NCC241885_FRO Submitted_20240620

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: 05498 CFA
2. Location of land-disturbing activity: County: Cabarrus or Township: Concord
Highway/Street: 268 Concord Pkwy. S Latitude 35.397728 Longitude-80.610275
3. Approximate date land-disturbing activity will commence: July 1, 2024
4. Purpose of development(residential, commercial, industrial, institutional, etc.): Commercial
5. Total acreage disturbed or uncovered (including off-site borrow and waste areas): 1.4 ac
6. Amount of fee enclosed $700.00. 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 ❑x No ❑
8. Person to contact should erosion and sediment control issues arise during land-disturbing activity:
Name: Brent Edmiston E-mail Address: [e-mail]
Phone: [phone] Mobile [phone]
9. Landowner(s)of Record (attach accompanied page to list additional owners):
Name: CONCORD 29 & 601 LLC. Contact: Charles Graham
Phone: Office# 704-527-7996 email. [e-mail]
PO BOX 19928 4324 BARRINGER DRIVE, SUITE 101
Current Mailing Address Current Street Address
Charlotte NC 28219 Charlotte NC 28217
City State Zip City State Zip
10. Deed Book No. 15869 Page No. 39-44
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).
Chick-Fil-A, Inc. [e-mail]
Company Name E-mail Address
5200 Buffington Rd. 5200 Buffington Rd.
Current Mailing Address Current Street Address
Atlanta GA 30349 Atlanta GA 30349
City State Zip City State Zip
Phone: 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:
CT Corporation System
Name of Registered Agent E-mail Address
160 Mine Lake Ct., Suite 200
Current Mailing Address Current Street Address
Raleigh NC 27615
City State Zip City State Zip
Phone: Office#[phone] Mobile#

(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:
Carter Engineering Consultants, Inc mark(a�carterengineerinq.com
Engineering firm or other consultant E-mail Address
Mark Campbell
Individual contact person (type or print) Phone: Office# [phone]
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.
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Signature Date
I, friaric- A. Cc,y,�, 4,(( , a Notary Public of the County of 0�n«
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State of Borth--are+trt, hereby certify that g r e-At 6—,1 m ;s 4-H. appeared personally
before me this day and being duly sworn acknowledged that the above form was executed by him/her.
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Witness my hand and notarial seal, this . day of /Nloe.rc-(- , 20 )`i
4,',e MARK A. CAMPBELaL
7/1,4 a_ 40/„..--e
y..04, :: Notary Public. Georgia
_•: Oconee County
:4l::4�; My Commission Expires Notary
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',./Z`' February 18, 2025
Seal My commission expires a/I c1'701-�a f

15869 0039 FILED ELECTRONICALLY
.CABARRUS COUNTY NC
M. WAYNE NIXON
FILED Feb 24, 2022
AT 03:24:00 PM
BOOK 15869
START PAGE 0039
END PAGE 0042
INSTRUMENT # 06521
EXCISE TAX $1,710.00
Excise Tax $1,710.00 Recording Time,Book and Page
NORTH CAROLINA SPECIAL WARRANTY DEED
Tax Lot No. Parcel Identifier No. 56200325970000
Verified by County on the ,day of
by
Mail after recording to GRANTEE
This instrument was prepared by RYAN C.HAWKINS,Ferguson Ilayes Hawkins,PLLC
NO OPINION OF TITLE EXPRESSED OR IMPLIED BY PREPARER
Brief Description for the index
_J
THIS DEED made this Q l day of FEBRUARY,2022, by and between
GRANTOR GRANTEE
CALL FEDERAL CREDIT UNION CONCORD 29 & 601, LLC
a North Carolina limited liability company
Mailing Addl=ess: : Mailinl Address':'
4605 Commerce Road 1341 E. Morehead Street, Suite 201
Richmond,VA 23234 Charlotte,NC 28204-2936
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
CABARRUS County,North Carolina and more particularly described as follows:
SEE ATTACHED EXHIBIT "A"
submitted electronically by "Robinson, Bradshaw & Hinsan, P.A."
in compliance with North Carolina statutes governing recordable documents
and the terms of the Memorandum of understanding with
the Office of the Register of Deeds of Cabarrus County. NCGS 47-14(a1)(5).

