NCC216413_FRO Submitted_20211116

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FINANCIAL RESPONSIBILITY/OWNERSHIP 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 N/A in the blank.)
Part A.
1. Project Name TAPROOT SUBDIVISION
2. Location of land -disturbing activity: County HENDERSON City or Township UNINCORPORATED
Address of Project: 296 TAP ROOT LANE Latitude -82.525 Longitude35.408
3. Approximate date land -disturbing activity will commence: OCTOBER 2021
4.
5.
6.
7.
8.
Purpose of development (residential, commercial, industrial, institutional, etc.): RESIDENTIAL
Total acreage disturbed or uncovered (including off -site borrow and waste areas): 185.0
Amount of fee enclosed: $ 1,800 . Fee Schedule FY 2018-2019 is available on
Water Resources at link https://www.hendersoncountync.gov/waterresources/page/fee-
schedule-fy2019 178.8-AC PREVIOUSLY PROPOSED ($53,900 PAID)
Has an erosion and sediment control plan been filed? Yes No Enclosed X
Person to contact should erosion and sediment control issues arise during land -disturbing activity:
Name BRIAN ETHERIDGE E-mail Address [e-mail]
8001 ARROWRIDGE BLVD
Current Mailing Address
CHARLOTTE NC
City State
Telephone [phone]
Current Street Address
28273 _
Zip City
Cell #
State
Zip
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:
D.R. HORTON, INC. A DELAWARE CORP. [phone]
Name Telephone Fax Number
8001 ARROWRIDGE BLVD
Current Mailing Address
CHARLOTTE NC
City State
Current Street Address
28971
Zip City State Zip
City of Hendersonville FRO.doc Revised 6-19-2018

665-671, 672-677,
678-682, 683-685,
10. Deed Book No. 3794 Page No.686-691 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 must be a listed member on the formation documents on file with the
state office at https://www.sosnc.gov/search/index/corp.
D.R. HORTON, INC. A DELAWARE CORP. BETHERIDGECo)DRHORTON.COM
Name E-mail Address
8001 ARROWRIDGE BLVD
Current Mailing Address Current Street Address
CHARLOTTE NC 28273
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:
CT CORPORATION SYSTEM
Name E-mail Address
160 MINE LAKE CT., SUITE 200
Current Mailing Address Current Street Address
RALEIGH NC 27615-6417
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 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 Financially Responsible Person). I agree to provide
corrected information should there_ be any change in the information provided herein. pye;�
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Type or print n Title or Authority
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Signature Date
I, �c �(�r'�S , a Notary Public of the County of Nedlenbuno
State of North Carolina, hereby certify that ����_� �C� L Ej_bec,o)ao appeared
personally before me this day and being duly sworn acknowledgeep that the above form was
executed by him.
Witness my hand and notarial seal, this _day of a. tac , 20-9-1—L—
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Notary
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City of Hendersonville FRO.doc Revised 6-19-2018