NCC222217_FRO Submitted_20220623

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 before this
form and an acceptable erosion and sedimentation control plan have bden 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 and/
or fax information unavailable, place N/A in the blank.)
Part A. Morlin Acres Drive Subdivision
1. Project Name
2. Location of land -disturbing activity: CountyMadison City or TownshipMarshall
Highway/Street Morlin Acres Dr Latitude35.756810 Longitude-82.637814
3. Approximate date land -disturbing activity will commence: 5/1 /22
4. Purpose of development (residential, commercial, industrial, institutional, etc.): Residential
5. Total acreage disturbed or uncovered (including off -site borrow and waste areas):5•0
6. Amount of fee enclosed: $ 500 . The application fee of $100.00 per acre
(rounded up to the next acre) is assessed without a ceiling amount (Example: 8.10 ac = $900.00).
7. Has an erosion and sediment control plan been filed? Yes No Enclosedx
8. Person to contact should erosion and sediment control issues arise during land -disturbing activity:
Name Kent Cole E-mail Address [e-mail]
Telephone [phone] Cell # Fax #
9. Landowner(s) of Record (attach accompanied page to list additional owners):
Cole Riddle, LLC 828-777-6497
Name Telephone Fax Number
310 Murphy Edwards Hollar Rd 310 Murphy Edwards Hollar Rd
Current Mailing Address Current Street Address
Mars Hill, NC 28754 Mars Hill, NC 28754
City State Zip City State Zip
10. Deed Book No. Page No. Provide 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.
Cole Riddle, LLC [e-mail]
Name E-mail Address
10 Murphy Edwards Hollar Rd 10 Murphy Edwards Hollar Rd
Current Mailing Address Current Street Address
Mars Hill, NC 28754 Mars Hill, NC 28754
City State Zip City State Zip
Telephone[phone] Fax Number

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
Current Mailing Address
City
Telephone
E-mail Address
Current Street Address
State Zip City State Zip
Fax Number.
(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:
Kent Cole
Name of Registered Agent
310 Murphy Edwards Hollar Road
Current Mailing Address
Mars Hill, NC 28754
City
State Zip
Telephone[phone]
[e-mail]
E-mail Address
310 Murphy Edwards Hollar Road
Current Street Address
Mars Hill, NC 28754
City
Fax Number,
State Zip
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.
22w
Title or Authority
_
Signature Date
a Notary Public of the County of
State of North Carolina, hereby certify that ' (4, appeared
personally before me this day and being duly sworn acknowledged that the above form was
executed by him.
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Witness my hand and notarial seal, this day of /l ,L 20
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Seal
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