NCC216154_FRO Submitted_20211105

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FINANCIAL RESPONSIBILITYIOWNERSHIP FORM
SEDIMENTATION POLLUTION CONTROL ACT
CITY OF HENDERSONVILLE
SOIL EROSION AND SEDIMENTATION CONTROL
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 Environment and Natural Resources. (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 Ride Kanuga Phase Two Trails
2. Location of land -disturbing activity: County Henderson City or Township Hendersonville
Address of Project: 1249 Kanuga Lake Road Latitude 35.26695 Longitude-82.51435
3. Approximate date land -disturbing activity will commence: GGIgIpIR 11 909f
4. Purpose of development (residential, commercial, industrial, institutional, etc.): Commercial
5. Total acreage disturbed or uncovered (including off -site borrow and waste areas): 1.98 acres
S. Amount of fee enclosed: $ $800 . Fee Schedule FY 2018-2019 is available on
Water Resources at link https:llwww.hetidersoncountync.gov/waterresources/pagelfee-
schedule-fy2019
7. Has an erosion and sediment control plan been filed? Yes No Enclosed x
8. Person to contact should erosion and sediment control issues arise during land -disturbing activity:
Name Callie Horwath E-mail Address [e-mail]
1249 Kanuga Lake Road 1249 Kanuga Lake Road
Current Mailing Address Current Street Address
nriorcnmrillo NC: 9873a Hendersonville NC 28739
City State Zip City State Zip
Telephone [phone] Cell # 610.515.4111
9. Landowner(s) of Record (attach accompanied page to list additional owners) NOTE: Must match
Henderson County Courthouse - Land records information or provide a recorded deed:
Name Telephone Fax Number
cmoov_ AC
Current Mailing Address Current Street Address
41k4tZaw w c4q f7n #C, —1-1W7
City State Zip City State Zip
City of Hendersonville FRO.doc Revised 6-19-2018

10. Deed Book No, Page No, Provide a copy of the most current deed.
Part B.
1. Person(s) or firms who are financially responsible for the land -disturbing activity (Provide a
comprehensive list of all responsible parties on an attached sheet) NOTE: The signature of a
corporation, or LLC roust be a listed member on the formation documents on file with the
state office at htt s:1/www.sosnc, ov/search/index/cor .
Pisgah Trail Company DBA: Ride Kanuga
David Lamond- Owner David. LaMondC� blueskymdxom
Name E-mail Address
60 Brookfield Lane 1249 Kanuga Lake Road
Current Mailing Address Current Street Address
Hendersonville NC 28739 Hendersonville NC 28739
City State Zip City State Zip
Telephone [phone]
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:
Name E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Telephone
(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's a Corporation, give name and street address of the Registered Agent:
Rare
Name of Registered Agent E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Telephone
City of Hendersonville FRO.doc Revised 6-19-2018

The above information is true and correct to the best of my knowledge and relief 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 Financially Responsible Person). I agree to provide
corrected information should there be any change in the information provided herein.
Pisgah Trail Company DBA: Ride Kanuga
Type or print name
0----
David Lamond- Owner
Title br Authority
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Signature Date
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I, K g-k A M e - VJAUG a a Notary Public of the County of E N D
State of North Carolina, hereby certify that -D ►4v ►i7 L iN yea t%z appeared
personally before me this day and being duly sworn acknowledged that the above form was
executed by him.
Witness my hand and notarial seat, this �d� day of Oc.-aber , 20 2-1
Notary
Seal
My commission expires C- • Z.,'ZDZ�}
Miriam E. Walsh
NOTARY PUBLIC
Hendatson County
North Caroona
MY CandWMIOn EOms December 2, 2024
City of Hendersonville FRO.doc Revised 6-19-2018