NCC232385_FRO Submitted_20230809

Check if this project is ARPA-funded U
Attach a copy of the Letter of Intent to Fund
FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
SEDIMENTATION POLLUTION CONTROL ACT
No person may initiate any land-disturbing activity cn one or more acres as covered by the Act, including any
activity under a common plan of development of th s size as covered by the NCGO1 permit. before this form
and an acceptable erosion and sedimentation cont'ol plan have been completed and approved by the Land
Quality Section, N.C. Department of Environment2l Quality. Submit the completed form to the appropriate
Regional Office. (Please type or print and, if the q Jestion is not applicable or the e-mail address or phone
number is unavailable, place N/A in the blank.)
Part A.
1. Project Name C, y h y-
*If this project invol s American Rescc'e Plan Act(ARPA) funds, list the Project Name or Project
Number(e.g., SRP -ARP-0121) belo�/ under which you were approved for funding through the
Division of Water In astructure (DWI). -
2. Location of land-disturbing. ctivity: CountyLi (y i City or Township f( L'
Highway/Street ( Q, Lip)' LatiNde(decimal degrees) Longitude(deamal degrees)
3. Approximate date land-dis rbing activity will opmmence: 9 L1- ) OZ1-
4. Purpose of development(r sidential, commerotial, industrial, institutional, etc.): Q. `,1 r V V 4 tr= 1
5. Total acreage disturbed or ncovered (includir{g off-site borrow and waste areas):
6. Amount of fee enclosed: $ . The application fee of$100.00 per acre (rounded
up to the next acre) is assessed without a ceil ng amount (Example: 8.10-acre application fee is $900).
Checks should be addressed to NCDEQ.
7. Has an erosion and sediment control plan beei,i filed? Yes► Enclosed 1 No C
8. Person to contact should erosion and sedimen control issues arise during land-disturbing activity:
Name DO \&)'1\11 clrY'I E-mail Address C r me t�-� CLi CO ,C.ekv
Phone: Office# ZS) - 3 Mobile# -- C) 7 _ V.4,C1 l p
9. Landowner(s)of Record (attach accompanied gage to list additional owners):
Nam CA k r'tj A C_) 1{' U& )'x== /A -C-1\- ?S:).D(:}-- )1- `i
Phone: Office# Mobile#
4d C _. ___JD,___(-Q — 1, yrl~-(At
urrent Mai ing A rest Current Street Address
City State Zip City V 1 State Zip
10. Deed Book No. RP 7 Page No. 4D `J Provide a copy of the most current deed.

Part B.
1. Company(ies)who are financially responsible fur the land-disturbing activity(Provide a comprehensive list
of all responsible parties on accompanied page.)If the company is a sole proprietorship or if the landowner(s)is
an individual(s), the name(s) of the owner(s) may be listed as the financially responsible party(ies).
Company Name I E-mail Address
tom' - -Dq 'U- n v-rr- —
Current Mailing Address Current Street Address
,� (\ 7r7Q,Sp
City �C � State Zip ' City t �`..� State `�� Zip
Phone: Office# 7 2- )....-0) Mobile# ,4 — :)> l Ci -.c
Note: If the Financially Responsible Party is not tha owner of the land to be disturbed, include with this form
the landowner's signed and dated written consent fc r the applicant to submit a draft erosion and sedimentation
control plan and to conduct the anticipated land disi:urbing activity.
2. (a) If the Financially Responsible Party is a domestic company registered on the NC Secretary of State
business registry, give name and street address of the Registered Agent:
n S \.0i 1i r,5 c o1 -c Gt51_,cory-
Name of Registered Agent E-mail Address J
VD B64- l/`ur.=,�,,�
Current Mailing Address Current Stre Address
rcv nc. ; -)q k nc -a� s�
City c�JJ State Zip City J State Zip
Phone: Office# ? ) .I Cf2O) Mobile # 2,5) 7 O Z Q �L4 f
ame of Individual to Contact (if Registered Ageit is a company)
(b) If the Financially Responsible Party is not a resident of North Carolina, give name and street address
of the designated North Carolina agent who is registered on the NC Secretary of State business registry:
Name of Registered Agent E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Phone: Office# Mobile#
Name of Individual to Contact(if Registered Agent is a company)

