NCC232945_FRO Submitted_20231019

FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
SEDIMENTATION POLLUTION CONTROL ACT
No person may initiate any land-disturbing activity on one or more acres as covered by the Act before this
form and an acceptable erosion and sedimentation control plan have been completed and approved by
the Land Quality Section, N.C. Department of Environmental Quality. Submit the completed form to the
appropriate Regional Office. (Please type or print and, if the question is not applicable or the e-mail and/
or fax information unavailable, place N/A in the blank.)
Part A. Family Dollar
1. Project Name y
2. Location of land-disturbing activity: County Stokes City or Township Walnut Cove
Highway/Street NC Hwy 8 S Latitude 36.369341 Longitude 80.182865
3. Approximate date land-disturbing activity will commence:June 1 , 2021
4. Purpose of development (residential, commercial, industrial, institutional, etc.):Commercial
5. Total acreage disturbed or uncovered (including off-site borrow and waste areas): 1 .63
6. Amount of fee enclosed: $ 130 . The application fee of$65.00 per acre (rounded
up to the next acre) is assessed without a ceiling amount (Example: a 9-acre application fee is$585).
7. Has an erosion and sediment control plan been filed? Yes No Enclosed Yes
8. Person to contact should erosion and sediment control issues arise during land-disturbing activity:
Name Will Stronach E-mail Address will©stronachproperties.com
Telephone [phone] Cell# 919-270-1750 Fax# [phone]
9. Landowner(s) of Record (attach accompanied page to list additional owners):
t rp
J Kn. w►,X��C.� C 0 9 (•t0 Y1 o-Ct\cl‘S*aol.cow.
Name / Telephone I ak Number
0 QOV
Current Mailing Address Current Street Address
bck.,A`Dv► C- 21016
City I State Zip City State Zip
10. Deed Book No. LP) Page No. 63-5 Provide a copy of the most current deed.
Part B.
1. Company(ies) or firm(s) who are financially responsible for the land-disturbing activity (Provide a
comprehensive list of all responsible parties on an attached sheet.) If the company or firm is a sole proprietorship,
the name of the owner or manager maybe listed as the financially responsible party.
5 P F Os, Lt-C- N1;11eS4t0na.cl,
r-�
Name P Qe, �Ps.cows
E-mail A ress
MCA t .,r r.eA br_- 10
Current Mailing Address Current Street Address
/V C. 2.1G0°I
City State Zip City State Zip
Telephone CV\ 1-1 0 ('I C 0 Fax Number ti(l 88Z 411$2j

2. (a) If the Financially Responsible Party is not a resident of North Carolina, give name and street address
of the designated North Carolina Agent:
Name E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Telephone Fax Number
(b) If the Financially Responsible Party is a Partnership or other person engaging in business under an
assumed name, attach a copy of the Certificate of Assumed Name. If the Financially Responsible
Party is a Corporation, give name and street address of the Registered Agent:
Name of Registered Agent E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Telephone Fax Number
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
I or his attorney-in-fact, or if not an individual, by an officer, director, partner, or registered agent with
the authority to execute instruments for the Financially Responsible Person). I agree to provide
corrected W information should there be any change in the information provided herein.
.,`t:a - A . c-ktoi,..c(--. /V,r.A..n.., -er-
Type or print name Title or Authority 5
..---; A?,r;\ 1 2-01- \
Sign ure Date
I, Ejr'ian r..,a\le e,7 , a Notary Public of the County of L/ aL e
State of North Carolina, hereby certify that L',t'%c,yr. A. ��c,na�1, appeared
personally before me this day and being duly sworn acknowledged that the above form was
executed by him.
Witness my hand and notarial seal, this day of AV► \ , 20 Z l
Notary
a
T m: My commission expires ( v [2 b /Z
çb0
-camN G ` %•

4PFt
.r1 /
trAx_SUr h;•'
•..,s .,-. — i'
_! FORM WD-1O1—WARRANTY DEED Printed and for Sala by JarG Eilli `reS&CcO I6. .33(inviile,N.C. ';?
NORTH CAROLINA, Stokes COUNTY
THIS DEED made this day off - ,A. D. 19 7.6
by JOSEPH A. BEAST EY and wife, •IUSFPHI•,NE Y BEASLE.y ..
Ili
of Stokes Countyand State of ',,
No r t ki—Ga-roe i na I,
l• of the first part,to Jim]i nR RLl I Ll)I NG C-ORP_ORAT 1-ON_,—a—cor_p.orat I a Aga wed—ante -s-t-.i-ng
under and by virtue of the laws of the State of Nor th_C r line with L.ts_.p_r_ c_i_pa-1- I .
o ofl ce and place of business in Walnut Cove,, Stokes County, North CarolCarolina
ounty aned Stae of
of thesecond part: whose address is: Walnut Cove, North Carolina, 27052
• - I WITN.ESSETH,That said pa rt lcs of—tthc f i-r-s t—p-a-r-t
— , in consideration of
TFN AND NOJIOG ($10.00) Dollars '.
to_tFrem m Kher valuable considerations party of the second pater
• the receipt of which is hereby acknowledged ha ye bargained and sold, and by these presents •''
do grant,bargain,sell and convey to said party of-the sec—and—part,its
heirs and assigns, a certain tract or parcel of land in Aiea.daws Township
Stokes County, State of tio-rt Caroi-.na , adjoining
the lands of
and others,and bounded as follows, viz:
"BEGINNING at an iron on the West side of N.C. Highway #8, Martha S. Neal and Joseph
W. Neal 's corner; thence N. 80-08 W. with the margin of Martha S. Neal 's south line,
643.40 feet to an iron, Martha S. Neal 's and Joseph W. Neal 's corner; thence N. 01-
54 E. to an iron 172.61 feet (passing iron in line at 131 .01 feet) , Joseph W. Neal
and W. C. Blalock's corner; thence S. 86-41 E. with Blalock's line 198.27 feet to
an iron, Blalock's, Mrs. Harvey Neal and Joseph W. Neal ' s corner; thence S. 84-27 E.
with Mrs. Harvey Neal 's tine 488.40 feet to an iron, Mrs. Harvey Neal 's and Mr.
Joseph W. Neal 's corner; thence S. 14-00 W. 231 .00 feet to the point of beginning
and containing 3.08 acres be the same more or less. For chain of title see that
Deed from Joseph W. Neal , et ux. to Joseph A. Beasley, et ux. under date of July 31 ,
- 1976 and recorded in Book 229 at page 828 in the Office of the Register of Deeds for
Stokes County, North Carolina."
'� :}".y�'r }O `ii x �l:i� ��� s� �-'cam,^ O Y'�F?'�� ;
- �;,•,�, � .1.it/(�'77 I.1•lJ4o9
< v. , iay , h j:fr,p e!--i •. 41. A •
• „......r....-..,ram
• DRAWN BY: ,. r �r Attorney at Law
, •