HomeMy WebLinkAboutNCC232280_FRO Submitted_20230905 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. 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.)
1. A. South ParkingArea - Phase 2 - South ParkingLot
1. Project Name
2. Location of land disturbing activity: County Buncombe City or Township Asheville
Highway/Street 61 Terminal Drive Latitude 35 26' 18.15 N Longitude 82 32' 13.91 W
3. Approximate date land-disturbing activity will commence:July 2023
4. Purpose of development(residential, commercial, industrial, institutional, etc.): Airport
5. Total acreage disturbed or uncovered (including off-site borrow and waste areas): 13.1 Acres
$200($1,40D total,$1,200 previously paid)
6. Amount of fee enclosed: $ . 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 h No Enclosed X
8. Person to contact should erosion and sediment control issues arise during land-disturbing activity:
Name James Moose, P.E E-mail Addresslmoase@avconinc.com
Telephone 704-954-9008 Cell# 704-650-6050 Fax#
9. Landowner(s)of Record (attach accompanied page to list additional owners):
Greater Asheville Regional Airport Authority 828-209-3660 828-684-3404
Name Telephone Fax Number
61 Terminal Drive, Suite 1
Current Mailing Address Current Street Address
Fletcher NC 28732
City State Zip City State Zip
10. Deed Book No.3775 Page No.508 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.
Greater Asheville Regional Airport Authority Ibleiweis@flyavl.com
Name E-mail Address
61 Terminal Drive, Suite 1 same
Current Mailing Address Current Street Address
Fletcher NC 28732
City State Zip City State Zip
Telephone 828-209-3660 Fax Number 828-684-3404
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:
N/A
Name E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Telephone 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:
N/A
Name of Registered Agent E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Telephone Fax Number
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.
Lew Bleiweis President and CEO
Type or print nam -- Title or Authority
Ye— 77
Signature Date
I, Eli k-r, ifv\° Pe_t1 td0014 , a Notary Public of the County of d-t t,t'\dtir f( }
State of North Carolina, hereby certify that Le-m) 6(e'i wi-?5 appeared
personally before me this day and being duly sworn acknowledged that the above form was
executed by him.
Witness my hand and notarial seal, this a -' day of IA �'YI l , 20, S
ELLEN M HEYWOOD U2' -e7
NOTARY PUBLIC Notary
HENDERSON COUNTY,NC
fission Expires 5-10-2024 I
My commission expires 31 tV/