NCC232521_FRO Submitted_20230829

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FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
SEDIMENTATION POLLUTION CONTROL ACT
EXPRESS PERMITTING OPTION
No person may initiate any land-disturbing activitvononeormomsaonauoeoovenadbvtheActbmforethioform
and an acceptable erosion and sedimentation control plan have been completed and approved by the Land
Cluo|ky Section, N.C. Department of Environmental C\uaUh/ Submit the completed homu to the appropriate
Regional Office. (Please h/pa or print and, if the question is not applicable or the e-mnoil address or phone
number iaunavailable, place N/A in the b|onk.)
Part A.
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1. Project�onoa=� ^ ~°°= Section ^,"
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2. Looahoncf land-disturbing aoUv�y: County ' C�yor Township�Jacksonville
H' hvvay/StnaetNCSR 1105 Latitudewemmmu°nae* 34043'44^ Long itudemaummdegrees) 77032'08"
3. Approximate date land-disturbing activity will commence: May 1 , 2022
4. Purpose of development(residential, commercial, industrial, institutional, etc.): Residential
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S. Total acreage disturbed or uncovered (indudingoff-site borrow and waste anaoa): ^^^'-'^1
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G. Amount of fee enclosed ~p `'-`==^~^~^ . The Express Permitting application fee is o dwo| charge.
The non-nal fee of$100.00 per acre(rounded up to the next acre)is assessed without a ceiling amount.
In addition,the Express Permitting supplement is$250 per acre up to eight acres,afterwhich the Express
Permitting supplemental fee iao fixed$2.0O0.00 (Exsmp|a:8.10-oone application fee im$2.90O). Checks
should bo addressed toNCDEQ.
7. Has an erosion and sediment control plan been filed? YoaF] Enclosed No �]
G. Person to contact should erosion and sediment control issues arise during land-disturbing activity:
NmmaUohn L. Pierce E-mail Address be+txb@jIpnc'com
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Phone: 0�c�# �~^ ^�/��^° =^^°= �ohika# ^"'""
8. Landowner(s)of Record (attach accompanied page to list additional owners):
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Name Phone Offica# Mobile#
P.O. Box 1685 405 Johnson Blvd.
Current Mailing Address Current Street Address
Jacksonville @C 28541 Jacksonville NC 28540
ZUy State Zip City State Zip
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10. DeedBookNo."^^`^-" Page No.=�`' °°'= Provide m copy of the most current deed.

PartB.
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(les).
Gate Stone1 | C @ilpMc_coM0
Company Name E-mailAddress
P.O, Box 1685 405 Johnson Blvd.
Current Mailing Address Current Street Address
Jacksonville NC 28541 Jacksonville NC 28540
City State Zip City State Zip
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Phone: O�c�# �� '°y =-'= �=^^" KAobika# '"'^`
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 ho conduct the anticipated land disturbing activity.
2. (a) If the Financially Responsible Party is a domestic company registered on the NC Secretary ofState
business registry, give name and street address cf the Registered Agent:
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 iaacompany)
(b) |f the Financially Responsible PahyionotonaoideniofNodhCaro|ino. givanomeondotnaetaddrama
of the designated North Carolina agent who is registered on the NC Secretary of State business registry:
Betty Bullock beftyb6�|K�nc_c����
NanoeofReO�tenydAgent E-mail Address
P.O' Box 1685 405 Johnson B1md,
Current Mailing Address Current Street Address
Jacksonville NC 28541 Jacksonville NC 28540
city State 3]p City State Zip
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Phone: OfOo�# �^� '"�^°-"= ^~=== K8obi|�# ^"'"^
Name of Individual ho Contact(if Registered Agent iaocompany)
(c) |f the Financially Responsible Party io engaging in business under on 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
(d) If order to facilitate Express Permitting, it is necessary to be able to contact the engineer or other
consultant who can assist in providing any necessary information regarding the plan and its preparation:
Engineering firm or other consultant E-mail Address
Individual contact person(type or print) Phone: Office# Mobile#
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.
John L. Pierce Member/Manager
Type or print name Title or Authority
Sign re Date
I,'DCS\r2Q, R.• P1 Y\C 1 QQ , a Notary Public of the County of Onslow
State of North Carolina, hereby certify that John L. Pierce 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 c0i 1 S*- day of A vr"1, , 20
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Notary
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PING ."1, 10/24/26
Seal �� tGf,,.•N- My commission expires
,: NARY �'':
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Continued from Items S & YOi7Patt A of the Financial ResponsibilitylOwnership Form for multiple
owners. Attach copies mf this page ms needed&olist all landowners.
Landowner 2ofRecord:
Name Phone: Office# Mobile#
Current Mailing Address Current Street Address
City State Zip City State Zip
Deed Book No. Page No. Provide o copy of the most current deed.
Landowner 3ofRecord:
Name Phone: Offioa# YNobi|e#
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 4ofRecord:
Name Phone: Offine# Mobile#
Current Mailing Address Current Street Address
City State Zip City State Zip
Deed Book No. Page No. Provide a copy uf the most current deed.
Landowner GofRecord:
Name Phone: Office# Mobile#
Current Mailing Address Current Street Address
City State Zip Qb/ State Zip
Deed Book No. Page No. Provide n copy of the most current deed.

Continued from Item I 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#

Stormwater & ESC Narrative
Gate Stone Section III Subdivision
Gate Stone, LLC. proposes to construct a 19 lot residential subdivision on a 28.77 acre tract
located along Haws Run Road (NCSR 1105)just south of Jacksonville in the Township,
Onslow County. The tract is currently vacant. Several small areas of non-coastal wetlands
exist along the western border of the proposed development and a drainage course which
bisects the tract.
Gate Stone, LLC. proposes to construct roadway, drainage &water distribution facilities
only. Lots will be developed by the Permittee. The disturbed area as proposed is 13.4
acres.
The project site sits on a ridge and drains to a UT of Southwest Creek in the White Oak
Basin, Stream Class C:NSW.
Site topography is moderately sloping (0— 6%), draining generally towards the south and
west.
Proposed Erosion & Sedimentation Control measures include a temporary construction
entrances as well as temporary skimmer basins. These measures have been sized and
located so as to contain sediment on site.
Soils are of the Norfolk Loamy Fine Sand, Goldsboro fine sandy loam, and Marvyn loamy
fine sand series.