(c) If the Financially Responsible Party is engaging in business under an assumed name,give name under
which the company is Doing Business As. If the Financially Responsible Party is an individual, General
Partnership, or other company not registered and doing business under an assumed name. attach a copy
of the Certificate of Assumed Name.
1 `Gt1r )^1 0,k1 (L'y1 -1-ruc Lc +-j�/�
Company DBA Name
The above information is true and correct to thc 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(s)
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 Party). I agree to provide
corrected information should there be any change in the information provided herein.
..1)01" S ‘A.), I I.t )(1) VP
Type or print name Title or Authority
L,L.
Signature ,1" �`
Date
Yh , a Votary Public of the County of---- , ajCrrAcik.i
State of North Carolina, hereby certify that, r%) Oki t t✓( I41t'j' � appeared personally
before me this day and being duly sworn acknow edged that the above form was executed by him/her.
Witness my hand and notarial seal, this - I clay of \,LA LL ,27 ZOZ-
Notary
My commission expires I 11
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p.N1100_
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Continued from Items 9 & 10 in Part A of the Financial Responsibility/Ownership Form for multiple
owners. Attach copies of this page as needed to list all landowners.
Landowner 2 of Record:
Name Phone: Office# Mobile#
Current Mailing Address Current Street Address
City State Zip City State Zip
Deed Book No. Page No. Provide a copy of the most current deed.
Landowner 3 of Record:
Name Phone: Office# Mobile#
Current Mailing Address Current Street Address
City State Zip City State Zip
Deed Book No. Page No, Provide a copy of the most current deed.
Landowner 4 of Record:
Name Phone: Office# Mobile#
Current Mailing Address Current Street Address
City State Zip City State Zip
Deed Book No. Page No. Provide a copy of the most current deed.
Landowner 5 of Record:
Name Phone: Office# Mobile#
Current Mailing Address Current Street Address
City State Zip City State Zip
Deed Book No. Page No._, Provide a copy of the most current deed.

Continued from Item 1 in Part B of the Financial Responsibility/Ownership Form for multiple parties.
Attach copies of this page as needed to list all financially responsible parties.
Company 2 Name E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Phone: Office# Mobile#
Company 3 Name E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Phone: Office# Mobile#
Company 4 Name E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Phone: Office# Mobile#
Company 5 Name E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Phone: Office# Mobile#

BK 1608 PG 540 - 543 (4) DOC# 362132
Exhibit "A"
Tract One:
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,BAH that certain property shown on the plat ehtitled: "Amended Boundary Survey for Thomas
Idon Jones" by William T. Robbins, Professional Land Surveyor, dated February 21, 2001, and
��corded in Plat Cabinet C-2, Slide 281 of the Cirrituck County Registry.
Tr`� Two:
BegirNrcing at an existing concrete monument shown on that plat prepared by Jasper W. Hassell,
RegisteM Land Surveyor, date March 13, 11i81, and recorded in Plat Cabinet A, Page 287,
Currituc Aunty Registrar of Deeds office, in the easterly margin of U. S. Highway No. 158, and
running th(I'ce North 71° 50' East 200.0 feet to a point; thence North 71° 02' East 230.0 feet to
an existing i pipe, thence continuing along a ditch North 70° 53' East 174.85 feet to a set iron
pipe on the a of a ditch,thence North 68° 10' East 208.26 feet to an iron pipe on the shoulder
of a ditch; thenceeNorth 69° Q3' East 696.15 feet to a set iron pipe; thence South 27° 28' East
8.99 feet to a set i<n pipe;thence continuing 5,outh 27° 28' East 51.02 feet to a point;thence in
a generally Westerly direction and parallel to the line specified above 1,079.26 feet, more or less,
to a point shown as the Southeast boundary between the Thomas Eldon Jones property and
Margaret J. Jolliff prop+, on the plat referred to hereinabove, thence along the Margaret J.
Jolliff property South 71°'P' West 231.43 feet to a point;thence South 71°59' West 192.90 feet
to a point on the East right ay of U.S. Highvt ay No. 158;thence along the right of way of U. S.
Highway No. 158 North 26°'` `'West 60.59 feet to an existing concrete monument, being the
point and place of beginning. y'
This property is conveyed subject an agreement dated February 25, 1982, by Thomas E. Jones
and wife, Evalena Jones and the Detment of transportation with said agreement being known
as a Sight Distance, and being more irticularly described as follows:
Beginning at an iron pin situated in the Eitnright of way line of U.S. Highway No. 158,which Iron
pin is located 40 feet East of and perpenlaw to the center line of U. S. Highway No. 158, and
is further described as T. Eldon Jones' Nli+vest corner; running thence from the point of
beginning along and with the Grantors' Northlie, North 71°02' East 54.42 feet to apoint;thence
South 19° 18' West 76.33 feet to an iron pipe t he East right of way of U. 5. Highway No. 158,
which iron pipe is in the common property bola Ary dividing the property of the grantors and
Margaret J.Jolliff;thence along and with the East right of way line of U. S. Highway No. 158, North
26°00'West 59.92 feet to the point of beginning.
Tract Three: i'
All right, title and interest of the grantors in and to any re3state located within the boundaries
of Tax ID Numbers 0069-000-0037-0000 and 0069-000-{ 2-0000 as shown on the aerial
photographs in the Currituck County Tax Supevisor's office JG1her or not included within the
boundaries of the first and second tract.
Less and Except: That certain portion of the above-described Tra'41 & 2 & 3 acquired by the
State of North Carolina and further described as a .0012-acre paace r1pbre or less in the Consent
Judgment in Book 984, Page 859, Currituck CoL my Public Registry.
6
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,,.k. Book 1608 Page 543

