NCC230967_FRO Submitted_20230405

FINANCIAL RESPONSIBILITY OWNERSHIP (FRO) FORM F,,,�aa '
Soil Erosion and Sedimentation Control Ordinance C� ��
NORTH CAROL IN.
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 Olde Poplar- Lot 7
2. Address of land-disturbing activity (number, street) 9630 Beatties Ford Rd, Huntersville, NC 28078
3. Approximate date land-disturbing activity will begin 03/01/2023
4. Purpose of development(Commercial, Residential, Residential
Industrial, etc.)
5. Total acreage of land to be disturbed or uncovered 1.40
6. Total site acreage 5.77
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 Contact Name Patrick Curran,Jennifer Curran
If applicable
Mailing Address 3042 Potomac River Pkwy,Charlotte, NC 28217
Physical Address
I.f FO 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
35516 963
Rev. 8/2022 TOH Staff Reviewer Ownership/Agent: Verified at Pre-Con Meeting By: Page 1 of 2

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FINANCIAL RESPONSIBILITY OWNERSHIP (FRO) FORM �, � �f• e
Soil Erosion and Sedimentation Control Ordinance NORTH CAR O L I N A
e
PART B— FRO AND NC REGISTERED AGENT '
1. Person(s), firm(s) or Company who is/are financially responsible for this land-disturbing activity.
Company Name(if applicable) / # D ,1 (,Contact Name ti fi p 7�0 C�Mailing Address Ql/�y�11? {J/I 1 fo� *-f--,,-/ j � �'/ `� of-� JCXd? 7JPhysical Address177l �L/ T`L
If PO Box listed above p. ��? - �, f /,� �f
Phone C7 ) 95 ✓f j1 Email a///�<t ��( 1hf C{.t`l00 ,C" '
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 .Anent for Financialh Responsible Part
NC Registered Agent Name Contact Name
Mailing Address
Physical Address
If PO Box listed above
Phone Email
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 \01 SIG\ I I IIS I OR\I I \ I II. l'Ol \RI I\ l III I'RI SI.\( I: OI \ \O I \Rl PI 131.I('
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 an4f7, r,
ain the information provided ein. p
/n
Printed Name ,rT tle. r or Authority (,
Wet-Ink Signaturen Date
I, /t S k i Sh -C- , a Notary Public of the County of 6, C < o✓\ ui
State of Not Col c I i vvA , hereby certify that ell ay ler(e M• C 6 I 1;'''') pe nally
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 2 31 d day of 3 c�.— o.4 , 20 2.
e��� P" '-- Notary Signature
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e) / 7%-y ' U6 My Commission Expires © 1 `� 20 2'
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Rev. 8/2022 Page 2 of 2

Financially Responsible Party Letter of Consent
Re: Olde Poplar Lot 7 EC(EPM #445699)
Dear Town of Huntersville,
This letter is in reference to the Erosion and Sedimentation Control Plan application submitted for Old
Poplar Lot 7 located at 9630 Beatties Ford Rd, Huntersville, NC 28078.
As the landowners of this property, we give consent to our contractor, Collin Homes, Inc,to submit this
application and to conduct the anticipated land disturbing activities for the development of the lot as
the financially responsible party.
Landowners:
Printed Name: et-- C— eti r ra.r‘,
Signature: L_ , � -- Date: //3° /2
JeiuCv ti avvt
Printed Name: 4
Signature: Ii1JiiIU4!4d Date: ' 6 rZ J
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