NCC240076_FRO Submitted_20240119

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 HILLHAVEN SUBDIVISION
CALDWELL LENOIR
2. Location of land-disturbing activity: County City or Township Highway/Street HILLHAVEN PL LailtUde(decimaldegrees) 35.9°5 LongitUde(decimaldegrees) —81 525
3. Approximate date land-disturbing activity will commence: 1 0/01/23
4. Purpose of development (residential, commercial, industrial, institutional, etc.):RESIDENTIAL
5. Total acreage disturbed or uncovered (including off-site borrow and waste areas): 3. 64
6. Amount of fee enclosed $400+$1 '��� 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 m No ❑
8. Person to contact should erosion and sediment control issues arise during land-disturbing activity:
WILLIAM CLAYTON [e-mail]
Name E-mail Address
Phone: Office# Mobile# [phone]
9. Landowner(s)of Record (attach accompanied page to list additional owners):
PI or'c,- ( MPfNi .c --LN`IC S>g - 19S7 - )-).g - 1i57
Name Phone: Office# Mobile#
P� ( )( i-1 3 4 lc? � s-- Ire s f 0-1!
Current Mailing Address Current Street Address
LI p-roii OctL1NLo.-IJ T \-) I`)C
City State Zip City State Zip
10. Deed Book No.e" v U 3 Page No. I_L 07-7 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).
4, or c2 DtJit-s :LNG,.
eA cor
Company Name E-mail Address
(
Current Mailing Address Current Street Address
J '09 3
Lc-icoc41/4J-Toii
City
State Zip City State ( Zip
Phone: Office# � !1 Mobile# t
51
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:
WILLIAM L HEAFNER
Name of Registered Agent E-mail Address
PO BOX 1732 2671 EAST MAIN STREET
Current Mailing Address Current Street Address
LINCOLNTON, NC 28093
City State Zip City State Zip
Phone: Office# 828-228-1957 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:
CLAYTON ENGINEERING & DESIGN [e-mail]
Engineering firm or other consultant E-mail Address
W I L L IAM CLAYTON 828-455-3456 828-455-3456
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.
\ At -‘.% P Ise c)1 -5 t oeo- ? Lc U - �,�rAc 'IC ,
Type or pri n e Title or Authority
e,, -",
Signature Date
I, ),///,`terd //, •�j�4,1-rs'e ti-- , a Notary Public of the County of ' ,fr
State of North Carolina, hereby certify that 1x,�/- ..n/ C'eL-.--,,,-,.-- 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 /) day of 5 ,�/ ,r;l3F F-- , 20 `
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9/13/23,9:56 AM Wayne L. Rash Register of Deeds, Caldwell County,NC
Wayne L. Rash
Register of Deeds, Caldwell County, NC
Consolidated Real Estate Index
Criteria - Last Name: piedmont companies, inc. Grantee/Grantor: Grantee Party Type: Either
Date: 05/10/2023 10:56:00 Doc #: 10084340 Kind: DEED Book: 2083 Page: 1077
Description
TP: LOWER CREEK
AC: 32.370
Tax: $0.00
Grantors Grantees
BROYHILL TIMBER RESOURCES, INC. PIEDMONT COMPANIES, INC.
https://us3.courthousecomputersystems.com/CaldwellNCNW/application.asp?resize=true
1/1

BK 2083 PG 1081 - 1084 (4) DOC# 10084341
This Document eRecorded: 05/10/2023 10:56:34 AM
Fee: $26.00 Tax: $654.00
Caldwell County, North Carolina
Wayne L. Rash, Register of Deeds
GENERAL WARRANTY DEED
Excise Tax: $6,64.00
Tax Parcel ID No, CM 123 1 1
Mall/Box to: Grantee
This instrument WaS prepared by Mon, Lackey, Rofir&Hal P,C.,608 College Avenue,SW, Lenoir, NC
28646
Brief description for the Intlex127:24PLacresret, HickoryBlvd.,Lenoir,NC
THIS DEED, made this the 1 day of May,2023,by and between
GRANTOR: P.B. REALTY, LLC, a North Carolina limited liability company
2310 Rising Sun Lane, Matthews, NC 2.8104
(hereinafter referred to as'Grantor")
GRANTEE; PIEDMONT COMPANIES, INC.,a North Carolina corporation
PO Box 1732, Lincointon, NC 28093
(hereinafter referred to as'Grantee')
WITNESSET11;
Per valuable consideration from Grantee to Grantor, the receipt and sufficiency of which is hereby
acknowledged,Grantor hereby gives,grants,bargains,sells and conveys unto Grantee in foe 81111We,subject to
the'Exceptions and Reservations hereinafter provided,if any,all of the following described property located in
the City of Lenoir, Lower Creek Township, County of Caldwell, State of North Carolina, more particularly
described es foltom
See the attached Exhibit A.
