NCC241411_FRO Submitted_20240513

cop Pitt County
�� e, Planning Department
Development Services Building
16 4, 1717 W. 5th Street
cAo Greenville, North Carolina 27834-1696 James F. Rhodes,AICP
Telephone: [phone]
Fax: [phone] Director
Financial Responsibility/Ownership Form
Soil Erosion and Sedimentation Control Ordinance
No person may initiate any land-disturbing activity on one or more contiguous acres as
covered by the Act before this form and an acceptable erosion and sedimentation control plan
have been completed and approved by the Pitt County Planning Department. (Please type or
print and, if question is not applicable, place N/A in the blank.)
Part A.
1. Project Name Belvoir Dollar General
2. Location of land-disturbing activity: County Pitt
City or Township Belvoir , and Highway/Street NC 33 W. Hwy.
3. Approximate date land-disturbing activity will be commenced: April 2024
4. Purpose of development(residential, commercial, industrial, etc.): commercial
5. Approximate acreage of land to be disturbed or uncovered: 2.00 acres
6. Has an erosion and sedimentation control plan been filed? Yes_ No X
7. Person to contact should sedimentation control issues arise during land-disturbing activity:
Name Bryan C. Fagundus, P.E. Telephone [phone]
8. Landowner(s) of Record(Use blank page to list additional owners):
Happy Trail Farms, LLC
Name(s) Name(s)
P.O. Box 1863
Current mailing address Street address
Greenville NC 27835
City State Zip City State Zip
9. Recorded in Deed Book No. 3624 Page No. 98
Part B.
1. Person(s) or firm(s) who are financially responsible for this land-disturbing activity (Use
the blank page to list additional persons or firms):
Glandon Forest Equity, LLC
Name of person(s)or Firm(s) Name(s)
3825 Barrett Dr., Suite 100
Current mailing address Street Address
Raleigh NC 27609
City State Zip City State Zip
919-459-2601
Telephone Telephone

2. (a) If the Financially Responsible Party is a Corporation, give name and street address of
the Registered Agent.
George T. Barnes, Jr.
Name(s)
3825 Barrett Dr., Suite 100
Current mailing address Street Address
Raleigh NC 27609
City State Zip City State Zip
919-459-2601
Telephone Telephone
(b) If the Financially Responsible Party is a Partnership give the name and street address
of each General Partner(Use blank page to list additional partners):
Name(s) Name(s)
Current mailing address Current mailing address
City State Zip City State Zip
Telephone Telephone
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/her attorney-in-fact or if not an individual by an officer, director, partner, or
registered agent with 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.
George T. Barn s, Jr. Manager
Type or p ntin Title or A thori
Signature Date
I, 1 1 I I G mil- AO id , a Notary Public oA the County of V VaK-�. State
of North Carolina, hereby certify that C e T JAIV1 e) Jr
appeared personally before me this day and berg duly sworn acknowledged that the above form
was executed by him. LL-
Witness my hand and notarial seal thislit day of Atk&r . 203
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Notary
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