NCC221463_FRO Submitted_20220413

it& FINANCIAL RESPONSIBILITY/OWNERSHIP FORM VM
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 Henderson County Site Development Department. (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.)
Sign the original form in BLUE INK.
Part A.
1. Project Name Townes at Stonecrest Phase 1
2. Location of land -disturbing activity: CountyHendersnn city Hendersonville
Highway/StreetClear Creek Rd Latitude 35.3506 Longitude 82.4564
Property Identification Number(s) PINS See attached documents
3. Approximate date land -disturbing activity will commence: 03-2 1 -2022
4. Purpose of development (residential, commercial, industrial, institutional, etc.): Residential
5. Total acreage disturbed or uncovered (including off -site borrow and waste areas):+/- 2
6. Amount of fee enclosed: $600 . The application fee of $300.00 per acre
(rounded up to the next acre) is assessed without a ceiling amount include a $200.00 plan review fee to
land disturbance fees. (Example: 8.10 ac = $2,900.00).
7. Has an erosion and sediment control plan been filed? Yes No Enclosed
8. Person to contact should erosion and sediment control issues arise during land -disturbing activity:
Namelan Miller E-mail Address Immlller d&drhorton.com
Telephone [phone]
9. Landowner(s) of Record (attach accompanied page to list additional owners):
D.R. Horton Inc 828-458-8566
Name Telephone
2 Walden Ridge Dr. Ste 80 2 Walden Ridge Dr. Ste 80
Current Mailing Address Current Street Address
Asheville NC 28803 Asheville NC 28803
City State Zip City State Zip
10. Deed Book No.2022 Page No.1 3966-13968Provide a copy of the most current deed.
Part B.
1. Company(ies) or firm(s) who are financially responsible for the land -disturbing activity (Provide a
comprehensive list of all responsible parties on an attached sheet.) If the company or firm is a sole proprietorship,
the name of the owner or manager may be listed as the financially responsible party.
D.R. Horton Inc [e-mail]
Name E-mail Address
2 Walden Ridge Dr. Ste 80 2 Walden Ridge Dr. Ste 80
Current Mailing Address Current Street Address
Asheville NC 28803 Asheville NC 28803
City
State Zip City
State
Telephone[phone] Fax Number 828-793-2347
Zip

2. (a) If the Financially Responsible Party is not a resident of North Carolina, give name and street address
ofL
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 is a Corporation, 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
Telephone
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.
Debra Green
T e or print je
Signature
City Manager
Title or Authority
03-07-2022
Date
I, Ian Miller , a Notary Public of the County of Buncombe
State of N C
appeared personally before
form was executed by him.
_, hereby certify that Debra Green
me this day and being duly sworn acknowledged that the above
Witness my hand and notarial seal, this 7th
IAN MILLER
Notary Public
Buncombe County, North Carolina
My Commission Expires
February 10, 2024
NN-
day of March , 20 22
Notary
My commission expires 02-10-2024

Stonecrest Townhomes PIN Numbers- D.R. Horton
Unit 208: 9660-90-5621
Unit 209: 9660-90-5519
Unit 210: 9660-90-5517
Unit 211: 9660-90-5505
Unit 212: 9660-90-5503
Unit 213: 9660-90-5309
Unit 214: 9660-90-5317
Unit 215: 9660-90-5325
Unit 216: 9660-90-5333
Unit 217: 9660-90-5331
Unit 218: 9660-90-5267
Unit 219: 9660-90-5285
Unit 220: 9660-90-5294
Unit 221: 9660-90-6212
Unit 222: 9660-90-6231
Unit 223: 9660-90-6149
Unit 283: 9660-90-6665
Unit 284: 9660-90-6652
Unit 285: 9660-90-6650
Unit 286: 9660-90-6548

CREEKVIEW RD
,
r
i
r
r
1
1 n
' O
9660-90-
4f
W�
C
6665
6652
5621
6650
5519 �o
0 6548
5517 a
5505
5503 W
sro
ti
'40
5309 ��FHSR'OGF
5317 Ro
5325
5333
5331
26
28
29
21
23
14
N
PIN Vs for Units 208-223 and 283-286
s