Said property having been previously conveyed to Grantorby insfrument(s)recorded in Book 1811,Page 558,
and being shown on plat map(s)recorded in Plat Seek_,at Page ,Caldwell County Registry,
All or a portion of the property herein conveyed does not include the primary residence of e Grantor.
The drafter of this document has not searched the title to the subject property and has given no opinion as
to the status of title.
To HAvE AND TO HOLD unto Grantee,together with all privileges and appurlenanoes thereunlo belonging,.in
fee simple,subject to the Exceptions and Reservations hereinafter and hereinabove provided,If any,
And Grantor hereby warrants that Grantor is seized of the premises in fee and has the right to convoy same in
Submitted electronically by "Morehead Title company"
in compliance with North Carolina statutes governing recordable documents
and the terms of the submitter agreement with the Caldwell County Register of Deeds.

BK 2083 PG 1082 DOC# 10084341
fee singe.,that tI is marketable end is'fres arxi deer of encumbrances other than as setforth herein,erld That
Grader will forever Warrant and defend tile We ageinalthe inwryttialtne of aN persons or onitaloovehool000vor.
Tii$conveyance is made subject to the following.Exceptions and Reservellonw;the Nhis of wi'y of OS Highway
321 and Hiiittuwan Nam",math*utility eminerrte,arid the lien of 2023 ad valorem taxes.
AU referenoes to Grantor arid Grantee ns used herein shag'irmluido tto paltesas mil**their holm,olkeosasors
and Matt's,and shall trade airigutor,ptut,maktagino,feminine or neutiv ir.riquh,,"' by contaX1
IN WITNESS WHEREOF:, the Grantor has-duly executed the'foregoing as of the day and year'hi above
winter'.
P.13,.REAL, , LIC
By: .
uoi Peery fin*No •
Chief Executive Officer
SEAL STATE OF NORTH CAROLIWi,
COUNTY OF VNior'
g,the andaralgued,a Notaiy Publie of the-County and State aforesaid,:certify
that Sarnueli !Peery McNeil, Jr. personay earns before me Ws day and
ackamiadged that he ia Chief EXecutive Ottior tP.ret,Redly,LLC,o North
Carolina tingled liability COMpany,and that he, taming authorized to do so,
malted the fonsgoinp on behalf.of the ow-nosily, Witness ray hand and
official stamp or scia4,this the. day a May,2023,
41 . 01191‘11110141144,
NOTARY TIM SIG TURE ,s,t;IAYL,
ex?.
NOTARY P SLIC PRitclED NAME --- 00.
viN 0°/120
Iv •Z'4„,7 ry Coromloolon Expiroo: P Ut3 11
•••••• --••" -
co'
4 00

BK 2083 PG 1083 DOC# 10084341
EXHIBIT"A"
NCPIN: 2759340506(Parcel#09123-1-1)
Approximately 32.370 acres of land located in the City of Lenoir,Lower Creek Township,Caldwell County,North Carolina,
being bounded, now or formerly: on the South by US Hwy 321, the paved entrance of Hillhaven Place, PB Realty, Inc.