BK 1608 PG 540 - 543 (4) DOC# 362132
This Document eRecorded: 03/18/2021 04:30:30 PM
Tax: $360.00 Fee: $26.00
6 Currituck County, North Caroline
v•-a Denise A. Hall, Register of Deeds
'
Currituck Count.vriand Transfer Tax: 1800.00 County Excise Tax: 1985 Sessions Law Chapter 670 (HB 215)
0
North Carolina
Currituck Count
Land Transfer Nu ber:
Land Transfer Tax: ,800.00
Excise Tax(.2%): s36Po
Parcel#:006900000370000 and 006;p00000520000
Prepared By:James R.Gilreath,Jr.,Rose Harrison Gilreath&Powers,P.C.,P.O.Box 4o5,Kill Devil Hills NC 27948
File No:zi-1168-S
Recu t to: Brumsey&Brumsey, j.C,P.O.Box too,Curritui.k,NC 27929
THIS INSTRUMENT PREPARED ES R.GILREATH,JR.,A LICENSED NORTH CAROLINA ATTORNEY.
DELINQUENT TAXES,IF ANY,TO AID BY THE CLONING ATTORNEY TO THE COUNTY TAX COLLECTOR UPON
DISBURSEMENT OF CLOSING PR cc.p,,F6pS.
NORTH CAlte9' GENERAL WARRANTY DEED
M & B 'a3acels, ',;aratoke Hwy, Barco,
� NC 27917
THIS DEED is made this I V '2 y Ailarch, 2021,by and between Thomas Eldon Jones,Jr.,
unmarried and Larry Wayne Jones,unma>r eel, of Post Office Box i, Camden, NC 27921, Grantor
AND Mainstay Construction,Inc.,a North Orolina corporation, of Post Office Box 429, Moyock,
NC 27958, Grantee. �k
The designation of Grantor and Grantee a:; herein shall include said parties, their heirs,
successors and assigns and shall include singular, pl a , masculine, feminine or neuter as required by
context.
WITNESSETH, that the Grantor, for valuable consiftation paid by the Grantee, the receipt of
which is hereby acknowledged, has and by these presents d4-e§grant, bargain, sell and convey unto the
Grantee in fee simple,all that certain lot or parcel of land situ d in Crawford Township, Currituck
County,North Carolina and more particularly described as forts:
SEE EXHIBIT"A"ATTACHED HERETO AAD INCORPORAVtb HEREIN BY REFERENCE.
Title to the property hereinabove described was acquired by0 'Grantor by instrument recorded
in Book 574, Page 306 and in Book 574, Page zo8,Currituck County .estry.
All or a portion of the property herein cot veyed does not include the„primary residence of a
Grant Submitted electronically by "Brumsey and 13rumsey PLLC"
in compliance with North Carolina statutes governing recordable doc nts
and the terms of the submitter agreement brith the Currituck County R ��s``ter of Deeds.
Y,A Book 1608 Page 540

BK 1608 PG 540 - 543 (4) DOC# 362132
TO HAVE AND TO HOLD the aforesaid .ot or parcel of land and all privileges and
,� appurtenances thereto belonging to the Grantee n fee simple.
0
Grantor covenants to and with Grantee that Grantor is seized of the premises in fee simple, has
\-t-' right to convey the same in fee simple, that ti:le is marketable and free and clear of all
eKumbrances, and that Grantor will warrant anc defend the title against the lawful claims of all
pe slibns whomsoever, subject to the exceptions h'reinafter stated:
Q)i. Ad valorem taxes for the year z)21 and subsequent years;
Restrictive covenants and the amendments thereto, if any, of record in the
aforesaid.Public Registry;
3.0 Easements of record;and
4. 0 Any local, county,state, or fedc,ral laws,ordinances, or regulations relating to
oning, environment,subdivision, occupancy,use, construction, or
velopment of the subject property.
IN WITS WHEREOF the Grantor sets his hand and seal on the day and the year first
above written.
eC
rk. ,„c_ ,J,,
f,l/ ...,_ (SEAL)C, Thomas Eldon Jones, Jr. ,r
State of thjzx iie
County of 7d.SQr/U TQ d4 re @
1, the undersigned, a Nota ublic, in and for the said jurisdiction, do hereby certify
that Thomas Eldon Jones,Jr. personA appezred before me this day and acknowledged the
due execution of the foregoing instrumat.
Witness my hand and official seas /� _day of March, 2021.
5
(SEAL/STAMP) `Q , Ui ./ ,, ' ,7
' otary Public
Dawn Ell in *w'r ` f 3
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Notary Pubic My commission expires: ' '
PasqUatafirth k ofl
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V,), Book 1608 Page 541

BK 1608 PG 540 - 543 (4) DOC# 362132
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;d - Di.'-V----- (SEAL)
\< • Larry Wayne Jones
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State of -_ -(
County o _.y r .,\\- t
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I, the • 4 ersigned, a Notary Public, in and for the said jurisdiction, do hereby certify
that Larry Wa l'•4 ones personally appeared before me this day and acknowledged the due
execution of the • egoing instrument.
Witness myand and official seal this day of March, 2021.
(SEAL/ST.nfir) ,
0 Notary Public
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`\\\ p ckU E /i/ My commission expires: IcyCanmissio Bcpirr3s3-19-2022
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Book 1608 Page 542