NCC242206_FRO Submitted_20240722

FINANCIAL RESPONSIBILITY/OWNERSHIP 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 N/A in the blank.)
Part A.
1. Project NameAtlantic Gateway Force Main and Pump Station Project
2. Location of land-disturbing activity: County Anson City or Township Lilesville
Highway/Street US 74 / SR-1801 Latltude(decimal degrees)34 945 -79 909
Longitude(decimal degrees)
3. Approximate date land-disturbing activity will commence: March 2024
4. Purpose of development (residential, commercial, industrial, institutional, etc.): Industrial
5. Total acreage disturbed or uncovered (including off-site borrow and waste areas): 8.6 Acres
6. Amount of fee enclosed: $900 . 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 0 No ❑
8. Person to contact should erosion and sediment control issues arise during land-disturbing activity:
Name Adam Hogan E-mail Address [e-mail]
Phone: Office# [phone] Mobile# [phone]
9. Landowner(s)of Record (attach accompanied page to list additional owners):
Pee Dee Electric Membership [phone]
Name Phone: Office# Mobile#
9825 Highway 74 East 9825 Highway 74 East
Current Mailing Address Current Street Address
Lilesville NC 28091 Lilesville NC 28091
City State Zip City State Zip
10. Deed Book No. 01237 Page No. 0329 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).
Anson Economic Development Corporation [e-mail]
Company Name E-mail Address
202 East Wade Street 202 East Wade Street
Current Mailing Address Current Street Address
Wadesboro NC 28170 Wadesboro NC 28170
City State Zip City State Zip
Phone: Office# [phone] Mobile# N/A
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 Party is a domestic company registered on the NC Secretary of State
business registry, give name and street address of the Registered Agent:
Donald P Scarborough [e-mail]
Name of Registered Agent E-mail Address
Post Office Box 29622 2 South Salisbury Street
Current Mailing Address Current Street Address
Raleigh NC 27626 Raleigh, NC 27601
City State Zip City State Zip
Phone: Office# 919-814-5400 Mobile# N/A
Name of Individual to Contact(if Registered Agent 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)

— a £E
(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 inform tion sho
uld there be any change in the information provided herein.
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1, t 1C,4vJs Tt V\1 tab , a Notary Public of the County of )itiy`l (
State of North Carolina,hereby certify that \N ii\r d f t\ (. \\(A i 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 ' day of , 20
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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:
Anson County Water Dept. 704-994-3281
Name Phone: Office# Mobile#
101 S Greene St, Suite 2023 00382 Haileys Ferry Road
Current Mailing Address Current Street Address
Wadesboro NC 28170 Lilesville NC 28091
City State Zip City State Zip
Deed Book No. 930 Page No. 0230 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.

FILED
ANSON COUNTY, NC
GREG L. EUDY
REGISTER OF DEEDS
FILED Apr 30, 2020
AT 02:28 pm
BOOK 01237
START PAGE 0329
END PAGE 0331
INSTRUMENT# 00842
RECORDING $26.00
EXCISE TAX $892.00
NORTH CAROLINA GENERAL WARRANTY DEED
Excise Tax: si 2.o0
Parcel Identifier No. 742300777754,742300878376, 742300970909 Verified by County on the day of ,20
By:
Mail/Box to:
This instrument was prepared by: Mark T. Lowe, Attorney at Law, Post Office Box 1039, Wadesboro,NC 28170
Brief description for the Index: 127.159 acres, Lilesville,North Carolina,28091
THIS DEED made this 3D�i day of April,2020,by and between
GRANTOR GRANTEE
Pee Dee Electric Membership Corporation
NPDR, LLC,a North Carolina Limited Liability Co. 575 US Highway 53 South
Post Office Box 1039 Wadesboro, NC 28170
Wadesboro,NC 28170
Enter in appropriate block for each party: name, address, and, if appropriate, character of entity, e.g. corporation or
partnership.
The designation Grantor and Grantee as used herein shall include said parties, their heirs, successors, and assigns, and shall
include singular,plural,masculine, feminine or neuter as required by context.
WITNESSETH, that the Grantor, for a valuable consideration paid by the Grantee, the receipt of which is hereby
acknowledged, has and by these presents does grant,bargain, sell and convey unto the Grantee in fee simple, all that certain lot
or parcel of land situated in the City of Lilesville_, Lilesville_Township, Anson County, North Carolina and more particularly
described as follows:
See attached Schedule "A"
The property hereinabove described was acquired by Grantor by instrument recorded in Book 1158, page 075, Book 1158,
Page 078 ,and Book 1158 page 84.
A map showing the above described property is recorded in__,__.
TO HAVE AND TO HOLD the aforesaid lot or parcel of land and all privileges and appurtenances thereto belonging to the
Grantee in fee simple.
NC Bar Association Form No. 3 © 1976, Revised© 1977,2002
Printed by Agreement with the NC Bar Association— 1981 -Chicago Title Insurance Company