15869 0040
The property hereinabove described was acquired by Grantor by instrument recorded in Book 7197,Page 125.
All or a portion of the property herein conveyed D does or Q does not include the primary residence of a Grantor.
A map showing the above described property is recorded in Plat Book 21,1'agc 75.
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 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
hereinafter stated.
Title to the property hereinabove described is subject to the following exceptions:
SUBJECT TO casements and restrictions of record.
SUBJECT TO casements and setback lines as shown on the recorded plat.
SUBJECT TO the matters set forth on Exhibit"B"attached hereto.
IN WITNESS WHEREOF,the Grantor has hereunto set his hand and seal,or if corporate,has caused this instrument to be signed in
its corporate name by its duly authorized officers and its seal to be hereunto affixed by authority of its Board of Directors,the day and
year first above written.
CALL FI DEP,- t;EDI I'UNION
x __r•---�-" Mom'_`
By: '` \ (SEAL)
JOHN 3ST, P sident ansCEO
STATE OF V l(a I n i (-I , COUNTY OF g { G h in t I rid
I certify that the following person(s)personally appeared before me this day, each acknowledging to me that he or
she signed the foregoing document:
JOHN WEST, President and CEO of
r� CALL FED ,CREUI ION
Date: 2.> 12 02 /,
r Notary Public
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(Official Seai40`N`SE 000p '�.
O�.¢y'Pve�<< Printed or Typed Name: q e 1 M aid
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15869 0041
EXHIBIT"A"
Lying and being situate in Cabarrus County, North Carolina, and being more particularly described as follows:
BEING all of Lot as shown on a map entitled "Map II of Final Plat of Concord Shopping Parkade" recorded in Plat Book
21, Page 75, Cabarrus County Public Registry and being more particularly described by metes and bounds as follows;
BEGINNING at a point on the westerly R.O.W. line of U.S. Highway 29, said point also being on the southeast property
corner of Lot 4 of Concord Shopping Parkade and preceding thence with the southerly property line of Lot 4 along a
bearing of N. 61-58-46 W. for a distance of 226.53 feet to a point, which point lies on the westerly property line of Lot 9
of Concord Shopping Parkade; thence proceeding with the property line of Lot 9''in a southwesterly.direction along the arc
of a circular curve to the right having a radius of 1115.40 feet, an arc distance of 1.11 feet, a cord distance of 1.11 feet and
a cord bearing of S. 29-00-21 W. to a point; thence continuing with the property line of Lot 9 along the arc of a circular
curve to the right having a radius of 1337.02 feet, an arc distance of 286.39 feet, a cord distance of 285,84 feet and a cord
bearing of S. 35-09-40 W. to a point lying at the common corner of the westerly property line of Lot 9 and the
northeastern property line of Lot 6 of Concord Shopping Parkade; thence proceeding with the property line of Lot 6 along
a bearing of S. 49-45-40 E. for a distance of 231.60 feet to a point lying in the westerly R.O.W. line of U.S. Highway 29;
thence proceeding with the westerly R.O.W. line of U.S. Highway 29 northeasterly along the arc of a circular curve to the
left having a radius of 1577.02 feet, an arc distance of 336.30 feet, a cord distance of 335.66 feet, and a cord bearing of N.
34-07-47 E. to the point and place of BEGINNING, containing 1.639 acres, more or less as shown on a survey of"Map II
of Final Plat of Concord Shopping Parkade" by Concord Engineering and Surveying, Inc. dated June 6, 1987, and being
designated as Lot 5 on said survey.
TOGETHER WITH easements contained or conveyed in that Declaration of Utility Network Easement recorded in Book
613, page 258; and as amended by Amendment to Declaration of Utility Network Easement recorded in Book 630, page
67 in the Cabarrus County Public Registry.
ALSO TOGETHER WITH easements contained or conveyed in that Declaration of Mutual Access Easement recorded in
Book 613, page 261; and as amended by Amendment to Declaration of Mutual Access Easement recorded in Book 630,
page 60, in the Cabarrus County Public Registry.

15869 0042
EXHIBIT"B"
Permitted Exceptions
1. The lien of taxes and assessments for the year 2022, not yet delinquent and subsequent years, not yet due and
payable;and
2. Subject the covenants, conditions, restrictions and easements contained in Declaration of Restrictions recorded in
Book 613, Page 265, and as amended by Amendment to Declaration of Restrictions recorded in Book 615, Page
454,Cabarrus County Registry; and
3. Subject to and together with the easements contained or conveyed in that Declaration of Utility Network Easement
recorded in Book 613, Page 258 and as amended by Amendment to Declaration of Utility Network Easement
recorded in Book 630,Page 67 in the Cabarrus County Public Registry; and
4. Subject to and together with easements contained or conveyed in that Declaration of Mutual Access Easement
recorded in Book 613, Page 261 and as amended by Amendment to Declaration of Mutual Access Easement
recorded in Book 630, Page 60, in the Cabarrus County Public Registry; and
5. Subject to and together with easements to Concord Telephone Company, Inc. (also known as The Concord
Telephone Company)recorded in Book 129,Page 583 and Book 611,Page 511, Cabarrus County Registry; and
6. Subject to the Utility Right of Way to the City of Concord recorded in Book 627 , Page 325, Cabarrus County
Registry; and
7. Any right, easement, setback, interest, claim, encroachment, encumbrance, violation,variation,or other adverse
circumstance affecting the Title disclosed by survey entitled "ALTA/NSPS Survey of Call Federal Credit Union"
by James C. Gray,Jr., P.L.S. of GPI, dated November 23, 2021 (the "Survey"); and
8. Any right, easement, setback, interest, claim, encroachment, encumbrance,violation,variations or other adverse
circumstance affecting the Title disclosed by plat(s) recorded in Plat Book 21,page 75, and as shown on the
Survey; and

Concord 29 & 601 , LLC
June 3, 2024
North Carolina Department of Environmental Quality("NCDEQ")
217 West Jones Street
Raleigh, NC 27603
Dear NCDEQ:
Concord 29 & 601, LLC ("Owner") is the current owner of 268 Concord Parkway
S.,Concord, NC 28027 known as Cabarrus County Parcel ID#02023-0004.32. The
Owner has entered into a contract to sell the property to Chick-fil-A, Inc. ("Buyer").
Buyer has Owner's permission to apply for permits in connection with its intended
development of the property, including land disturbance permits.
Sincerely,
Concord 29 & 601, LLC
By: Withrow Capital, Inc., Its Manager
By:
Terry L. Williams, President
1341 E.MOREHEAD ST.,ST E.201,CHARLOTTE,NC 28204
T(704)344-1868 EXT. 101
TWILLIAMS@WITHRO WCAPITAL.COM