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Home My WebLink AboutNCC215536_FRO Submitted_20211006FINANCIAL 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 Environment and Natural Resources. (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. 1. Project Name NC HWY-119 Industrial Development 2. Location of land -disturbing activity: County Alamance City or Township Graham Highway/Street South NC HWY-119 Latitude 36' 02' 38" N Longitude 79° 19' 48" W 3. Approximate date land -disturbing activity will commence: Summer 2020 4. Purpose of development (residential, commercial, industrial, institutional, etc.): Industrial 5. Total acreage disturbed or uncovered (including off -site borrow and waste areas): 50 acres 6. Amount of fee enclosed: $ 3,250 . 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 X 8. Person to contact should erosion and sediment control issues arise during land -disturbing activity: Name William Seymour E-mail Address bseymour@windsorcommercial.com Telephone 336.282.3550 ext: 233 Cell # 336.362.0734 Fax # 9. Landowner(s) of Record (attach accompanied page to list additional owners): Scott Mayo Properties 111, LLC Name Telephone Fax Number 840 Plantation Drive Current Mailing Address Current Street Address Burlington NC 27215 City State Zip City State Zip 10. Deed Book No._3866 Page No. 0553-0556 Provide a copy of the most current deed. Part B. 1. Person(s) or firm(s) who are financially responsible for the land -disturbing activity (Provide a comprehensive list of all responsible parties on an attached sheet): Scott Mayo Properties III, LLC Name E-mail Address 840 Plantation Drive Current Mailing Address Current Street Address Burlington NC 27215 City State Zip City State Zip Telephone __ Fax Number 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 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 information should there be any change in the information provided herein. William C. Scott, Jr Manager Type or print name Title or Authority Signature Date I, L61Tb\_\ Y\ a Notary Public of the County of State of North Carolina, hereby certify that W , \\ \0.M 1�1<=tt� 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 L -) day of �� t _-\i , 20 L-- Notary Seal p My commission expires — q ';� y OFFICIAL SEAL /� ~� `� Notary Puvo North Carolina "f STOKES COUNTY '��: CAROLYN H. MORAN My Commission Expires — As of the Date of this Certification, On the Real Property described in this Deed, there are No Delinquent Taxes Owed which are (1) ad valorem County Taxes, (2) ad FILED valorem Municipal Taxes collected by Alamance County ALAMANCE COUNTY, NC or (3) any oth axgs co lected by Alamance County. I HUGH WEBSTER REGISTER OF DEEDS Date: Deputy/raxCollector: FILED Apr 11, 2019 AT 12:20:48 prn BOOK 03866 START PAGE 0553 END PAGE 0556 INSTRUMENT # 05448 Prepared by and after EXCISE TAX (None) recordation return to; MADONNAA. EVANS 235 N. EDGEWORTH STREET CDR Christopher J. Vaughn GREENSBORO, NC 27401 �.— Carruthers & Roth, P.A. Post Office Box 540 Greensboro, North Carolina 27402 Delinquent taxes, if any, to be paid by the closing attorney to the county tax collector upon disbursement of closing pr ceefig- By: ry / Cht stopher . V hn, Carruthers & Rmt , P.A. Licensed Attorney Excise Tax: NTC Parcel Identification Number: 159502 NORTH CAROLINA GENERAL WARRANTY DEED ALAMANCE COUNTY THIS DEED made as of the // day of April, 2019, by and between SCOTT/MAYO PROPERTIES II, LLC, a North Carolina limited liability company("Grantor"), whose address is 840 Plantation Drive, Burlington, NC 27215, and SCOTT/MAYO PROPERTIES III, LLC, a North Carolina limited liability company ("Grantee") whose address is 840 Plantation Drive, Burlington, NC 27215. The designation Grantor and Grantee, as used herein, shall include said parties, their heirs, successors and assigns, and shall include singular, plural, masculine, feminine or neuter, as required by context. This is not the personal residence of Grantor. WITNESSETH: That the Grantor, for a valuable consideration paid by the Grantee, the receipt of which is hereby acknowledged, has and by these presents does grant, bargain, sell and convey unto the Grantee in fee simple, all that certain lot or parcel of land situated in Melville Township, Alamance County, North Carolina and more particularly described on Exhibit A attached hereto and made a part hereof. The property hereinabove described was acquired by Grantor by instrument recorded in Book 3506, Page 227 Alamance County Registry. Maps showing portions of the above described property are recorded in Plat Book 65, Page 177, and Plat Book 77, Page 155, Alamance County Registry. TO HAVE AND TO HOLD the aforesaid lot or parcel of land and all privileges and appurtenances thereto belonging to the Grantee in fee simple. And the Grantor covenants with the Grantee, that Grantor is seized of the premises in fee simple, has the right to convey the same in fee simple, that title is marketable and free and clear of all encumbrances, and that Grantor will warrant and defend the title against the lawful claims of all persons whomsoever except for the exceptions hereinafter stated. Title to the property hereinabove described is subject to the following exceptions: All easements, restrictions and rights -of -way of record and the lien for ad valorem taxes for 2019 and subsequent years. IN WITNESS WHEREOF, the Grantor has caused this instrument to be duly executed as of the day and year first above written. SCOTT/MAYO PROPERTIES II, LLC, a North Carolina limited liability company By: Na4:1 m#cott, Title: Manager Itil< County, State of North Carolina I certify that the following person(s) personally appeared before me this day, each acknowledging to me that he or she signed the foregoing document: William C. Scott, Jr. (insert name, not title) Date: April �2019 mom EXHIBIT A Prove All those certain pieces, parcels, or tracts of land lying and being in Melville Township, Alamance County, North Carolina, and being more particularly described as follows: BEING a tract of land containing 249.01 acres, more or less, according to a survey entitled "Final Plat, Property of William C. Scott and Jane M. Scott, made by Robert E. Boswell, Surveyor, dated August 1, 2000, a map of which is recorded in Plat Book No. 65, at Page 177, of the Alamance County Registry. SAVE AND EXCEPT FROM THE ABOVE -DESCRIBED PROPERTY those certain Lots IA,1B and 2 as per plat thereof recorded in Plat Book 77, Page 155, in the Office of the Register of Deeds of Alamance County, North Carolina.