NCC221113_FRO Submitted_20220321

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 NameBojangles' Restaurant - Hampstead
2. Location of land -disturbing activity: CountvPender City or Township Hampstead
Highway/Street 15125 US Highway 17 Latitude(decima, degrees) 34.3722 -77.7065
Long itude(decirnal degrees)
n 4
3. Approximate date land -disturbing activity will commence: '3- I 6-2
4. Purpose of development (residential, commercial, industrial, institutional, etc.): Commercial
5. Total acreage disturbed or uncovered (including off -site borrow and waste areas):0.81
6. Amount of fee enclosed: $200.00 . The application fee of $100.00 per acre (rounded
up to the next acre) is assessed without a ceiling amount (Example: 8.1 0-acre application fee is $900).
Checks should be addressed to NCDEQ.
7. Has an erosion and sediment control plan been filed? Yes Z Enclosed 0 No ❑
8. Person to contact should erosion and sediment control issues arise during land -disturbing activity:
Name -Matt Mitchell
Phone: Office #9103272907
E-mail Address [e-mail]
Mobile # [phone]
9. Landowner(s) of Record (attach accompanied page to list additional owners):
Hampstead Development Partners, LLC 9105126684 9105126684
Name
2906 St. Regis Rd.
Current Mailing Address
Greensboro, NC 27408
City
Phone: Office # Mobile #
2906 St. Regis Rd.
Current Street Address
State Zip City
10. Deed Book No.4781 Page No.992-9-
State
E.

10, A"
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).
Hampstead Development Partners, LLC
Company Name
2906 St. Regis Rd._
Current Mailing Address
Greensboro, NC 27408
City State Zip
Phone: Office #9105126684
[e-mail]
E-mail Address
2906 St. Regis Rd.
Current Street Address
City
State
"I'MMUMUMM
Um
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:
Christopher A. Sneeden
Name of Registered Agent
2906 St. Regis Rd.
Current Mailing Address
Greensboro, NC 27408
[e-mail]
Nz;F
E-mail Address
2906 St. Regis Rd.
Current Street Address
Greensboro, NC 27408
City State zip city State Zip
Phone: Office #9105126684 Mobile #[phone]
Chris Sneeden
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.
Hampstead Development Partners, LLC, - Chris Sneeden Manager
Type or pTt name
Signature
Title or Authority
3/14/22
Date
i, (Asso-nd-4- I AIL,, , a Notary Public of the County of (aw i -cz) (-d
State of North Carolina, hereby certify that Sl\ec&'l appeared personally
before me this day and being duly swom acknowledged that the above form was executed by him/her.
Witness my hand and notarial seal, this 41day of J\Acs-rJ,\-
20 9a
Notary
My commission expires lJ/qtd-oa-A

Continued from Items 9 & 10 in Part A of the Financial ResponsibilitylOwnership Form for multiple
owners. Attach copies of this page as needed to list all landowners.
Landowner 2 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 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.
Name
Current Mailing Address
City
Deed Book No._
Landowner 5 of Record:
Name
Current Mailing Address
Phone: Office # Mobile #
Current Street Address
State Zip CRY State Zip
Page No. Provide a copy of the most current deed.
Phone: Office # Mobile #
Current Street Address
City State Zip city State Zip
Deed Book No. Page No. Provide a 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
Current Mailing Address
F4 r, IT. ff WITITIT =_
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
Current Mailing Address
E-mail Address
Current Street Address
City State Zip City State Zip
Phone: Office # Mobile #
Company 5 Name
Current Mailing Address
E-mail Address
Current Street Address
City State Zip city State Zip
Phone: Office# Mobile #

