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Home My WebLink AboutNCC222666_FRO Submitted_20220725FINANCIAL 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 NIA in the blank.) Part A. 1. Project Name Brevard Hotel - City Camper 2. Location of land -disturbing activity: County Transylvania City or Township Brevard N Broad Street 35.235243-82.732645 HighwaylStreet LatltUde{decimal degrees} Longitude(decimal degrees) 3. Approximate date land -disturbing activity will commence: 3.87 AC 4. Purpose of development (residential, commercial, industrial, institutional, etc.): Commercial 5. Total acreage disturbed or uncovered (including off -site borrow and waste areas): 3.87 6. Amount of fee enclosed: $ 400 . 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 [jx, No ❑ 8. Person to contact should erosion and sediment control issues arise during land -disturbing activity: Name Alan O'Neal E-mail Address alan@citycamper.com Phone: Office# 8Zi�) S ZD S Z2-S Mobile#—�Z70 9_Z 9. Landowner(s) of Record (attach accompanied page to list additional owners): The Brevard Hotel, LLC Name 217 Country Club Park #422 Current Mailing Address Birmingham, AL 35213 City State 10. Deed Book No. 978 j-z 2-cl 77o 72-y Phone: Office # Mobile # 217 Country Club Park #422 Current Street Address Birmingham, AL 35213 Zip City Page No. 473-475 State Zip 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 owners) may be listed as the financially responsible party(ies). The Brevard Hotel, LLC Company Name 217 Country Club Park #422 Current Mailing Address Birmingham, AL 35213 City Le -) _ G r T' G r rZ - L-O M E-mail Address 217 Country Club Park #422 Current Street Address Birmingham, AL 35213 State Zip City State Phone: Office # E?rZj� .-Zro S ?_ j Mobile # -7 7 a ? Z S' —Z Zip 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: PVi110ulJ;s, �r,(ntSt'fgagt) �n�i 7GiLyiGf -T4C rrt ,vc SI�w` r�61571�i�� AG ,uM Name of Registered Agent E-mail Address wrAleF r +zesr faa cTIiF_ 3 9 q S"Z.Z �l la, raF rL5 r+!j Current Mailing Address Current Street Address 1Z L Y�I�f-f lv C. Z�� Sj�ctc�,v VVA City State Zip City State Zip Phone: Office # S-09 -- — 7,Z Ll ! 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. "4g r-1 14 0 ftL Type or rint name Signature Title or Authority S_ - "3 - Z2. Date i, L w� �� a Notary Public of the County of �i� w, State off4 ert4r6ae�, hereby certify thatl appeared personally before me this day and being duly sworn acknowledged that the above form was executed by him/her. iW�N'�A Witness my hand and notarial seal, this k- day of 2g t C:STA:TEO,F CORNEUUSY PUBLIC ALASI � A ---- r r ..r a -w - e r r 11111M1111111111111 2021003172 TRANSYLVANIA CO, NC FEE MOD STATE OF NC REAL ESTATE EXTX $11400.00 PMSLWWaM 04-22-2021 04:18:20 PM . CINDY M OWNSEY AaWM0F08M$ MUM LAMMMTH BK: DOC 978 PG: 4473-475 NORTH CAROLINA GENERAL WARRANTY DEED Excise Tax: $11,400 Return after recording to: Donald E. Jordan Brief description for the Index: Three parcels, North Broad This Deed was prepared by: Donald E. Jordan, Attorney at Law This property does not include the primary residence of Grantor This DEED is made this 22`' day of April, 2021, by and between: GRANTOR: CITY CAMPER, LLC a Delaware limited liability company Grantor's Address: 217 Country Club Park #422, Birmingham, AL 35213 GRANTEE: THE BREVARD HOTEL, LLC a Delaware limited liability company Grantee's Address: 217 Country Club Park #422, Birmingham, AL 35213 The designation Grantor and Grantee in this Deed shall include the parties, their heirs, successors, and assigns, and shall include singular, plural, masculine, feminine or neuter as required by context. The Grantor, for a valuable consideration paid by the Grantee (the receipt of which is acknowledged) grants, bargains, sells and conveys to the Grantee in fee simple, all of the lot or parcel of land located in Brevard Township, Transylvania County, North Carolina, and as is described in the attached Exhibit A. This is all of the same property acquired by Grantor by Deed recorded in Document Book 6'7 90 , Page 1169, Transylvania County Registry. This conveyance is made subject to easements and rights of way of record, to any covenants of record, and to real property taxes for the current year. THIS CONVEYANCE IS MADE FOR THE GRANTEE TO HAVE AND TO HOLD the Property and all privileges and appurtenances belonging to the Property in fee simple. The Grantor covenants with the Grantee that Grantor is seized of the Property 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, subject only to the stated exceptions. Grantor is signing this Deed as of the date specified above. CITY CAMPER, L TidrWarren, Managing Member STATE OF NORTH CAROLINA COUNTY OF TRANSYLVANIA I, Donald E. Jordan, a Notary Public of the specified County and State, certify that Tye Warren personally appeared before me this day and acknowledged that he is the Managing Member of City Camper, LLC, and that by authority given and as the act of the Company, he signed this Deed on its behalf. Witness my signature and official stamp or seaLthis ?-Z day of April, 2021. My commission expires: August 30, 2024 `�� 11111 tli� NOTARY ; • 9U61.IC ; j >>I11111t�� r---0-- . - EXHIBIT A - LEGAL DESCRIPTION Being all of Parcels 5355,-6590 and 7374 as shown on a plat thereof recorded in Plat File 18, Slide 345, Records of Plats for Transylvania County, with the exception of that portion thereof containing 469 square feet, more or less, and designated as "Overlap Parcel A" on the recorded plat hereinabove referred to. This conveyance is made subject to all easements and other matters shown which may be shown on the recorded plat hereinabove -referred to. Being all of the same land conveyed in a deed from Valley Auto Sales, Inc., to North Broad Street Brevard, LLC, a North Carolina limited liability company, dated November 1, 2018, and recorded in the office of the Register of Deeds for Transylvania County in Document Book 863, page 567. Being all of "Overlap Parcel A," containing 469 square feet, more or less as shown on the plat hereinabove referred to. Being all of the same land conveyed in a non -warranty deed from Valley Auto Sales,. . Inc., to North Broad Street Brevard, LLC, a North Carolina limited liability company, dated November 1, 2018,• 4.nd recorded in the office of the Register of Deeds for Transylvania County in Document Book 863, page 575. It is understood and agreed that the covenants of title hereinafter set forth shall not be applicable Tract H. Subject to the terms and conditions specified in the Deed from the City of Brevard to City Camper, LLC