NCC243321_FRO Submitted_20241106

Check if this project is ARPA-funded ❑
Attach a copy of the Letter of Intent tr) F,,nrt
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, including any
activity under a common plan of development of this size as covered by the NCG01 permit, 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 Name Ace Mini Storage Expansion
if this project involves American Rescue Plan Act(ARPA) funds, list the Project Name or Project
Number(e.g., SRP-D-ARP-0121) below under which you were approved for funding through the
Division of Water Infrastructure (DWI).
2. Location of land-disturbing activity: County Dare City or Township
Highway/Street S.R. 1118 Latitude(decimal degrees)35.916 Longitude(decimai degrees) 75.683
3. Approximate date land-disturbing activity will commence: 8/24/24
4. Purpose of development(residential, commercial, industrial, institutional, etc.): Commercial
5. Total acreage disturbed or uncovered(including off-site borrow and waste areas): 4.58
6. Amount of fee enclosed: $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 El No ❑
8. Person to contact should erosion and sediment control issues arise during land-disturbing activity:
Name James T. Dixon, Ill E-mail [e-mail]
Phone: Office# 2523305539 Mobile# [phone]
9. Landowner(s)of Record (attach accompanied page to list additional owners):
City Beverage Co., Inc. 2523305539 2522022608
Name Phone: Office# Mobile#
P.O. Box 1036 1471 Weeksville Rd.
Current Mailing Address Current Street Address
Elizabeth City, NC 27906 Elizabeth City, NC 27909
City State Zip City State Zip
10. Deed Book No.0947 Page No.0847 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).
City Beverage Co., Inc. [e-mail]
Company Name E-mail Address
P.O. Box 1036 1200 Park Drive
Current Mailing Address Current Street Address
Elizabeth City, NC 27906 Elizabeth City, NC 27909
City State Zip City State Zip
Phone: Office# 2523313985 Mobile#[phone]
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:
Jeffrey L. Dixon
Name of Registered Agent E-mail Address
P.O. Box 1036 1200 Park Drive
Current Mailing Address Current Street Address
Elizabeth City, NC 27906 Elizabeth City, NC 27909
City State Zip City State Zip
Phone: Office# 2523313985 Mobile#
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)

(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.
James T. Dixon, III Vice President
Tyr print name Title or Authority
/z
r Signature Date
I, 1,-M1 , In IZCtl a Notary Public of the County of pgL
State of North Carolina, hereby certify that ]P S 1 , ()COA. 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 Z1 day of t&A L1 , 20
Elizabeth E. Urch
Notary Public Notary Z.Att
Dare CoUnty, North Carolina �� �
My commission expires 04/12/2025 My commission expires J

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G�" _x13141e ' -:•' 0. 001= FILED
•--!._ ';i'i 6;:015 PM 1 90
.. , . . risY
. RE::. . DEEDS
o, .: • ", N.C.
v •
.1:{• $2400.00 •
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3421-94 Tax $480.00 Recording Tim,Book and Page
,;�,•i,4't. Tax Lot No. Parcel Identifier No. ...
r E••"•.,`n Verified by
x''�+,�''J County on the.,..._...,.day of 01/4'to
.. ,19
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' :':-8 ' Mail after recording to ...XkI,I+UGG,..`iNUE, EY. S... A ORAX ♦ / ''.
;..L .' Ras.t...Qf,£ice..Bax..).,N9.�.,�la.ntea,. NC Z7914...... .,. ' .. -4 •ii.,1,,
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This instrument was prepared by.John..C...,Graham....III.,.,_. ..,.. ...... .................. •
,,,! Brief descript:,Nr for the Index DRIFTWOOD ROAD, MANTEO, NC >�' t ``,
NORTH CAROLINA GENERAL WARRANTY DEE' a°.•,''''''`:
- •-q,: THIS DEED made this .. 8tl>< day of...August.................... ,ICJ.94.-.-,by and between % .
(' GRANTOR GRANTEE
ARNOLD G. TOLSON, JR. AND WIFE, DEBORAH TOLSON CITY BEVERAGE CO., INC.
11110 Post Office Box 1098 Poet Office Box 1036
Menteo, NC 27954 Elizabeth City, NC 27909
yA s
Enter la appropriate block for each party:new,address,am,V appropriate,chancier of entity,e.q.corporation or partnerabep.
•
The designation Grantor and Grantee as used herein shall include said parties,their heirs,successors,and assigns,and
shell include singular,plural,masculine, feminine or neuter as required by context.
WITNESSETH, that the Grantor, for a valuable consldertNon paid by the Grantee, the receipt of which is hereby
acknowledged, has and by these presents does grant. bargair, Fell and convey unto the Grantee in fee simple, all that
.
certain lot or parcel of land situated In the City of._ .. . . •Na$a Heed, Township,
DARE County,North Carolina and more partical.rly described as follows:
•
SEE ATTACHMENT MARKED "EXHIBIT A" INCORPORATED B-dP2IN AS IF FULLY SET OUT.
There is also conveyed hereby an easement alipur.ebant'.to:the lands described in "Exhibit A"*
ingress to and from the lands herein conveyed and North Carolina Secondary Road No.
1118,eaid easement to be used in common by the parties hereto and those to whom they
•
may convey an interest in the same. Same being the easemer.. conveyed to Grantor •
in Deed Book 296. Page 793, Dare County Public Registry which is incorporated herein •
as if fully set out.
*for access, egress and
0
1
N.C.BnAe:c.Form No.301976.Rmind e1977-moomo...e co.oo..sm,mmo..e a,e.nu,
' ,.MI b,,.....m with IMa C.YM.-.nf

