NCC241797_FRO Submitted_20240612

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 Runway 05-23 On Airport Tree Obstruction Removal and Fencing, Charlotte-Monroe Executive Airport
2. Location of land-disturbing activity: County Union City or Township Monroe
Goldmine Road/Old Charlotte Highway 35.006617/35.025570 80.63 5 5 91/8 0611 3 94
Highway/Street Latitude(decimal degrees) Longitude(decimal degrees)
3. Approximate date land-disturbing activity will commence:July 10, 2023
4. Purpose of development(residential, commercial, industrial, institutional, etc.):Airport Development
5. Total acreage disturbed or uncovered (including off-site borrow and waste areas):23.6 *
6. Amount of fee enclosed: $2,300.00 . 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❑x Enclosed ❑ No ❑
8. Person to contact should erosion and sediment control issues arise during land-disturbing activity:
Name Peter Cevallos — Airport Manager E-mail Address [e-mail]
Phone: Office# 704-282-4730 Mobile# [phone]
9. Landowner(s) of Record (attach accompanied page to list additional owners):
City of Monroe 704-282-4730 864-430-4072
Name Phone: Office# Mobile#
3900 Paul J. Helms Drive 3900 Paul J. Helms Drive
Current Mailing Address Current Street Address
Monroe NC 28110 Monroe NC 28110
City State Zip City State Zip
10. Deed Book No.5046 Page No. 725 Provide a copy of the most current deed.
*Additional check for$100.00 is attached to supplement the original check of$2,300.00 for a total
erosion control review fee of$2,400.00.

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).
City of Monroe [e-mail]
Company Name E-mail Address
3900 Paul J. Helms Drive 3900 Paul J. Helms Drive
Current Mailing Address Current Street Address
Monroe NC 28110 Monroe NC 28110
City State Zip City State Zip
Phone: Office# 704-282-4730 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:
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
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.
Borne City Manager
•: • • �;�,- ;orAuthorltYSi,natur-
I, -YrJ y 1` • 14( S , a Notary Public of the County of Ur1 1 Orl
State of North Carolina, hereby certify that:6 y Ian 3. 3fDr n >✓ 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 cRrell day of i CIA C- , 200?.
I( - L\'ICY
,_��Ft..........
Y K ,S,.c•,: Notary
i. NOTARY •.•cn My commission expires Dt ig-tliDc. b
2'•. PUBLIC
•, couN�' .,'

Continued from Items 9 & 10 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:
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 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 1 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.
Company 2 Name E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Phone: Office# Mobile#
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#

5046 •
0725
FILED
UNION COUNTY
CRYSTAL CRUMP
REGISTER OF DEEDS
FILED Feb 05, 2009
AT 0421 pm
BOOK 05046
START PAGE 0725
END PAGE 0726
INSTRUMENT# 03325
EXCISE TAX $1,164 00
sok
NORTH CAROLINA GENERAL WARRANTY DEED
Excise Tax:$1,164.00
Parcel Identifier No.09-403-005C Verified by County on the day of ,20
By:
Mail/Box to. J.Bennett Glass,P.A.,P.O.Box 1049,Monroe,NC 28111-1049
This instrument was prepared by: J.Bennett Glass.P.A.,Attorney at Law
Brief description for the Index: 10.84 acres on SR 1394(Sanford Lane)
THIS DEED made this 4"day of February,2009 by and between
GRANTOR GRANTEE
R.D.Harrell Company,Inc.,a North Carolina corporation City of Monroe,a North Carolina municipal corporation
P.O.Box 69
Monroe,NC 28111
Enter in appropriate block for each party: name,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 unto the Grantee in fee simple,all that certain lot or parcel of land situated
in the City of N/A,Monroe Township.Union County.North Carolina and more particularly described as follows:
BEGINNING at a nail in the center line of State Road tk1394,common corner with Thomas G.Evans
property,and running thence with the centerline of said road,South 52 degrees 22 minutes East 553.49
feet to a nail in the center line of the road,common corner with Leonard Hargett,Jr.property;thence
with said Leonard Hargett,Jr.property,South 29 degrees 34 minutes 50 seconds West 1012.53 feet to
an old iron, common corner with I. W. Keels property; thence with I. W. Keels property North 29
degrees 52 minutes West 788.97 feet to an old iron,common corner with Thomas G.Evans property;
thence with said Thomas G.Evans property,North 42 degrees 15 minutes 30 seconds East 596.50 feet to
the point of BEGINNING, containing therein approximately 10.84 acres, according to a map and
survey dated January 27,1981,by John R.Yarbrough,NCRI.S.
NC Bar Association Form No.3© 1976,Revised©1977,2002
Printed by Agreement with the NC Bar Association—1981-Chicago Title Insurance Company

5046 -
0726
The property hereinabove described was acquired by Grantor by instrument recorded in Book 1527,page 329.
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:
Right of way of SR 1394(known as Sanford Lane)and any casements and rights of way for public utilities which cross the
property.
IN WITNESS WHEREOF,the Grantor has duly executed the foregoing as of the day and year first above written.
R.D.HARRELL OMPANY,INC. (SEAL)
EntityN:,e)
By: s.,11$ "'I 1
R.Dean Harrell,President (SEAL)
(SEAL)
(SEAL)
SEAL:STAMP State of North Carolina-County of Union
I.Leslie G.Helms,the undersigned Notary Public of the County and State aforesaid,certify that R.Dean
Harrell personally came before me this day and acknowledged that he is the President of R.D. Harrell
Company,Inc.,a North Carolina corporation,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.Witnessss my hand and Notarial
stamp or scat,this 4'"day of February,2009 ��J[.��C --
My Commission Expires: 1
May 8,2011 ', F t G. h No ry Public
The foregoing Certificate(s)of 3 .1
is/are certified to be correct. This instrument and thtneofrAabt are duly registered at the date and time and in the Hook and Page shown
on the first page hereof a
a
Itlrster iti1111-arfor County
By ',*r. `:;", Deeufy/Assistant-Register of Deeds
il
NC Bar Association Form No.3 O I976,Revised©1977,2002
Printed by Agreement with the NC Bar Association—1981 -Chicago Title Insurance Company

ADDITIONAL DEEDS RELATIVE TO PROJECT AREAS
RUNWAY 05-23 ON AIRPORT TREE OBSTRUCTION REMOVAL AND FENCING
CHARLOTTE-MONROE EXECUTIVE AIRPORT
MAY 2022
RUNWAY 5 END
DEED BOOK PAGE NUMBER
5257 39
5257 42
1698 335
5565 536
RUNWAY 23 END
DEED BOOK PAGE NUMBER
314 296
372 778
418 127
875 682
3218 599
353 705