NCC223979_FRO Submitted_20221130

FINANCIAL RESPONSIBILITYIOWNERSHIP 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 address or phone
number is unavailable, place NIA in the blank.)
Part A.
1. Project Name North Topsail Land
2. Location of land -disturbing activity: County_Onslow City or Township_Sneads Ferry_
Highway/Street—NC 210 Latltude(decimai degrees)_34.5413_ Longitude(decimal degrees),_ 77.4289_
3. Approximate date land -disturbing activity will commence:_1/8/2022
4. Purpose of development (residential, commercial, industrial, institutional, etc.):_Mixed Use
5. Total acreage disturbed or uncovered (including off -site borrow and waste areas):_74.76
6. Amount of fee enclosed: $_7,500.00 . The application fee of $100.00 per acre
(rounded up to the next acre) is assessed without a ceiling amount (Example: 8.10-acre application fee
is $900). Checks should be addressed to NCDEQ.
7. Has an erosion and sediment control plan been filed? Yes ❑ Enclosed ® No ❑
8. Person to contact should erosion and sediment control issues arise during land -disturbing activity:
Name Mark Thurman E-mail [e-mail]
Phone: Office # 214-220-3421 Mobile #
9. Landowrier(s) of Record (attach accompanied page to list additional owners):
Kenneth Pratt. Topsail Landing , LLC
Name
_5950 Berkshire Lane Suite 800
Current Mailing Address
Dallas, TX 75225
City
10. Deed Book No.-4099
_214-220-3411 214-220-3411
Phone: Office # Mobile #
_Same
Current Street Address
State Zip City
Page No._91-95
State
Zip
Provide a copy of the most current deed.

Part B.
1. Company(ies) who are financially responsible for 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).
Topsail Landing, LLC.
Company Name
[e-mail]
E-mail Address
_5950 Berkshire Lane, Suite 800 _Same
Current Mailing Address Current Street Address
_Dallas TX 75225_ Same
City State Zip City State
Phone: Office # 214-220-3411 Mobile # [phone]
Zip
Note: if the Financially Responsible Party is not the owner of the land to be disturbed, include with this form
the landowner's signed and dated written consent for the applicant to submit a draft erosion and sedimentation
control plan and to conduct the anticipated land disturbing activity.
2. (a) If the Financially Responsible Parry is a domestic company registered on the NC Secretary of State
business registry, give name and street address of the Registered Agent:
Capitol Corporate Services, Inc.
Name of Registered Agent
_120 Penmarc Drive Suite 118
Current Mailing Address
_Raleigh, NC 27603
City State
Phone: Office # 800-345-4647
[e-mail]
E-mail Address
_Same
Current Street Address
Zip City
Mobile # NIA
Yvette Cleveland Assistant Secretary on behalf of Capitol Corporate Services Inc.
Name of Individual to Contact (if Registered Agent is a company)
State Zip
(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:
—Capitol Corporate Services, Inc.
Name of Registered Agent
_120 Penmarc Drive Suite 118
Current Mailing Address
_ Raleigh, NC 27603
City
State Zip
Phone: Office # 800-345-4647
[e-mail]
E-mail Address
Current Street Address
City
Mobile # NIA
Yvette Cleveland, Assistant Secretary on behalf of Capitol Corporate Services, Inc.
Name of Individual to Contact (if Registered Agent is a company)
State Zip

(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.
Company DBA Name
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(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.
Kenneth Pratt
name
Sig
Manager, Stockdale Investment Group, LLC
(sole Member of Topsail Landing, LLC)
Title or Authority
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Date
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State of , hereby certify that _ k e.nnakK P appeared personally
before me this day and being duly sworn acknowledged that the above form was executed by him/her.
Witness my hand and notarial seal, this 2-4 day of A&/ , y 20 -
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