13K 4781 PG 992 - 994 (3) DOC# 20098591
This Document eRecorded: 03/02/2022 04:26:10 PM
Fee: $26.00 DocType: DEED Tax: $1,580.00
Pender County, North Carolina
Sharon Lear Willoughby, Register of Deeds
Prepared by and return to:
Clark, Newton & Evans, PA
509 Princess Street, Wilmington, NC 28401
Brief Description. PT Proposed LT C PB 571126 Albrecht
— Check here if all or part of subject
property is any Seller's personal
residence
PIN: 3292-08-3928-0000
Stamps: $1,580.00
NO TITLE EXAMINATION PERFORMED OR
TAX ADVICE GIVEN BY PREPARER
NORTH CAROLINA
SPECIAL WARRANTY DEED
COUNTY OF PENDER
THIS DEED, made this the 28" day of February, 2022, by and between Fred Robert Kurt
Albrecht and Dolli Blake Albrecht, Trustees of the Albrecht Family Revocable Living Trust
dated July 11, 2013 and any amendments thereto, with an address at 113 Wild Berry Lane,
Hampstead, NC 28443 (collectively, the "Grantor"), and Hampstead Development Partners, LLC,
a North Carolina limited liability company with an address of 2906 St. Regis Road, Greensboro, NC
27408 ("Grantee"). The designations 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 Pender County,
North Carolina, and more particularly described as:
See attached Exhibit A
TO HAVE AND TO HOLD the aforesaid tot or parcel of land and all privileges, casements
and appurtenances thereto belonging to the Grantee in fee simple.
submitted electronically by "J.C. Hearne ,,, Attorney at Law"
in compliance with North Carolina statutes governing recordable documents
and the terms of the submitter agreement with the Pender county Register of Deeds.

BK 4781 PG 993 DOC# 20098591
And the Grantor covenants in his/heir fiduciary capacity with the Grantee, that Grantor has
done nothing to impair such title as it received, and Grantor will warrant and defend the title against
the lawful claims of all persons claiming by, under or through Grantor, except for the exceptions
hereinafter stated:
1. Ad valorem taxes for 2022 and subsequent years, which are not yet billed;
2. Rights of way and easements of record in the Pender County Registry, if any;
3, Zoning and/or subdivision ordinances and regulations, if any;
4. Restrictive covenants of record in the Pender County Registry, if any; and
5. Matters arising prior to Grantor taking title.
IN WITNESS WHEREOF, the Grantor has hereunto set his hand and seal, or if corporate,
has caused this instrument to be signed in the manner prescribed by law, as of the day and year first
above written.
Albrecht Family Revocable Living Trust
Dated July 11, 2013
By:4-
Dolli Blake Albrecht, Trustee
By: IA��RYWSEAL)
`Fred kobert Kurt Albrecht, Trustee
PENDER COUNTY, NORTH CAROLINA
I certify that the following person(s) personally appeared before me this day, each
acknowledging to me that he or she voluntarily signed the foregoing document for the purpose stated
therein and in the capacity indicated: Dolli Blake Albrecht and Fred Robert Kurt Albrecht
F-46
Date: M=h 2022
No Public
a A
My commission expires: KARLA M. WESTPHAL otary's Printed or Typed ��'a—me
New
Hanover C0UnV';;;*% comfine
&4y Con"niss" Expires 22.2W023
1 - - 112-631
Rq

BK 4781 PG 994 DOC# 20098591
1 *3 111 1.11
Being all of that property refereed to as Proposed Lot "C", "Three Lot Subdivision on NCDOT Road"
as shown on Map Book 57, Page 126, in the Pender County Registry.
Less and Except that portion. of fight -of -way to Department of Transportation by Consent Judgment
recorded in Book 475"), Page 2560, in the Pender County Registry.
Together with the Commercial 24'and 30' Cross Access and Utility Easements for the purpose of
access, ingress, egress and regress as set forth in that Declaration of Easement and Restrictions
recorded in Book 4581, Page 100, in the Pender County , Registry and as set forth on that plat
recorded in Map Book 57, Page 126, in the Pender County Registry.
The property hereinabove described is a portion of the property that was acquired by Grantor by
instrument recorded in Book 4289., Page 247 in the Pender County Registry.