NCC241520_FRO Submitted_20240517

Check if this project is ARPA-funded ❑
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, 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 NameAshcroft Dam Repair
*If this project involves American Rescue Plan Act (ARPA) funds, list the Project Name below
under which you applied for funding through the Division of Water Infrastructure (DWI).
2. Location of land-disturbing activity: County Rockingham City or Township Reidsville
Winterberry Drive 36.32611 -79.69389
Highway/Street Latitude degrees) Long itude(decimal degrees)
3. Approximate date land-disturbing activity will commence:July/Aug 2023 (if approved by Dam Safety)
4. Purpose of development (residential, commercial, industrial, institutional, etc.): Dam repair
5. Total acreage disturbed or uncovered (including off-site borrow and waste areas): 2.89
6. Amount of fee enclosed: $300.00 . 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 E Enclosed ❑x No E
8. Person to contact should erosion and sediment control issues arise during land-disturbing activity:
Name Amy Black E-mail Address [e-mail]
ljbinc.COm
Phone: Office# 336-996-9974 Mobile# [phone]
9. Landowner(s)of Record (attach accompanied page to list additional owners):
Ashcroft Lake Association,Inc.do Larry Huffman,President 336-491-0382
Name Phone: Office# Mobile#
1318 Winterberry Drive
Current Mailing Address Current Street Address
Reidsville, NC 27320
City State Zip City State Zip
10. Deed Book No.0971 Page No.2251 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 owner(s)may be listed as the financially responsible party(ies).
Ashcroft Lake Association, Inc [e-mail]
Company Name E-mail Address
1318 Winterberry Drive
Current Mailing Address Current Street Address
Reidsville, NC 27320
City State Zip City State Zip
Phone: Office# Mobile# [phone]
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:
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)
(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.
Larry Huffman President Ashcroft Lake Association
Typ or print name Title or Authority
941741 ka3
ignat e Date
I, 11 I LEI 1 . a Notary Public of the County of FD 2S�l
State of North Carolina, hereby certify that Lie-`( appeared personally
before me this day and being duly sworn acknowledged that the above form was executed by him/her
Witness my hand and notarial seal, this 9 day of j'Yl , 20 2
(16?Wi5e7J-(
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My commission expires ,0/ /7/ ZO`L
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Continued from Items 9 & 10 in Part A of the Financial Responsibility/Ownership Form for multiple
owners. Attach copies of this page as needed to list all landowners.
Landowner 2 of Record: Right-of-entry has been provided for construction acces.
Lafayette & Randy Judkins
Name Phone: Office# Mobile#
1322 Winterberry Drive
Current Mailing Address Current Street Address
Reidsville, NC 27320
City State Zip City State Zip
Deed Book No.0973 Page No.2055 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.
Landowner 4 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 5 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.

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This mstru.ment prepared (without examination of title) by/Mail to: _, - .- r. - �._
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• Richard H. Hicks, Jr_, Attorney at Law Rq r ,. _ �;_
Hicks, McDonald, Allen, Noecker & Aycock, Lill, v
- 101 South Elm Street, Suite 220 Bork 971
2251
Greeensboro, North Carolina 27401 page
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NORTH CAROLINA
LI I OCKINGHAM COUNTY
;- GENERAL WARRANTYDEED r•
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THIS DEED, made this 5th day of December, 1997, by Ashcroft Development, -
. i L.L.C., a North Carolina limited liabilitycompany having p y an office and place of .,; .',.
LI business in Rockingham County, North Carolina, hereinafter referred to as "Grantor,"
and Ashcroft Lake Association, Inc., a North Carolina nonprofit corporation having
• its principal office and place of business at 129 East Morehead Street, Reidsville, . `'
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North Carolina 27320, hereinafter referred to as "Grantee_" ,,..- . .::1:::- -1.,
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1 The Grantor, for and in consideration of the sum of Ten Dollars ($10.00) and other .._: ':
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good and valuable considerations in hand paid by the Grantee, the receipt and N
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of which are hereby acknowledged, has and by these presents does hereby 43:. ',
grant, bargain, sell and convey unto the Grantee, its successors and assigns, in fee ::s-
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simple, all that certain tract or parcel of land consisting of 10.31 acres, more or less,and known as the Lake Tract, situated in Sim sonville Townshi Rockin ham Coun P P g
County, ., .
