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Home My WebLink AboutNCC232975_FRO Submitted_20231004 RECEIVED (RECEIVED SE 2 �!. 2177 Check if this project is ARPA-funded - r Attach a copy of the Letter of Intent to Fund �i;� iT •�t-�•,-;r�,1 LAND Q►.=A!!TY SEC T if)"? L�;,,�, QUA; SECT;ON FINANCI3R1SVOISIBILITY/OWNERSHIP FORM ASHE 'f''! 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 NCGO1 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 JWkor 'ryiwrf, AItDCT c tJ *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 POLIL City or Township CoOPeg. GA P-SuNt'4 SwF Highway/Street PARKWAY NOR 1- LatitUde(decimaI degrees)—ea'22"-OngitUde(decimal degrees)35.31Rp 3. Approximate date land-disturbing activity will commence: oer I6, 2 D23 4. Purpose of development(residential, commercial, industrial, institutional, etc.): gESIDEMTIAL 5. Total acreage disturbed or uncovered (including off-site borrow and waste areas): . 8 6. Amount of fee enclosed: $ IOO. . 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$900). Checks should be addressed to NCDEQ. 7. Has an erosion and sediment control plan been filed? Yes 1 Enclosed D No ❑ 8. Person to contact should erosion and sediment control issues arise during land-disturbing activity: Name M41Zot4 '40DE12... E-mail Address YNyOd2VC01 s-tr1d.L-ti011111c.63ntdlI.Ow Phone: Office# 92.8-$(o3-0b(ola Mobile# 828-8If-0L10(o 9. Landowner(s)of Record (attach accompanied page to list additional owners): FATRw C/1k 374wzer Arit. W► ,L1 Sig aRPei 1" -6250 Name Phone: Office# Mobile# 308 Aa2j 4&1 N o ro sone Current Mailing Address Current Street Address I mW SPRirJC‹ Mc 2816(0 SAw City State Zip City State Zip 10. Deed Book No. a Page No. 13(1, Provide a copy of the most current deed. Part B. 1. Cam an ies who are financiallyresponsible for the land-disturbingactivity(Provide a comprehensive list p YC ) PP 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). M. ObfR_OWSTRIA-C 1O1J, INC.. PAtioderrontra ioninc @grilail•ow Company Name E-mail Address PM. x 1z.c 15.(0 SC.4ba. IZoAD Current Mailing Address Current Street Address Yhlu SiVinllr ►J t 28151, MILL SPQ*N N c, 20151, City State Zip City ,�Sttate Zip Phone: Office# S245-Sfo3'p5(oco Mobile# 828 Bt4-O' 3 o 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: /OD eoNSTiZucnOJ iNc. nlycadeecors4rt�c4ioAin(- 4mai(.Cow► Name of Registered Agent E-mil Address P 0. Pox. 125 (5(0 SCitoot, t2�. Current Mailing Address • Current Street Address 1(1/ltu $F *JG N(, 281610 YhIU, SKI NC 28/Stp City State Zip City State Zip Phone: Office# S21313‘93-05106P Mobile# 8223- -040(o Vri`IRO'J 4ODE2- 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) 1 (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. YYI1 Rohl Io1)E2 OLei YIJIA, pe or print name /' Title or Authority ig tUre Date 9 - z ( — *13 I, d , re& , a Notary Public of the County of ?Ciokk_ State of North Carolina, hereby certify that a�,�_ appeared personally before me this day and being duly sworn acknowleged that t e above form was executed by him/her. Witness my hand and notarial seal, this Z1 day of P. lit' `., , 20 - // ERIN FRECK �� NOTARY PUBLIC Notary HENDERSON COUNTY S _ JJ ,- 2!2-e7North Carolina My commission expires I lY (,(� / My Commission Expires AUGUST 16,2027 FCEI VED RECEIVED September 18, 2023 SFP L1 ND QUALITY SEC i;(' ASHEVIL LE LAND QUALIFY SECTION ASHEVILLE To Whom it May Concern: We hereby consent for M. Yoder Construction Inc, acting on our behalf, to draft an erosion and sedimentation control plan and to conduct the anticipated land disturbing activity. Owners of 383 Parkway North Road, Mill Spring, NC, 28756 �^ it y l } / rA A • elA c}--\)Q.S.V Patrick Jarrett Lisa Jarrett