And the Grantor covenants with the Grantee, that Grantor is seized of the premises in fee simple, has the right to convey the
same in fee simple,that title is marketable and free and clear of all encumbrances, and that Grantor will warrant and defend the
title against the lawful claims of all persons whomsoever,other than the following exceptions:
IN WITNESS WHEREOF,the Grantor has duly executed the foregoing as of the day and year first above written.
NPDR, LLC,A NORTH CAROLINA LIMITED LIABILITY (SEAL)
COMPANY
(Entity Name)
By:
Mar T. Lowe (SEAL)
Title: Member/Manager
By:
(SEAL)
Title:
By:
(SEAL)
Title:
SEAL-STAMP State of North Carolina—County of
I, the undersigned Notary Public of the County and State aforesaid, certify that
personally
appeared before me this day and acknowledged the due execution of the foregoing instrument for the
purposes therein expressed. Witness my hand and Notarial stamp or seal this day of
20
My Commission Expires:
Notary Public
��446t[{-, MP State of North Carolina-County of ANSON
e •• • ., i�RyV \ I, Allison C. Austin,the undersigned Notary Public of the County and State aforesaid, certify that Mark T.
� :\ � Lowe personally came before me this day and acknowledged that_he is the Member/Manager of NPDR,
s -`G• ci LLC, a North Carolina limited liability company, and that by authority duly given and as the act of such
p U B L ,4' ,' entity, he signed the foregoing instrment in its name on its behalf its act and deed. Wrtne my nd
'/,`'•.• ',.• • and Notarial stamp or seal,this .0 day of April,2020. v N
. ••......• fi '
,q1-1-
i My C mission Expires:
we,, ;N
...� Q2 (.(- 023 Notary Public 4 w S b-1\ 4-t /1
SEAL-STAMP State of North Carolina-County of
I,the undersigned Notary Public of the County and State aforesaid,certify that
Witness my hand and Notarial stamp or seal,this day of ,20 .
My Commission Expires:
Notary Public
NC Bar Association Form No. 3 © 1976,Revised© 1977,2002
Printed by Agreement with the NC Bar Association— 1981 -Chicago Title Insurance Company

SCHEDULE "A"
Lying and being located in Lilesville Township, Anson County, North Carolina, and more
particularly described as follows:
FIRST TRACT:
BEING all of Parcel 1 containing a total of 48.350 acres, more or less, lying to the north of U.S.
Highway 74, according to and as shown on that certain plat, plan, and survey entitled "Minor
Division & Recombination Plat for Property of NPDR, LLC," dated April 24, 2020, drawn by
Tony D. Carpenter, NCPLS, and recorded in Plat Book 2020, Pages 4-4I- , 95 , G, y'7L ,
and 4 g , Anson County Registry, reference to which plat, plan, and survey is hereby made for a
more complete description of the aforesaid Parcel 1 containing a total of 48.350 acres, more or
less, by metes, bounds, courses, and distances.
BEING the portion lying to the north of U.S. Highway #74 of that certain property as was
conveyed by Leak Rental Account, LLC to NPDR, LLC by deed dated July 5t , 2016, and
recorded in Deed Book 1158, Page 78, Anson County Registry.
ALSO containing all of the property as was conveyed by James A. Leak, III and wife, Sandra C.
Leak to NPDR, LLC by deed dated July 5th, 2016, and recorded in Deed Book 1158, Page 75,
Anson County Registry.
SECOND TRACT:
BEING all of Parcel 2 containing a total of 78.809 acres, more or less, lying to the south of U.S.
Highway 74, according to and as shown on that certain plat, plan, and survey entitled "Minor
Division & Recombination Plat for Property of NPDR, LLC," dated April 24, 2020, drawn by
Tony D. Carpenter, NCPLS, and recorded in Plat Book 2020, Pages Li4 , Li 5 , q/o , ,
and y 8 , Anson County Registry, reference to which plat, plan, and survey is hereby made for a
more complete description of the aforesaid Parcel 2 containing a total of 78.809 acres, more or
less, by metes, bounds, courses, and distances.
BEING the portion lying to the south of U.S. Highway #74 of that certain property as was
conveyed by Leak Rental Account, LLC to NPDR, LLC by deed dated July 5th, 2016, and
recorded in Deed Book 1158, Page 78, Anson County Registry.
ALSO containing all of the property as was conveyed by John William Leak and wife, Jean G.
Leak to NPDR, LLC by deed dated July 19th, 2016, and recorded in Deed Book 1158, Page 84,
Anson County Registry.
NC Bar Association Form No. 3 © 1976, Revised© 1977,2002
Printed by Agreement with the NC Bar Association— 1981 -Chicago Title Insurance Company

