NCC241064_FRO Submitted_20240410

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 and/
or fax information unavailable, place N/A in the blank.)
P1.art A.Project Name Johnson's Front Yard
2. Location of land-disturbing activity: CountyCaldwell City or TownshipGranite Falls
HighwayistreetWindward Lane Latitude 35'7863 Longitude-81 '5343
3. Approximate date land-disturbing activity will commence:4/26/24
4. Purpose of development (residential, commercial, industrial, institutional, etc.):Residential
5. Total acreage disturbed or uncovered (including off-site borrow and waste areas): 1 '53
6. Amount of fee enclosed: $ 200 . The application fee of$100.00 per acre
(rounded up to the next acre) is assessed without a ceiling amount(Example: 8.10 ac= $900.00).
7. Has an erosion and sediment control plan been filed? YesX No Enclosed
8. Person to contact should erosion and sediment control issues arise during land-disturbing activity:
Name David Johnson E-mail [e-mail]
Telephone [phone] Cell# 828-514-0168 Fax# N/A
9. Landowner(s) of Record (attach accompanied page to list additional owners):
David/Carly Johnson 828-514-0168 N/A
Name Telephone Fax Number
5691 Windward Lane 5691 Windward Lane
Current Mailing Address Current Street Address
Granite Falls NC 28630 Granbite Falls NC 28630
City State Zip City State Zip
10. Deed Book No.1972 Page No.1419 Provide a copy of the most current deed.
Part B.
1. Company(ies) or firm(s) who are financially responsible for the land-disturbing activity (Provide a
comprehensive list of all responsible parties on an attached sheet.) If the company or firm is a sole proprietorship,
the name of the owner or manager maybe listed as the financially responsible party.
David Johnson [e-mail]
Name E-mail Address
5691 Windward Lane 5691 Windward Lane
Current Mailing Address Current Street Address
Granite Falls NC 28630 Granite Falls NC 28630
City State Zip City State Zip
Telephone[phone] _ Fax NumberN/A

2. (a) If the Financially Responsible Party is not a resident of North Carolina, give name and street address
of the designated North Carolina Agent:
Name E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Telephone Fax Number
(b) If the Financially Responsible Party is a Partnership or other person engaging in business under an
assumed name, attach a copy of the Certificate of Assumed Name. if the Financially Responsible
Party is a Corporation,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
Telephone Fax Number
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, or if not an individual, by an officer, director, partner, or registered agent with
the authority to execute instruments for the Financially Responsible Person). I agree to provide
corrected information should there be any change in the information provided herein.
David Johnson Property Owner
Typ or print me Title or Authority
4/4/24
Signature Date
I, g A,Ls C. Kut J Y , a Notary Public of the County of fu
State of North Carolina, hereby certify that .DAY- d �1 °1.n 5d/N. —appeared
personally before me this day and being duly sworn acknowledged that the above form was
executed by him.Witness my hand and notarial seal, this S /�4 day of �fil / , 20L
Y Notary
m OS�ealR
r. C.)E My commission expires Gt'Up. .2 / , o�(
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BK 1972 PG 1419 - 1422 (4)
This document presented and filed:
10/01/2019 12:59:12 PM
Fee$26.00 Excise Tax:$76.00
I I11IIIIIIIINII I 11
10037223
Caldwell County North Carolina
Wayne L. Rash,Register of Deeds
NORTH CAROLINA SPECIAL WARRANTY DEED
Excise Tax:$76.00
Parcel Identifier No. 1 i-55A-1-13 and PIN No.2745804740
Verified by County on the day of ,20
By:
✓✓
Mail/Box to: G.REDMOND DILL,JR.,ATTORNEY,Post Office Box 66,Morganton,North Carolina 28680
This instrument was prepared by:G.REDMOND DILL,JR.,ATTORNEY,Post Office Box 66,Morganton,North Carolina 28680
Brief description for the Index: BEING Lot No. 13,containing 1.528 acres,The Waterfront Club-Phase I-A,Plat Book 34,
Page 140,Caldwell County Registry.
THIS DEED made this 30th -day of September ,2019,by and between
GRANTOR GRANTEE
CALDWELL TIMBER PARTNERS,LLC, CARLY NICOLE JOHNSON and husband,
a Colorado limited liability company DAVID JASON JOHNSON
Mailing Address: Mailing Address:
1400 16t°Street,Suite 320 1730 Acorn Avenue
Denver,Colorado 80202 Hudson,North Carolina 28638
Enter in appropriate block for each Grantor and Grantee: name,mailing 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,subject to the easements,restrictions,reservations,conditions,and other
exceptions set forth below,unto the Grantee in fee simple,all that certain lot or parcel of land situated in, North Catawba Township,
Caldwell County,North Carolina and more particularly described in Exhibit A attached hereto(the"Property"):
See Attached Exhibit"A"
The property hereinabove described was acquired by Grantor by instrument recorded in Book 1886 page 146 .
All or a portion of the property herein conveyed includes or X does not include the primary residence of a Grantor.
A map showing the above described property is recorded in Plat Book 34 page 140 .
NC Bar Association Form No.6 1/1/20I0
Printed by Agreement with the NC Bar Association

