NCC240741_FRO Submitted_20240315

FINANCIAL RESPONSIBILITY OWNERSHIP (FRO) FORM
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Soil Erosion and Sedimentation Control Ordinance NOR I II c A Roili n
Instructions: No person shall initiate any land-disturbing activity on one or more acres, as covered in the Town of
Huntersville Soil Erosion and Sedimentation Control Ordinance, before this form and an acceptable erosion and
sedimentation control plan have been completed and approved by the Town of Huntersville. The Financially
Responsible Party will be on record as the party to accept any Notices of Violation or related documents for any non-
compliance of the Town of Huntersville Soil Erosion and Sedimentation Control Ordinance. If the Financially
Responsible Party resides out of state,a North Carolina agent must be assigned. All items on this form must be
filled out accurately and completely.
PART A— PROJECT AND LANDOWNER INFORMATION
1. Project name Bryton Townhomes Parcel 2
2. Address of land-disturbing activity (number, street) 11842 Old Statesville Rd, Huntersville, NC
3. Approximate date land-disturbing activity will begin 6/1/23
4. Purpose of development (Commercial. Residential,
Industrial, etc.) Residential
5. Total acreage of land to be disturbed or uncovered 2.95
6. Total site acreage 3.114
7. Landowner(s) of Record. The names listed below must match the Deed(s).Attach a list of additional owners, if
applicable.
Note: If the landowner of record is not the person(s)firm(s),or Company's Financially Responsible Party,
as listed in Part B, item 1, a separate Letter of Consent, signed and dated by the Landowner of
Record or their Authorized A l ent is re.uired.
Landowner I of Record
Company Name Northbridge LLC Contact Name Stephen McCarthy
(if applicable)
Mailing Address 3080 England Street, Suite B
City Charlotte State NC Zip J28273
Phone [phone] Email [e-mail]
Landowner 2 of Record
Company Name Contact Name
(if applicable)
Mailing Address
City State I Zip
Phone Email
8. Indicate the Deed Book and Page number where the deed or instrument is filed. Attach a list of additional deeds
if'applicable.
Deed Book Page Deed Book Page Deed Book Page
37379 757
Rev. 8/2022 TOH Staff Reviewer Ownership/Agent: Verified at Pre-Con Meeting By: Page 1 of 2

FINANCIAL RESPONSIBILITY OWNERSHIP (FRO)FORM
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Soil Erosion and Sedimentation Control Ordinance NORTH C A R D I.1 N A
PART B — FRO AND NC REGISTERED AGENT
I. Person(s),firm(s)or Company who is/are financially responsible for this land-disturbing activity.
Financially Responsible Party
Company Name(ifapplicahle) Northbridge, LLC Contact Name Stephen McCarthy
Mailing Address 3080 England Street, Ste B
CIt' Charlotte State NC Zip 28273
Phone [phone] Email [e-mail]
2. If the Financially Responsible Party listed above does not reside in the state of North Carolina, they must
provide a designated North Carolina agent below. This agent must be registered with/on the NC Secretary of
State business re l's .
North Carolina ;kgeut for I inancially Responsible Party
NC Registered Agent Name Paragon Site Solutions, LLC Contact Name Stephen McCarthy
Mailing Address 3080 England Street, Ste B
City Charlotte State NC 2 P 28273
Phone [phone] Email [e-mail]
3. (Optional) Additional contact familiar with the site, who understands the plans,and may represent the company.
Site Contact's Name Email
Phone: Office Phone: Mobile
PART C — SIGNATURE WITNESSED BY A NOTARY PUBLIC
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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,or his attorney-in-fact. If the
Financially Responsible Owner is not an individual, this form must be signed 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.
Printed Name Stephen McCarthy Title or Authority Managing Member
Wet-Ink Signature Date 4/14/23
I, Savi Menzel , a Notary Public of the County of York
State of South Carolina , hereby certify that Stephen McCarthy personally
appeared 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 14th day of April , 20 23 .
(seal)
SAVI eerexz$r, Notary Signature •o
Notary Public, State of South Carolina
My Commission Expires 2/27/2030
My Commission Expires 2/27/2030
Rev. 8/2022 Page 2 of 2