. North Carolina, and more particularly described in Schedule A, Legal Description for =
��- - Ashcroft Lake, which is attached to this Deed and incorporated herein by reference as
. � if fully set forth. `,
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• The above-described property is a part of the property conveyed by Deed dated January ;-k-'-'
a 15, 1986, from Citizens Development Corporation to Oak Island Associates, Joint _;_;-
_ Venture, Edward V. Wilkins and Joseph B. King, Jr., recorded in Book 778, Page �3 r
2042, in the Office of the Register of = ...
1"'~ �; Deeds of Rockingham County North Carolina. A =,.
( ) undivided interestand to the -':.
one-third 113 in said property was conveyed by Deed ; :
dated January 21, 1986, from the said Oak Island Associates, Joint Venture, to
��- Mitchelene A. Martin recorded in Book 779, Page 796, in the Office of the Register of
-�- Deeds of Rockingham County, North Carolina; and by Deed dated January 15, 1986, : .
Lam. :
from the said Mitchelene A. Martin to Johnsin M. Martin recorded Book 779, Page :_:
798, in the Office of the Register of Deeds of Rockingham County, North Carolina. .,;
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• TO HAVE AND TO HOLD the aforesaid tract or parcel of land and all privileges and
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appurtenances thereto belonging to the Grantee in fee simple_ ...
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against the lawful claims of all persons whomsoever; subject to municipal ordinances . „. .
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When reference is made herein to either the Grantor or the Grantee, the singular shall
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IN WITNESS WHEREOF, the Grantor, Ashcroft Development, L_L_C., has caused
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Grantors have hereunto set their hands and seals, the day and year first above written. .. . _
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ASHCROFT DEVELOPMENT, L.L.C.
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....: I, a Notary Public of the County and State aforesaid, certify that t...:.-7.-.
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7. i \12i.. ; -P-k- ..„ .„ persona ly appeared before me this day and
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. I ac=ledged that they are the Managers of Ashcroft Development, L.L.C., a North -
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Carolina limited liability company, and that by authority duly given and as the act of
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i WITNESS my hand and official seal stamp or stamp, this 54-- day of
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The foregoing certificates of Catherine P. Conte, a tiotary Public of 4---.-.4-;....„.
• NodEinghas County. N. C. are certified to be correct. This the 15th
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• SCHEDULE A
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• Legal Descrip-ti_on_frAshcroftLake ,
BEGINNING at a new iron pipe located in the southeastern corner of Lot 34 of
' 1 Ashcroft, Phase II, Map III, as shown on plat recorded in Plat Book 28. at Page 517.
I in the Office of the Register of Deeds of Rockingham County, North Carolina. said � -
new iron pipe being located also South 17 degrees 00 minutes 00 seconds East 145.00 ,..
In i feet from the southern margin of Ashcroft Drive: thence South 73 degrees 59 minutes
45 seconds 116.83 feet to a new iron pipe; thence North 80 degrees 32 minutes 25
seconds East 213.27 feet to a new iron pipe, a corner with the "Building No_ 1" lot as
i 1- 1 shown on plats of Ashcroft Townhouses, Maps I and II, as recorded, respectively. in
. Plat Book 25, at Page 10, and Plat Book 27, at Page 37, in the Office of the Register of
Deeds of Rockingham County, North Carolina; thence along the western line of the
a said "Building No. 1 " lot South 19 degrees 04 minutes 00 seconds West 157.67 feet to _
an iron pipe, a corner between the said "Building No. 1" lot and "Building No_ 3" lot }_.
as shown on said plats; thence along the western line of the said "Building No_ 3" lot
South 48 degrees 37 minutes 00 degrees West 139.71 feet to an iron pipe, a corner [ +3_`
with the undesignated tract or parcel of property as shown on plat of Ashcroft V4V .'-
„ Townhouses, Map II, as recorded in Plat Book 27, at Page 37, in the Office of the r : .. .:
- Register of Deeds of Rockingham County, North Carolina; thence along the western
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lines of the said undesignated tract or parcel the following courses and distances: �,fk
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} South 44 degrees 26 minutes 25 seconds West 229.97 feet; South 07 degrees 33 fi
minutes 55 seconds West 155.21 feet; South 27 degrees 35 minutes 05 seconds East �
. 85.61 feet; South 05 degrees 33 minutes 05 seconds East 128.42 feet to an iron pipe;
thence South 84 degrees 26 minutes 55 seconds West 174. 19 feet to an existing iron ' 7F -r
• 1 r • pipe; thence South 39 degrees 26 minutes 55 seconds West 493.67 feet to an existing �: _,.