BK 1972 PG 1420 DOC# 10037223
The Property is conveyed subject to the following easements, restrictions,reservations, covenants,conditions and other exceptions
(collectively,the"Exceptions"):
1. Flood Easements in favor of Duke Energy Carolinas,LLC(formerly known as Duke Power Company and as Duke
Energy Corporation)to flood to the 1,005 foot contour line and all other reservations,restrictions and conditions
contained in that deed recorded in Deed Book 601, Page 169,and riparian rights of others;
2. Transmission line and retail electric line rights-of-way,if any,reserved by or granted to Duke Energy Carolinas,LLC
(formerly known as Duke Energy Corporation and as Duke Power Company);
3. Ad valorem taxes for the year 2019;
4. Any"rollback"or other deferred ad valorem property taxes;
5. Matters affecting title to the Property as shown on the Plat(defined below)or which would be shown on a current
and accurate survey of the Property(including any encroachments);
6. Easements,covenants,restrictions and conditions of record,and rights-of-way of public and private streets and roads;
7. All easements,restrictions and rights-of-way as may be apparent from an inspection of the Property;and
8. All zoning,subdivision, land use and other laws,regulations or ordinances applicable to Property.
TO HAVE AND TO HOLD,subject to the Exceptions,the Property and all privileges and appurtenances thereto belonging to the
Grantee in fee simple.
Subject to the Exceptions,Grantor covenants with the Grantee,that Grantor has done nothing to impair such title as Grantor received,
and Grantor will warrant and defend the title against the lawful claims of all persons claiming by,under or through Grantor,except for
the Exceptions.
[Signature Page to Follow]

BK 1972 PG 1421 DOC# 10037223
IN WITNESS WHEREOF,the Grantor has duly executed the foregoing as of the day and year first above written.
CAL L TIMBER PARTNERS,LLC,
a Col a limited company
B .
Printed Name:AARON M.PATSCH
Title:AUTHORIZED REPRESENTATIVE
STATE OF COLORAD n,,
COUNTY OR CITY OF4� rame"" ,, A
I,the undersigned Notary Public of the County or City of d.r)\1 L1�--- and State aforesaid,certify that
AARON M.PATSCH personally came before me this day and acknowledged that he is the Authorized Representative
(title)of CALDWELL TIMBER PARTNERS.LLC a Colorado limited liability company,and that by authority
duly given and as the act of such entity,_he signed the foregoing instrument in its name on its behalf as its act and deed.
I certify that the Signatory personally appeared before me this day,and
(check one of the following)
(I have personal of the identity of the Signatory;or
(I have seen satisfactory evidence of the Signatory's identity,by a current state or federal identification with the
Signatory's photograph in the form of:
A driver's license or
In the form of );or
(A credible witness has sworn to the identity of the Signatory.
The Signatory acknowledged to me that he/she voluntarily signed the foregoing document for the purposes stated therein and
in the capacity indicated. "" w
Witness my hand and Notarial stamp or seal,this day of ir1 br—f' ,2019.
My Commission Expires: .I I i otary Public
Notary's Printed or Typed e
SUSAN WENGLER -
Notary Public
State of Colorado
Notary ID#201 24071314
My Commission expires 11-07-2020
(Affix Notary Seal)

BK 1972 PG 1422 DOC# 10037223
EXHIBIT"A"
CALDWELL TIMBER PARTNERS,LLC—Grantor
CARLY NICOLE JOHNSON and husband,DAVID JASON JOHNSON—Grantee
Located in North Catawba Township,Caldwell County,North Carolina:
BEING ALL OF LOT NO. 13 containing 1.528 acres,more or less,of the Waterfront Club-Phase I-A Subdivision,as shown on
plat prepared by Lake Norman Surveying&Mapping,PLLC dated June 5,2018 as recorded in Plat Book 34,Page 140 of the
Caldwell County Registry,AND BEING a portion of land conveyed to Caldwell Timber Partners,LLC,by deed from Crescent
Communities,LLC,dated December 22,2015,recorded December 28,2015,in Book 1886,Page 146(Portion of Tract 2163.01),
of the Caldwell County Registry.
This conveyance is made together with and subject to that certain Declaration of Covenants,Conditions,and Restrictions for The
Waterfront Club recorded in Book 1943,Page 1088,as amended in Book 1943,Page 1578,and as further amended in the Second
Amendment to Declaration of Covenants.Conditions and Restrictions for The Waterfront Club in Book 1945,Page 1391,and as
further supplemented in the Supplement to Declaration of Covenants,Conditions and Restrictions for The Waterfront Club in
Book 1954,Page 1056,all of the Caldwell County Registry,and any subsequent amendments or supplements thereto.
DEED REFERENCES: Book 1886,Page 146;Book 601,Page 169;Book 107,Page 307;Book 103,Page 122: all of the
Caldwell County Registry.
BEING Tax Parcel No. 11-55A-1-13 and Tax PIN No.2745804740