NCC242308_FRO Submitted_20240730

FINANCIAL RESPONSIBILITY OWNERSHIP (FRO) FORM ciTIente Town
of• e
S oil Erosion and Sedimentation Control Ordinance NORTH CAROLINA
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 TSolis North Creek
2. Address of land-disturbing activity (number, street) 17705 Davidson-Concord Road
3. Approximate date land-disturbing activity will begin August 12, 2024
4. Purpose of development (Commercial, Residential, Residential Apartments
Industrial, etc.)
5. Total acreage of land to be disturbed or uncovered 18.54
6. Total site acreage 20.23
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 Agent,is required.
Landowner 1 of Record
Company Name North Creek MultiFamily LLC Contact Name Thomas R Barker
If applicable
Mailing Address 4777 Sharon Rd,Ste 550, Charlotte, NC 28210
Physical Address
If PO Box listed above
Phone [phone] Email [e-mail]
Landowner 2 of Record
Company Name Contact Name
If applicable
Mailing Address
Physical Address
If PO Box listed above
Phone Email
8. Indicate the Deed Book and Page number the deed or instrument is filed. Attach a list of additional deeds if
applicable.
Deed Book Page Deed Book Page Deed Book Page
38644 605
Rev. 8/2022 TOH Staff Reviewer Ownership/Agent: Verified at Pre-Con Meeting By: Page 1 of 3

T ,
Town of•
FINANCIAL RESPONSIBILITY OWNERSHIP (FRO) FORM clantee
Soil Erosion and Sedimentation Control Ordinance NORTH C A R O L I N A
PART B — FRO AND NC REGISTERED AGENT
1. Person(s), firm(s)or Company who is/are financially responsible for this land-disturbing activity.
Financially Responsible Party
Company Name(if applicable) North Creek Contact Name Thomas R Barker
Mulitfamily LLC
Mailing Address 4777 Sharon Rd,Suite 550, Charlotte, NC 28210
Physical Address
If PO Box listed above
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 the NC Secretary of State.
North Carolina Agent for Financially Responsible Party NC Registered Agent Name i Iliarn Q.MAcNei.( Contact Name Thomas I'{�
1 BarkQ,r
Mailing Address 11777 Shoran 13d,S vile 550,Gharlofte,NJC a$al 0
Physical Address
If PO Box listed above Phone qj 1 q q 55 I a 5 q Email 7 bbrhOr@"1 el'CA11IIl
iierpapi2aS.COM
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
DO NOT SIGN THIS FORM UNTIL YOU ARE IN THE PRESENCE OF A NOTARY PUBLIC
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 '19,4/4, / � Titl Authority u7��r i Zed///.-VA,i - h 6' —
Wet-Ink ignature Date 7 24
I, di-let 1���1 4c/Q f�� , a Notary Public of the County of id,_ .e, ,
State of �tld l 640 t el et, , hereby certifythat k.tylia ,e &1 4. ; personally
appeared before me this day and being duly sworn acknowledged that thy above form was executed by him/her.
Witness my hand and notarial seal, this e2 y day of 6:-1 , 20 d Y.
(seal)
Notary Signature 7 ,el
A ,414 C G�Cvg7 jr
Rev. 8/2022 Page 2 of 3

FINANCIAL RESPONSIBILITY OWNERSHIP (FRO) FORM lenteM" e
Soil Erosion and Sedimentation Control Ordinance NORTH CAROLINA
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Rev. 8/2022 Page 3 of 3