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The property hereinabove described was acquired by Grantor by instrument recorded in •
Book 276,,,.page 509, Dare County Registry.
A map:showing the above described property is recorded in Plat Book..............................page .
• I •
TO HAVE A ND TO HOLD the aforesaid lot or parcel of land and all privileges and appurtenances thereto halonging to .,q'>•
the Grantee In fee simple. i!;r y.+'3�''
And the Grantor covenants with the Grantee, that Grantor Is seized of the premises In fee simple,has the rigat►,convey `• V a;'�'
1'.
the some in See simple,that title is marketable and free and clear of all encumbrances,and that Grantor will warrant and a•:`
defend the title 48alnat the lawful claims of all persons whomsoever except for the exceptions hereinafter stated. �rt � .•
Title to the props.°y hereinabove described is subject to the following exceptions: r+ •'�l,
fret;'r7
.fps It..
All restrict.o*s and easements of record, Dare County Public Registry. �s .,1.
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IN warm, b wHR[Or, the Grantor haa hereunto bet eis hand and seal,or a corporate has ears, this Inetrsmost to be dined to lea .q•I••i :
corporate name by Ha duly aulhorhcd officers and Its seal to be hereunto affix authority o� D S. the day an year MU : ;*:
>t '07Il•i
.0 r (SItALI "...(Corporate Name) •a Arnold G. Tolson, Jr.
O 'rr /,
sro
President Y Deborah Tol
ATTEST: Q
(SEAL.) h.1+?
31
.� secretary(Corporate Seal) •Ith`� je.
4‘14 .,: it,
• 4T P #� NORTH CAROLINA, Cowley. - d.
r I,a Notary Public of the County and State aforesaid,certify that ••re?.4•4;
111414 4 AkDrad._at__TRIMIll JIB and wife,t_lieborah Tolson Greater. y ! ,;.
bbuasya xi tat :.
ft tit personally apycerod Delon me this day and aeY.••wtedg.d the execution
/,et W foregoing leatramestt.WI w my t`t1.t:•
/ 17r p hand and oftleisi stamp or seal.Mkt ICd_day of_.•�!_ /'SRT H.r!_ r et . r
•� �iq/ (/'] Y�_� - is•
ni tr. cry eommWloa onp4se ../�.�1`.''p.,(i Y ' '_'� - Ne4ry Public �,.•,. :
SEAL-STAMP NORTH CAROLINA. Count-. •'i1 :.
I,a Notary Public of the County and State aforesaid,certify that . '....
er..yy m personally came before to.tN s dayand acknowledged that____he b secretary of '.(' �: 1ti
a North Carellaa corporation,and that by authority del' 'e,�Y f
1 giros and as the act of lbs corporation,the foregoing Instrument was ih fts name by its t
i7•f:
President,denied with lie serpents all and altedtod by as Its__.. Secretary. y�
Witness my band sad official stamp or seal,this day of ,Is
My eommlulon expired: Notary Public -
The foregoing . tleate(e) __. .,.f_ ~_A
hnV CI D r•
Ware ermines to be correct.This instrument sad this certificate are dray registered at the date and time and In the Book and Para shown on the
tint i:de hersek
-r-�.�.t I� �/��.p
i/L e_Sw._. _-A_ - r REGISTER OF DEEDS FOR-_J!__• . er COUtiTT.
By _-.Y. �,�ria.____/_f.1-___d_.far', e.f Depsr/Amlaunt•Register of Dohs
t.. .
N.C.Bar Amor.Form No.le 197n,Revised a 1977-aim.swine■Co.lee,P.red.Yuan..N.C.rime -
Anal ae an..�..nwee...N QWMs•list
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"EXHIBIT A"
All that certain parcel of land located in Nags Head Township of
Dare County, North Carolina on Roanoke Island and more particularly ,
described as follows:
•
Beginning at a concrete monument located in the eastern right of
way of N.C.S.R. 1118, also known as Driftwood Dri:•a. a 50 foot
right of way; running thence from the point of beginning a course
of South 71° 27' 00' East a distance of 150.0 feet tc a IIVP monument; thence turning and running North 08° 43' 05° East a
distance of 185.0 feet to a concrete monument; thence turning and
crossing a 20 foot easement and running South 71° 27' 00' East a c.
distance of 300.0 feet to a concrete monument; thence turning and
• ' running South 08° 43' 00' West a distance of 370.0 feet to a .''
concrete monument; thence turning and running North 71° 27' 00'
' West a distance of 144.0 feet to an iron pin; thence continuing
• North 71° 27' 00' West a distance of 296.43 feet to an iron pin;
thence continuing North 71° 27' 00' West a distance of 9.57 feet to
a:, i$on pin and located in the eastern right of way of N.C.S.R. ;
111d; thence turning and following the right of way of N.C.S.R. ;:•
1118 a ^ourse of North 08° 43' 00' East a distance of 185.0 feet to
the pl,ce of beginning.
.
Same being a parcel of land consisting of 3.1385 acres and being
shown on a map or plat entitled 'Survey for City Beverage Company,
Inc.' prepo:sd by W. M. Meekins, Jr. & Assoc., Inc., Land Surveyors
and Planner', dated August 6, 1994 (Meekins job number
RIN-1426-94) . Said survey is attached hereto for further
reference. '_
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SURVEY FOR
a. lei US
C/TY BEVERAGE COMPANY /NC.
RoAJekt hula 4244L WAD 7'.�sp •
W. ►t. MECCAS, JR. &eS A 90C., t
i;+.rl Surveyors and Planners DARL [oud,Y AdoRni CARouk
P.O. Hai 1.998., •. :
hn,cao, N.C. 2.795‘ • SCALE:1.8 60+ :_j':i. .
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AGENTS FOB•S:CURI UNION•CHICAGOTITIE•PIRSTANERICAN