NCC216131_FRO Submitted_20211108

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 and/
or fax information unavailable, place N/A in the blank.)
Part A. 1. Project Name B & S Enterprises - Kinston
2. Location of land -disturbing activity: County Lenoir City or Township Contentnea Neck
Highway/Street NC 11 Latitude35d19'24.42"N Longitude-77d30'27.73"N
3. Approximate date land -disturbing activity will commence: October 18, 2021
4. Purpose of development (residential, commercial, industrial, institutional, etc.): Commercial
5. Total acreage disturbed or uncovered (including off -site borrow and waste areas): 8.00
6. Amount of fee enclosed: $ 520.00 . The application fee of $65.00 per acre (rounded
up to the next acre) is assessed without a ceiling amount (Example: a 9-acre application fee is $585).
7. Has an erosion and sediment control plan been filed? Yes No Enclosed X
8. Person to contact should erosion and sediment control issues arise during land -disturbing activity
Name Scott Edwards
E-mail Address [e-mail]
Telephone [phone] Cell #
919-580-6498 Fax # [phone]
9. Landowner(s) of Record (attach accompanied page to list additional owners):
B & S Land Holdings, LLC
252-264-2400 252-264-4289
Name
Telephone Fax Number
1395 US 17 South
1395 US 17 South
Current Mailing Address
Current Street Address
Elizabeth City NC 27909
Elizabeth City NC 27909
City State Zip
City State Zip
10. Deed Book No. 1917,1917,1917 Page No. 372,376,380 provide a copy of the most current deed.
Part B.
1. Company(ies) or firm(s) who are financially
responsible for the land -disturbing activity (Provide a
comprehensive list of all responsible parties on an
attached sheet.) If the company or firm is a sole proprietorship,
the name of the owner or manager may be listed as the
financially responsible party.
B & S Enterprises, Inc.
[e-mail]
Name
E-mail Address
1395 US 17 South
1395 US 17 South
Current Mailing Address
Elizabeth City NC 27909
City
Telephone.
State Zip
252-264-2400
Current Street Address
Elizabeth City NC 27909
City State Zip
Fax Number 252-264-4289

2. (a) If the Financially Responsible Party is not a resident of North Carolina, give name and street address
of the designated North Carolina Agent:
Name E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Telephone Fax Number
(b) If the Financially Responsible Party is a Partnership or other person engaging in business under an
assumed name, attach a copy of the Certificate of Assumed Name. If the Financially Responsible
Party is a Corporation, give name and street address of the Registered Agent:
Brian Jennings [e-mail]
Name of Registered Agent E-mail Address
1395 US 17 South 1395 US 17 South
Current Mailing Address Current Street Address
Elizabeth City NC 27909 Elizabeth City NC 27909
City State Zip City State Zip
Telephone.
252-264-2400 Fax Number 252-264-4289
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 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 Person). I agree to provide
corrected information should there be any change in the information provided herein.
Brian Jennings
Type or pri ange
Si nature
Dealer Principle, Registered Agent
Title or Authority
Date
I, Sandra T. Peele , a Notary Public of the County of Wayne
State of North Carolina, hereby certify that Brian Jennings 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
20 day September 20 21
My commission expires 05/03/2025