NCC231968_FRO Submitted_20230628

FINANCIAL RESPONSIBILITY OWNERSHIP (FRO) FORM
GeT kite °f' e
Soil Erosion and Sedimentation Control Ordinance NORTH C A R O L I N A
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 Stephens Farm
2. Address of land-disturbing activity (number, street) Stephens Road, Huntersville, NC 28078
3. Approximate date land-disturbing activity will begin 6/1/2023
4. Purpose of development (Commercial, Residential, Residential
Industrial, etc.)
5. Total acreage of land to be disturbed or uncovered 12.60
6. Total site acreage 43.24
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 Anthony David Kidd
If applicable
IVIailing Address 5600 Stephens Road, Huntersville, NC 28078
Physical Address
If PO Box listed above
Phone Email
Landowner 2 of Record
Company Name Contact Name Anthony David Kidd & Sadie T Kidd
If applicable
Mailing Address 5900 Stephens Road, Huntersville, NC 28078
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
3740 0885 4129 0335 12863 9010-9012
Rev. 8/2022 TOH Staff Reviewer Ownership/Agent: Verified at Pre-Con Meeting By: Page 1 of 2

FINANCIAL RESPONSIBILITY OWNERSHIP (FRO) FORM
i ante of. e
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), finn(s) or Company who is/are financially responsible for this land-disturbing activity.
Financially Responsible Party
Company Name(if applicable) PDG-Stephens Farm,LLC Contact Name Brian Pace
Mailing Address 6719-C Fairview Road,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 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 David Faulkner Email [e-mail]
Phone: Office 704-365-1208 Phone: Mobile [phone]
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 con-ect 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 e any change in the information provided herein.
Printed Name PIC. Title or Authority 1"I,
Wet-Ink Signature(-------____` Date GI /•75
I, '-LU kor��(�%r�- , a Notary Public of the County of Yr +t'Ck1ef\ (,)v
State of 1JQ i ' i C,01 fi 411.l,-,G1 , hereby certify that -J r f Mil Tel C e personally
appeared before me this day and being duly sworn acknowledged that the above form was executed by hire/her.
Witness my hand and notarial seal, this day of , .
P�r1E Hq
(sea Oe oMMISsiON �R � rN
+A Notary Signature /\-/
l '`)121,e'er
NOTARY PUBLIC
�nF os 6 0 ' 'My Commission Expires o y 9J,,j 0-Q
08/202 K
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Rev. 8/2022 Page 2 of 2