iron pipe; thence North 07 degrees 48 minutes 50 seconds West 111 .87 feet to an
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existing iron pipe; thence North 07 degrees 00 minutes 50 seconds West 420.36 feet to .; -
L .__I a new iron pipe; thence North 35 degrees 49 minutes 40 seconds West 92.31 feet to a r-
. • new iron pipe; thence North 11 degrees 24 minutes 10 seconds West 89.68 feet to a =�.▪y
• new iron pipe; thence North 19 degrees 23 minutes 25 seconds East 87.42 feet to a new
iron pipe; thence with the southeastern line of Lot 30 of Ashcroft, Phase H. Map III, as - -
shown on plat recorded in Plat Book 28, Page 517, in the Office of the Register of ii_7:::lico-i:
• Deeds of Rockingham County, North Carolina, North 19 degrees 23 minutes 25
seconds 80.00 feet to a new iron pipe, a corner between Lots 30 and 31 of Ashcroft,
•• Phase II, Map III, as recorded in Plat Book 28, at Page 517, in the Office of the `" ''
._ Register of Deeds of Rockingham County, North Carolina; thence along the respective -f =l• '
_1 southern lines of Lots 31, 32, 33 and 34 of Ashcroft, Phase II, Map III, as recorded in ,_
. Plat Book 28, at Page 517, in the Office of the Register of Deeds of Rockingham -
County, North Carolina, the following courses and distances: North 79 degrees 06
L..J minutes 55 seconds East 140.80 feet to a new iron pipe; thence North 73 degrees 00
minutes 00 seconds East 150.00 feet to a new iron pipe; thence North 54 degrees 33 �:.
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minutes 55 seconds East 158. 11 feet to a new iron pipe; thence North 54 degrees 33 0-�=�
. 1. minutes 55 seconds East 105.00 feet to a new iron pipe; thence along the southeastern ` 'r°
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Ujio ! icia1 Document UIofficia1çcument IgIP Q
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MECCA B. CIPRIANI
- -• -_ 4 Resister Of Deeds ..,. ..
y ROCKINc1t p COUNTY 8C OL/20/98 i.:
T.6bUKpReal Estate Book 973, Page '''�• q'; Tax '` ":-_
__ :` Excise 4-°"
1.1 ' Excise Tax Recording Time. Book and Page
Parcel Identifier Via_Tax Lot No, - .Verified by County on the day of • .,;. _.. by ,`"`-
-! Grantee j c -- `3 �` r c t_ , / -iv S( f ;:..T..
Mail after recordingto ... .. _ -. _._ '- •.
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This instrument was prepared by _ _ C (.- ... ,- -
I I'I - Brief description fur the Index
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NORTH CAROLINA GENERAL DEED W.r_ _ .-
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THIS DEED made this ..- ...... day of January , 19 98 , by and between
GRANTEE "
GRANTOR �__
. _
ASHCROFT DEVELOPMENT , LLC , LAFAYETTE JUDKINS and wife ,
I • a North Carolina Limited RANDY JUDKINS _
:-- Liability Company :-7.:::-1.47;!:;
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Enter in appropriate black tar eachpartr: name, address, and, it apprnpriatr. character of cntit�, e.q- corporation orpartnership. ;
am, - r e
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• The designation 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. '�i;,-
WITNESSETH, that the Grantor, for a valuable considerationreceipt of which is hereby i....70-
paid by the Grantee, the ,
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acknowledged, has and by these presents does grant, bargain, sell and coney- unto the Grantee in fee simple, all that Y- .. -• 7_,
Simpsonville p, . -`
certain lot or parcel of land situated in the City of P Townshi =4
�--, Rockingham . .. _. . County, North Carolina and more particularly described as follows : _. ' �.
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'" Being a tract of 0 . 71 acres designated as Lot #15 of "Ashcroft" =R _-
1997 and 4"t`-_
Phase IV as per survey by Nixon, RLS dated August ,
4.
I recorded in Map Book 37 , page 100 of the Rockingham County 1--,
. Registry. 7-: - ,
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I This conveyance is made subject of utility easements , and setback : �
l ines as appear on the aforesaid survey recorded i n Map Book 3 7 , a ---
page 100 . s.
_ This conveyance is made subject to "Declaration of Covenants , �, -.