0930 BOOK 9 3 0 PAGE 0 230
0230
2009 DEC 30 AM 9: 15
ANSON COUN Y. N.C.
Cr) REGISTER OF DEEDS
C
0
Prepared by: Poisson, Poisson& Bower, PLLC
Attorneys At Law
STATE OF NORTH CAROLINA
COUNTY OF ANSON
THIS DEED,made this the 27th day of August 2009.
by Hornwood, Inc., a North Carolina corporation with its principal place of
business in Anson County,North Carolina
of Anson County,North Carolina
grantor (whether one or more);
to The County of Anson, a body politic of North Carolina
c/o The County Manager
of 101 S. Greene Street
Wadesboro,North Carolina 28170
grantee (whether one or more),
WITNESSETH :
That for and in consideration of the sum of Ten Dollars ($10.00) paid to the
grantor by the grantee, the receipt of which is hereby acknowledged, together with other
good and valuable considerations, the grantor has bargained and sold and by these
presents does hereby grant, bargain, sell and convey to the grantee and its, his, her, or
their heirs, successors and assigns, a certain tract or parcel of land, lying in Lilesville
Township, Anson County, State of North Carolina, and more particularly described as
follows:
SEE SCHEDULE A ATTACHED

0930
0231 BOOK 9 3 0 PAGE 0231
TO HAVE AND TO HOLD said land and premises, with all the rights,
privileges and appurtenances thereunto belonging, or in anywise appertaining, to the said
grantee, The County of Anson and his,her, its, or their successors and assigns, in fee
simple.
And the grantor, for himself, herself, itself and themselves and their successors,
heirs, executors and administrators, covenant with the grantee and the grantee's heirs,
successors and assigns, that the grantor is seized of said premises in fee and has the right
to convey the same in fee simple; that the same are free and clear from encumbrances and
that the grantor does hereby forever warrant and will forever defend the title to the same
against the lawful claims of all persons whomsoever.
Whenever used, the singular number shall include the plural, the plural the
singular, and the use of any gender shall be applicable to all genders.
IN TESTIMONY WHEREOF, the said grantor does hereto subscribe his name
and affix his seal the day and year first above written.
Hornwood, Inc. r
�� ®� ��1 `(�ai`1!1 zJi
By: L �lc�"''4 �1'
President • `
�' -35
`
,\

0930
0232 BOOK 3 0 PAGE 0232
STATE OF NORTH CAROLINA
COUNTY OF ANSON
I, a Nota/ry. Public for said County and State, do hereby certify that
�,gpz& /hiZ. personally came before me this day and acknowledged that
he is President of Hornwood, Inc. and acknowledged, on behalf of Homwood, Inc., the
due execution of the foregoing instrument.
T,
Witness my hand and notarial stamp or seal this the 2 7 day of Af uUus j',
2009.
Girt/I-- •.. -ee" :410---r-777----.,
Notary Public , 1" J,,
My Commission Expires: %/ aD/� r� 1 u 11 �
Vi Q
J, t
�' '44+ Nr4 :

0930
0233
bUUK 930 Nk\v-0 2 3,3
SCHEDULE A
BEGINNING at a point that is located in the western right of way line of State
Road No. 1801 (Haileys Ferry Road)where the southern right of way line of SAL
Railroad crosses said highway right of way according to the plat entitled, "Map of James
D. Liles Tract, property of Dr. J. Edwin Kerr"dated November 12, 1919, and recorded in
the Anson County Registry in Plat Book 1 at Page 53 and runs thence N. 56-10 W. along
the southern edge of said railroad right of way fifty (50) feet to a point in said right of
way; thence in a southeasterly direction and parallel with the centerline of said State
Road No. 1801 fifty (50) feet to a point; thence S. 56-10 E. parallel with said railroad
right of way line fifty(50) feet; thence in a northwesterly direction along the western
edge of said public highway right of way fifty(50) feet to the point of beginning. The
same being a rectangular piece of land with each side fifty (50) feet.
The same being a portion of that tract of land conveyed to Collier B. and Mildred
P. Aycock by Charles W. Poplin, et als, by deed dated April 29, 1968 and recorded in the
Anson County Registry in Deed Book 161, Page 452.
Reference is made to Book 205, Page 832, Anson County Registry.