(Deed Book 1811 at Page 558;NCPIN: 2759236589) ("PB Realty I"),Barbara Lee Bush(Deed Book 2060 at Page 1796
and Deed Book 2071 at Page 529; NCPIN: 2759249166) ("Bush"), and PB Realty, Inc. (Deed Book 1811 at Page 558;
NCPIN: 2759334501) ("PB Realty II"); on the East by Broyhill Timber Resources, Inc. (Deed Book 1131 at Page 1299;
NCPIN: 2759433724) (`Broyhill Timber"), Cy Real Estate, LLC (Deed Book 1984 at Page 1131; NCPIN: 2759366025)
("Cy Real Estate I"), and an unnamed tributary branch of Lower Creek;on the North by Cy Real Estate I and Lower Creek;
on the West by US I-Iwy 321,Cy Real Estate,LLC(Deed Book 1984 at Page 1131;NCPIN:2759154579)("Cy Real Estate
II"), Cy Real Estate, LLC (Deed Book 1984 at Page 1131; NCPIN: 2759146497) ("Cy Real Estate III"), and Broyhill
Investments,Inc, (Deed Book 1071 at Page 488;NCPIN:2759231673)(`Broyhill Investments"); and internally by James
Lee Strom(Deed Book 2057 at Page 1679;NCPIN:2759245887)("Strom");and more particularly described according to
that actual survey plat by Jacob W. Helton, PLS #L-5105, dated October 31, 2022, entitled "A Boundary Survey for
Piedmont Companies Inc do Guy Long;City of Lenoir,Caldwell County,NC"and Job No.22165,as follows:
Beginning at a survey spike in the Eastern edge of the right of way of US Hwy 321 North and the pavement of the public
roadway known as Hillhaven Place,said point being the Northwest corner of PB Realty I; thence with a Northern line of
PB Realty I,North 78 deg 31 min 56 sec East 455.33 ft to an iron pipe at Fasting 1252834.021 and Northing 794043.967
in the Western line of Bush;thence with Bush,the following seven(7)lines:North 13 deg 05 min 33 sec West 186.91 ft to
a point, (1)North 20 deg 08 min 30 sec West 21.00 ft to a point, (2)North 23 deg 19 min 45 sec West 13.66 ft to a point,
(3)North 29 deg 23 min 57 sec West 15.39 ft to a point, (4)North 36 deg 04 min 29 sec West 22.00 ft to an existing rebar
at the Northwest corner of Bush,(5)North 70 deg 34 min 30 sec East 284.04 ft to an existing rebar at the Northeast corner
of Bush, said rebar also being the corner tie point to locate the Strom property("Tie Point"), (6) South 16 deg 46 min 19
sec East 296.17 ft to an iron pipe in the Eastern line of Bush and a corner of PB Realty II,and(7)North 78 deg 30 min 35
sec East 303.28 ft to an iron pipe in the Northwestern corner of PB Realty II and a corner of Broyhill Timber;thence with
the Eastern line of Broyhill Timber,the following sixteen(16)lines:(1)North 77 deg 52 min 06 sec East 65.39 ft to an iron
pipe, (2)North 77 deg 52 min 06 sec East 12.73 ft to a point within the unnamed tributary branch of Lower Creek, said
point being located North 18 deg 30 min 51 sec East 19.52 ft from a rock-lined spring within Broyhill Timber, (3)North
49 deg 59 ruin 11 sec West 94.84 ft to a point, (4)North 46 dog 15 min 18 see West 123.79 ft to a point,(5)North 38 deg
03 min 57 sec East 35,08 ft to a point,(6)North 56 deg 30 min 07 sec West 38.07 ft to a point, (7)North 05 deg 25 min 17
sec West 99.98 ft to a point, (8)North 21 deg 19 min 00 sec West 41.18 ft to a point,(9)North 22 deg 47 min 54 sec West
81.53 ft to a point,(10)North 38 deg 56 min 37 sec East 76.94 ft to a point,(11)North 00 deg 52 min 03 sec West 31.58 ft
to a point, (12)North 16 deg 12 min 13 sec East 40.85 ft to a point, (13)North 21 deg 22 min 28 sec West 30.68 ft to a
point, (14)North 67 deg 00 min 28 sec West 38,26 ft to a point,(15)North 59 deg 03 min 45 sec West 81.64 ft to a point,
and(16)North 72 deg 07 min 41 sec West 54.32 ft to a point in the Northwestern corner of Broyhill Timber,said point
being South 59 deg 18 min 51 sec West 11.10 ft from a 1 inch pipe in the Northern line of Broyhill Timber and the Southern
line of Cy Real Estate;thence with the Eastern line of Cy Real Estate and the branch of Lower Creek,the following twenty-
five(25)lines: (1)North 19 deg 04 min 28 sec West 64.21 ft to a point,(2)North 29 deg 44 mein 08 sec West 60.87 ft to a
point,(3)North 12 deg 15 min 39 sec West 70.88 ft to a point,(4)North 19 deg 22 min 14 sec West 43.06 ft to a point, (5)