I. I Conditions and Restrictions " as recorded in Book 971 , page 2256 of .- -,1,
the Rocking ty Registry and Restrictions set forth in Book
Registry . ( 98 - 1 -16 .A) ``
9'T�3 Page �of the Rockingham Countyg y
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- , N. C. Bar Assoc. Form No.3 4� 1976. Revised 1977 —ia,r W.i.s,m a Co.Inc...Boa 127•Yaa►•nrase.H c.voSs - ..
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` .• - Pa,-ass by Agreement nob the H.C.BM Assoc - 1981 -f - b
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The hereinabove described was acquired by Grantor by
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A map showing the abore described property is recorded in Plat Bonk page
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.-i '''- - TO HA E AND TO HOLD the aforesaid l©t or parcel of land and all privileges and appurtenances thereto belonging to T:...;.�
�+ the Grantee in fee simple.
to -
,_., , and the Grantor covenants with the Grantee, that Grantor is seized of the premises in fee simple. has the right to convey F-.;:.
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 whomsoever except for the exceptions hereinafter stated.
Title to the property hereinabove described is subject to the following exceptions : , _-_. '•-'•
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�+�+•- I Li WITNESS WHEREOF. the Grantor has hereunto set his hand and seal, or if corporate, has caused this instrument to be signed in its ? y..
corporate name by its duly authorized officers and its seal to be hereunto affixed by authority of its Board of Directors. the day and year first , -;{
above written- As)hc ro t D eve 1 opine t LL - t '
+ . (SELL) ~ :.
:.III. -ij - er=Ni - eri..- .
I 4 ----- ', os. phi" in Jr, -nag
(Corporate Name)
By: _ (SEAL)
fY
President ,� :,
•
ATTEST: ---_•• __(SEAL) � y
1 i I
•' Secretary (Corporate Seat) `l_
- -- - (SEAL) '- ,
Rockingham t -f_
NORTH CAROLINA, g County. ' a
SEAL-STAMP• . ' `""�
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. 1Joseph B B . King , Jr . , __ :d_
at 1- a Notary Public of the Count • and State aforesaid. certify that -`'
Manager of Ashcroft Development, LLC , a North Carolina
Grantor,
' _ - T L 8 e L<i 1tec1-Liability Company r. ��
personally appeared before me this day and acknowledged the execution of the foregoing iustrumcn Zi itnrss any .7r:
~ !DIARY I tJ ''. . on behalf of the coma! fly
�, January -- _
i�ING COUNTY, NC 5 hand and official stamp or seal. this _1iL day of t
) F--Z, "-:,-
i l Lr'=' "-�-_ _ �' Notary Public
• !IRy commission expires: ____ _ ._ _
_ SEAL-STAMP
NORTH CAROLINA, County_
I. a Notary Public of the County and State aforesaid, certify that _ _`` .
'• ji personally came before me this day and acknowledged that -___ he is ___ - Secretary of _ .
n ,m r
at a North Carolina corporation, and that by authority duly = -'34
•1 o f'w-
m given and as the act of the corporation, the foregoing instrument was signed in its name by its ',_ ` a
Z' . -sue
. .. o President, sealed with its corporate seal and attested by as its Secretary. ,.b:...
19 1r-:y�;
� Witness my band and official stamp or seal, this day of , x,
My commission expires: -
Notary Public '"Iv _
_ oth _ a Notary Public of Cast , State of
IC
}-•w the !o=<. :;n= Certificated. of __Teresa_�t 4 r ;''
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.err_.` --- -- ��-+�'
- I.. I' �, isg certified to be correct ?his instrument and this certificate are duly registered at the dale and time and in the Book and Page shown on the
first page hereof. ckingham `'l
w ♦�r for/
'R,,- -_-- _B.__Cipr Cipriani REGISTER OF DEEDS FOR COUNTY
'1 I li- By 0 S. _ Deputy;AtwiM�i-Register of Deeds .
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?�•• .Seri.y z- a .. S te;r N. isea 977 Jar.•+es%Jh ams&Co,Inc-.Box 127.
t �,� r Y C. Bar ,issoc. Form 10. 3 i 1�',6. [Zee 1 v .nr,i,e,ti.c z7o5s f . y
_ jT.,- :• _ '':. rC'!: R.nsed� AgreF'Ka�'�t w,th TN-N C $a' Atooe 1981 s` _
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