NCC222501_FRO Submitted_20220726

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 been completed and approved by the
Land Quality Section, N.C. Department of Environmental Quality. (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.
Project Name Eden Rock Village Subdivision
2. Location of land -disturbing activity: County Madison City or Township Mars Hill
Highway/Street 30 Parkway View Road Latitude 35°50'5.00"N Longitude_ 82°32'5.00"W
3. Approximate date land -disturbing activity will commence: March 1, 2019
4. Purpose of development (residential, commercial, industrial, institutional, etc.):_Residential
5. Total acreage disturbed or uncovered (including off -site borrow and waste areas): 23
6. Amount of fee enclosed: $ 1,495.00 . The application fee of $65.00 per acre
(rounded up to the next acre) is assessed without a ceiling amount (Example: a 9-acre application fee
is $585).
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 Brandon Quinn E-mail Address edenrockenterprises(aDgmail.com
Telephone [phone] Cell # same Fax #
9. Landowner(s) of Record (attach accompanied page to list additional owners):
EDEN ROCK ENTERPRISES, LLC
Name
PO BOX 326
Current Mailing Address
828.778.9457
Telephone Fax Number
Current Street Address
Mars Hill North Carolina 28754
City State Zip City State Zip
10. Deed Book No. (SEE ATTACHED) Page No. 155 Provide a copy of the most
current deed.
Part B.
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.
Eden Rock Enterprises, LLC edenrockenterprises(@gmail.com
Name E-mail Address
72 Anderson Street same
Current Mailing Address Current Street Address
Mars Hill North Carolina 28754 same
City State Zip City State Zip

2. a 3f tl 1= aff� y - u
of the €t�r�ated a r a r._ ` ' ofWx1h Cara'"a,rye aFW sbre
Name E-mail Address
Current +iairag in meet Ads�s
City State Zip City
State Zip
Telephone Fax Number
fib) If the Finaraay Rpor&bie Par€y is a PaMwsiliptic person e,gaing i�I buss`ressir,det an
assumed name, attach a copy of the Certificate of Assured Dame. If the Financially Responsible
Party is a Corporation, give name and street address of the Registered Agent_
Name of Registered Agent Email Address
Current Mailing Address Current Street Address
City
State ,Zip City
Telephone Fax Number
State
Zip
The above information is true and correct to the best of my knowledge and belief and was prirvided
by tie 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.
Brandon Quinn
Manager
Typ r print ame Title or Authority
Signature 4Dnate*
a Notary Public of the County of ffi&dt* l )
State of North Carolina, hereby certify thatA
!�Jyswo�rnackkow�ledged
�
ared
personally before me this day and being that the above formappe was
executed by him.
Witness my hand and noiarial seat, this ZAP _clay of In
2g j
SMADISON,
anyMy commission expires

10a. Deed Book No ... 424
Page No. 155 Provide a copy of the most current deed.
10b. Deed Book No. 118 Page No. 347 ' Provide a copy of the most current deed.
10c. Deed Book No. 118 Page No. 442 Provide a copy of the most current deed.