and between Boos-GW Shopton, LLC,
as Landlord and Goodwill Industries of the Southern Piedmont, Inc., as Tenant, as
evidenced and affected by that Subordination, Non-Disturbance and Attornment
Agreement dated April 20,2023.
10. Any right, easement, setback, interest, claim, encroachment, encumbrance, violation,
variation,or other adverse circumstance affecting the Title regarding the following matters
disclosed by survey entitled "ALTA/NSPS Land Title Survey, Goodwill - Steele Creek"
by Christopher C. Glosson,P.L.S.,dated April 17, 2023:
a. Service utilities.
074487.0001536 DMS 301215427v3