NCC220284_FRO Submitted_20220114

FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
SEDIMENTATION POLLUTION CONTROL ACT
EXPRESS PERMITTING OPTION 08012007
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 NIA in the blank.)
Part A. 1. Project Name Woodfin Solar Facility
2. Location of land -disturbing activity: CountyBuncombe
City nr Township Asheville
Highway/Street
2700 Riverside Drive Latitude 35.393092 Longitude__
-82 345826
3. Approximate date land -disturbing activity will commence: December 2021
4. Purpose of development (residential, commercial, industrial, institutional, etc.)' Utility/Solar
5. Total acreage distyrbed or uncovered (including off -site borrow and waste areas): 19.6
8. Amount of fee enqgsgd: $ 31300 . The Express Permitting application fee is a dual charge.
The normal fee of $65.00 per acre is assessed without a ceiling amount. In addition, the Express
Permitting supplement is $250.00 per acre up to eight acres, after which the Express Permitting
supplemental fee is a fixed $2,000.00 (Example: 9 acres total is $2,585). NOTE: Both fees are
rounded up to the rikWWhole acre and need to be paid by separate checksito-NCOENR.
7. Has an erosion and` gedimenl control plan been filed? Yes No . ^� Enclosed X
8. Person to contact should erosion and sediment control issues arise.during land -disturbing activity:
Robert GQodgame
[e-mail]
Name
E-mail Address
telephone [phone] Cell #
Fax #
9. Landowner(s) of Record (attach accompanied page to list additional owners):
Buncombe County
828-250-4100 828-250-6076
Name
Telephone Fax Number
200 College St, Suite 300
NA
Current Mailing Address
Current Street Address
Asheville, NC 28801
NA
City State Zip
City State Zip
10. Deed Book No.1285 11263 page No. 0029 10182 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
of comprehensive list all responsible parties on an attached sheet.) if the company or firm s a sole proprietorship.
the name of the owner or manager may be listed as the financially responsible party.
Duke Energy Carolinas, LLC
Name
E-mail Address
P.O. Box 1003.
400 S. Tryon S#
Current Mailing Address
Current Street Address
Charlotte, NC 28202
Charlotte NC 28202
City Stt#te Zip
City State Zip
Telephone [phone]
Fax Number

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:
NIA
NIA
Name
E-mail Address
NIA
NIA
Current Mailing Address
Current Street Address
NIA
NIA
City State Zip
City State Zip
Telephone NIA
Fax Number NIA
(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:
C T Corporation System
[e-mail]
Name of Registered Agent
E-mail Address
160 Mine Lake Court Ste 200
NA
Current Mailing Address
Current Street Address
Raleigh, NC 27615
NA
City State Zip
City State Zip
Telephone [phone]
Fax Number
(c) In order to facilitate Express Permitting, it
is necessary to be able to contact the Engineer or other
consultant who can assist in providing any necessary information rcgafding the plan and its preparation:
Hammer Land Engineering
[e-mail]
Engineering Firm or other consultant
E-mail Address
Mike Sousa
908-864-7674
Individual contact person (type or print)
Telephone Fax Number
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 Firoodally Responsible Person). I agree to provide corrected information should there be
any change in the information provided herein.
Jaclyn Whiteman Director, CD PRoject Management
Type 1.4rint name Title or Authority
JJov- I— t
Date
a Notary Public of the County of Mann
�rlor�
State of N-m i, Trereby certify that LA; ffM appeared personally
before me this day and being duly sworn ackno vle-cl6ed that the above form was executed by him.
Witness my hand and notarial seal, this day of as 1
f
t3RIAN Hp Notary
Seal NOWY t SU to of Fbdit
MhOwmEgx a 07h2M My commission expires C199 C7
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