North 38 deg 22 min 52 sec West 22.28 ft to a point, (6)North 03 deg 25 min 40 sec East 31.31 ft to a point,(7)North 34
deg 38 min 16 sec West 24.91 ft to a point, (8)North 50 deg 44 min 39 sec West 28.52 ft to a point, (9)North 34 deg 55
min 19 sec West 101,17 ft to a point, (10)North 26 deg 35 min 20 sec West 40.98 ft to a point, (11)North 32 deg 07 min
48 sec West 85.94 ft to a point,(12)North 29 deg 04 min 12 sec West 74.11 ft to a point,(13)North 23 deg 07 min 40 sec
West 29.15 ft to a point,(14)North 58 deg 48 min 20 see West 34.47 ft to a point, (15)North 44 deg 50 min 46 sec West
52.88 ft to a point,(16)North 69 deg 02 min 15 sec West 26.34 ft to a point, (17)North 43 deg 03 min 48 sec West 62.47
ft to a point,(18)North 61 deg 52 min 19 sec West 36.95 ft to a point,(19)North 50 deg 08 min 39 sec West 28.26 ft to a
point, (20)North 57 deg 22.min 23 sec West 32.86 ft to a point, (21)North 47 deg 12 min 17 sec West 51.73 ft to a point
in the middle of Lower Creek, (22) South 87 deg 21 m.in 30 sec West 4.69 ft to a point, (23)North 80 deg 30 min 37 sec
West 48.15 it to a point,(24) South 73 deg 34 min 42 sec West 384,69 ft to a point, and(25) South 48 deg 20 min 10 sec
West 101.53 ft to a survey spike in the culvert located within the Eastern margin of the right of way of US Hwy 321 North;
thence South 64 dog 55 min 35 sec West 81.91 ft to a point in in the common corner of Cy Real Estate I,Cy Real Estate II,
Cy Real Estate III, and the centerline of US Hwy 321 South, said point being South 08 deg 26 min 55 sec West 958.38 ft

BK 2083 PG 1084 DOC# 10084341
from NCGS "MISTER"at Fasting 1252166.03 and Northing 796356.39; thence continuing with the Eastern lines of Cy
Real Estate II,Cy Real Estate III,and Broyhill Investments,along the centerline of ITS Hwy 321 South,the following eleven
(11)lines:(1)South 04 deg 47 min 04 sec West 72.72 ft to a point,(2)South 02 deg 01 min 38 sec West 98.01 ft to a point,
(3) South 00 deg 39 min 41 see East 99.46 ft to a point, (4) South 02 deg 08 min 40 sec East 100.02 ft to a point,
(5)South 04 deg 46 min 09 sec East 102.47 ft to a point,(6)South 07 deg 24 min 42 sec East 105.47 ft to a point,(7)South
08 deg 26 min 25 sec East 103.56 ft to a point, (8) South 11 deg 18 min 27 sec East 103.19 ft to a point,(9) South 14 deg
45 min 25 sec East 103.54 ft to a point, (10)South 16 deg 01 min 35 sec East 103.15 ft to a point,and(11)South 17 deg 07
min 12 sec East 519.23 ft to a point;thence North 78 deg 31 min 56 sec East 103.98 ft to the point and place of BEGINNING;
less and excepting the following internal parcel of Strom,now or formerly:beginning at an iron pipe in the Western margin
of the public roadway known as Hillhaven Place and the Southeast corner of Strom,said point being North 47 deg 05 min
51 sec West 479.48 ft from the Tie Point located in the Northeast corner of Bush, thence continuing with Strom, the
following seventeen(17)lines: (1)North 85 deg 17 min 00 sec West 100.73 ft to an iron pipe,(2)North 84 deg 16 min 35
sec West 86.54 ft to an iron pipe,(3)North 51 deg 29 min 06 sec West 86.03 ft to an iron pipe, (4)North 39 deg 04 min 27
sec West 112.16 ft to an iron pipe,(5)North 05 deg 15 min 38 see East 89.12 ft to a 1.25 inch rod, (6)North 14 deg 17 min
23 sec East 69.56 ft to an iron pipe, (7)North 25 deg 21 min 29 sec East 78.18 ft to an iron pipe, (8)North 46 deg 36 min
32 see East 103.98 ft to a 1.25 inch square rod,(9)South 85 deg 27 min 19 sec East 45.02 ft to an iron pipe,(10) South 58
deg 45 min 46 sec East 115.11 ft to a point in the Western margin of Hillhaven Place,(11)South 48 deg 40 min 00 sec East
50.00 ft to a point,(12) South 29 deg 34 min 00 sec East 50.00 ft to a point,(13) South 13 deg 39 min 00 sec East 50.00 ft
to a point, (14) South 05 deg 31 min 00 sec East 50.00 ft to a point, (15) South 01 deg 02 min 00 sec West 50.00 ft to a
point,(16)South 07 deg 35 min 00 sec West 50.00 ft to a point,and(17)South 11 deg 43 min 13 sec West 120.62 ft.to the
iron pipe at the Southeast corner of Strom.
Portions of the above land have been identified as NCPIN: 2759340506 (Parcel # 09123-1-1) and NCPIN: 2759433724
(Parcel#09125-1-10),now or formerly.