NCC240705_FRO Submitted_20240313

FINANCIAL RESPONSIBILITY OWNERSHIP (FRO) FORM GeTkrntersville
Soil 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
I. Project name Gilead Rd. Mixed Use
2. Address of land-disturbing activity (number, street) See Attached - Lots 1-5 & 14-16 & 29 ONLY
3. Approximate date land-disturbing activity will begin March 2024
4. Purpose of development (Commercial, Residential, Residental
Industrial, etc.)
5. Total acreage of land to be disturbed or uncovered 1.47
6. Total site acreage 3.94
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 A_ent,is required.
Landowner 1 of Record
Company Name Meeting Street Towns, IV LLC Contact Name Joseph T Roy, IV
(i f applicable)
Mailing Address 19925 Jane Crump Way
City Cornelius State NC Zip 28031
Phone [phone] Email [e-mail]
Landowner 2 of Record
Company Name HFH Partners, LLC Contact Name Jay Henson
Of applicable)
Mailing Address 121 Gilead Rd
City Huntersville State NC Zip 28078
Phone [phone] Email •[e-mail]
8. Indicate the Deed Book and Page number where"thee deed or instrument is filed. Attach a list of additional deeds
if applicable.toulp who, I La O ►'
_Deed Book Page Deed Book Page Deed Book Page
300 /0/—/0 1.137447 63
35707 745
37447 47
35048 268
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
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) Meeting Street Towns, IV LLC Contact Name Joseph T Roy, IV
Mailing Address 19925 Jane Crump Way
City Cornelius State NC Zip 28031
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/on the NC Secretary of
State business re•istr .
North Carolina Agent for Financially Responsible Party
NC Registered Agent Name Contact Name
Mailing Address
City State Zip
Phone Email
3. (Optional)Additional contact familiar with the site,who understands the plans, and may represent the company.
Site Contact's Name Terry Cleary Email [e-mail]
Phone: Office 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 informati n should there be change in the information provided herein...
Printed Name Q L 1 `\v ' Title or Authority //44A/ b
Wet-Ink Signature Date Zf"
I, L/ �V'' �1�
�� , a Notary Public of the County o
State of or//i (hri)/i Q , hereby certify that d *ft 13\1 personally
appeare efore me this day . • :-mg duly sworn acknowledged that e above form was executed by him/heir.
Witness my hand and notarial seal, this day of a,ch , 20
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Rev. 8/2022' "ism l itoo` Page 2 of 2

Attachment for Part A -
LOT SUMMARY TABLE
LOT AREA (SQ FT) AREA (AC)
#2 Address of land-disturbing activity 1 1815 SQ FT 0.042 AC
2 1113 SQ FT 0.026 AC
Address Street Lot 3 1113 SO FT 0.026 AC
-a 4 1821 SQ FT 0.042 AC
m
234 Gilead Rd. 1 1 5 1821 SQ FT 0.042 AC
6 1113 SQ FT 0.026 AC
232 Gilead Rd. 1 2 7 1455 SQ FT 0.033 AC
8 1113 SQ FT 0.026 AC
230 Gilead Rd. 1 3 9 1822 SQ FT 0.042 AC
228 Gilead Rd. 1 4 10 1823 SQ FT 0.042 AC
11 1157 SQ FT 0.027 AC
12 1348 SQ FT 0.031 AC
13 2572 SQ El 0.059 AC
226 Gilead Rd. 2 5 14 2553 SQ FT 0.059 AC
15 1254 SQ FT 0.029 AC
16 2553 SQ FT 0.059 AC
240 Gilead Rd. 4 14 17 2553 SQ FT 0.059 AC
18 2178 SQ FT 0.050 AC
242 Gilead Rd. 4 15 19 2178 SQ FT 0.050 AC
244 Gilead Rd. 4 16 20 2582 SQ FT 0.059 AC
21 3590 SQ FT 0.082 AC
22 2847 SQ FT 0.065 AC
' � 23 :: ::
I/ / I ' 24 FT 0.050 AC
25 2178 SQ ET 0.050 AC
26 2553 SQ FT 0.059 AC
27 2553 SQ FT 0.059 AC .
28 1254 SQ FT 0.029 AC
29 2521 SQ FT 0.058 AC