NCC232692_FRO Submitted_20230912

Vlient Townof. e
FINANCIAL RESPONSIBILITY OWNERSHIP (FRO) FORM
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 I-luntersville.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 Hill Street Phase 3
2. Address of land-disturbing activity (number, street) 13895 Hill Street
3. Approximate date land-disturbing activity will begin 04/15/2023
4. Purpose of development(Commercial, Residential, Residental
Industrial, etc.)
5. Total acreage of land to be disturbed or uncovered 0.434
6. Total site acreage 0.66
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 Hill Street Bowman, LLC. Contact Name Nate Bowman
If applicable
Mailing Address 13815 Cinnabar Place, Huntersville NC 28078
Physical Address
IfP0 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
36625 305
Rev. 8/2022 TOH Staff Reviewer Ownership/Agent: Verified at Pie-Con Meeting By: Page 1 of 3

�.�ntem,of. e
FINANCIAL RESPONSIBILITY OWNERSHIP (FRO) �
FORM j
Soil Erosion and Sedimentation Control Ordinance NORTH CAROLINA
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) Hill Street Bowman, Contact Name Nate Bowman
LLC.
Mailing Address 13815 Cinnabar Place, Huntersville NC 28078
Physical Address
if PO Box listed above
Phone [phone] I 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 Nate Bowman Contact Name Nate Bowman
Mailing Address 13815 Cinnabar Place, Huntersville NC 28078
Physical Address
.117)0 Box listed above
Phone [phone] Email [e-mail]
3. (Optional)Additional contact familiar with the site,who understands the plans,and may represent the company.
Site Contact's Name Vince Keene Email [e-mail]
Phone: Office 704-556-1990 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 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 the��ree be any change in the information provided herein.
Printed Name i ft)/5 `r /J, 60141i1/9i\ Title or Authority GC'f"
Wet-Ink Signature `" Date ,/9
I t W ONKaS . i►n�TN i►Z , a Notary Public of the County of 6 kc-t- 1,4
State of N m t t Ro41 N A , hereby cent )that Pi:4w 1-r W. 7345 1,4tANI personally
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 co day of IAA tic.ti , 20
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(seal) ��`�O� 'y,//�.�
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1'7Notary Public rtary Signature
Gaston County
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Rev.8/2022 - '���`�� Page 2 of 3

T Town of.
FINANCIAL RESPONSIBILITY OWNERSHIP (FRO) FORM c ante Mlle
Soil Erosion and Sedimentation Control Ordinance NORTH CAROLINA
My Commission Expires
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Rev. 8/2022 Page 3 of 3