NCC241951_FRO Submitted_20240710

Cot*
Pitt County
4 L`1'�. Planning Department
Development Services Building
I 1717 W. 5th Street
' rcw7� Greenville, North Carolina 27834-1696
Telephone: [phone] James F.Rhodes,AICP
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 Eagle Rock Concrete Ayden Plant
2. Location of land-disturbing activity: County Pitt
City or Township Ayden , and Highway/Street Old NC 11
3. Approximate date land-disturbing activity will be commenced: June 2024
4. Purpose of development(residential, commercial, industrial, etc.): Industrial
5. Approximate acreage of land to be disturbed or uncovered: 14.0
6. Has an erosion and sedimentation control plan been filed? Yes X No
7. Person to contact should sedimentation control issues arise during land-disturbing activity:
Name Dexter Tart Telephone [phone]
8. Landowner(s) of Record(Use blank page to list additional owners):
Eagle Rock Concrete,LLC Tripp Farms,LLC
Name(s) Name(s)
8311 Ban dford Way.Suite 7 105 Marion Dr.
Current mailing address Street address
Raleigh, NC 27615 Greenville NC 27858
City State Zip City State Zip
9. Recorded in Deed Book No. 4490 Deed Book: 3649 Page 30, DB889 PG169
Part B. Page No. 142 & DB889 PG 175
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):
Eagle Rock Concrete,LLC
Name of person(s)or Firm(s) Name(s)
8311 Bandford Way, Suite 7 8311 Bandford Way,Suite 7
Current mailing address Street Address
Raleigh, NC 27615 Raleigh, NC 27615
City State Zip City State Zip
919-781-3744 919-781-3744
Telephone Telephone

2. (a) If the Financially Responsible Party is a Corporation, give name and street address of
the Registered Agent.
J.G.Loftin,Jr.
Name(s)
8311 Sandford Way,Suite 7 8311 Bandford Way,Suite 7
Current mailing address Street Address
Raleigh. NC 27615 Raleigh, NC 27615
City State Zip City State Zip
919-781-3744 919-781-3744
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):
N/A
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.
J.G.Loftin,Jr. Managing Member
Typ o print e Title or Authority
Sig lure Date
I, tract UJ � n , a Notary Public of the County of W aak.e. State
• of North Carolina,hereby certify that 3'.G. L c3P1-i✓v, Tr-.
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 Lo- day of -TvA e_ . 20 a 4.
Notary
My commission expires 518/48 .
TRACY W GREEN
NOTARY PUBLIC
WAKE County
North Carolina
My Commission Expires May 8, 2028