NCC232843_FRO Submitted (3)_20230920

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 address or phone
number is unavailable, place N/A in the blank.)
Part A.
II nn
1. Project Name OJvl fr4� (�)0 el
5- 1—A%-4— rt 11 Ly,o II I.PAk) tiA) 47 e
7
2. Location of land-disturbiactivity: CountyC C �
g 1�^^ � City or Township 17JrZN5 ,,;Ile
v►t.t,$fj t,► �
Highway/Street (-"-e- n�Mv►Gk LatitUde(decimal degrees) , Z7 Longitude(decimal degrees) a • a 3/
3. Approximate date land-disturbing activity will commence: /21 V1( 2424
4. Purpose of development (residential, commercial, industrial, institutional, etc.): 1a24 ,
5. Total acreage disturbed or uncovered (including off-site borrow and waste areas): Ste.,
oa.ipetvi Iz" Ne,,) iti?D
6. Amount of fee enclosed: $ 112Q . The application fee of$100.00 per acre (rounded
up to the next acre) is assessed without a ceiling amount(Example: 8.10-acre application fee is $900).
Checks should be addressed to NCDEQ.
7. Has an erosion and sediment control plan been filed? Yes I ' Enclosed No ❑
8. Person to contact should erosion and sediment control issues arise during land-disturbing activity:
Name °" 6 )\L is 1Z E-mail Address ) Q S ti S
Phone: Office# 4?� 11 `1 Z t'I Mobile# Sac v►�t,e
9. Landowner(s)of Record (attach accompanied page to list additional owners):
A-14ntT7— a`6 7/3 l zt,
5o5 4 t) al) 1011 tA race -7 I's q9 z i" `& 1 l 3 ci t
Name Phone: Office# Mobile#
Current Mailing Address Current Street Address
ASk.,►1L. 1JQ— ?ckoc S
City State Zip City State Zip
10. Deed Book No. S 3 2 Page No. q Provide a copy of the most current deed.
RECEIVED
LAND 0101-11'60;I iC�'

(c) If the Financially Responsible Party is engaging in business under an assumed name, give name under
which the company is Doing Business As. If the Financially Responsible Party is an individual, General
Partnership, or other company not registered and doing business under an assumed name, attach a copy
of the Certificate of Assumed Name.
Company DBA Name
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(s)
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 Party). I agree to provide
correctedinform?tiori should there be any change in the information provided herein.
—3-0s LA,A- C- 1,4 4‘r44, r2a04010 Levi 00 ,3 yt e.rt_S
Type or print name Title or Authorit
c9 Z3
ign ur - -/ Date
I, ACIfig S , a Notary Public of the County of nC.Oryl
State of North Carolina, hereby certify that ' �taQ�C Bflk-{TDn appeared personally
before me this day and being duly sworn acknowledged that the above form was executed by him/her.
Witness my hand and notarial seal, this ` t day of 20 23
otary tL))1-e- 1
Seal 21
My commission expires
•,,PpRIA . ",�••��,
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y B4 C le.
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RPGEIVED
LAND(MC I1 10'

Continued from Item 1 in Part B of the Financial Responsibility/Ownership Form for multiple parties.
Attach copies of this page as needed to list all financially responsible parties.
Company 2 Name E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Phone: Office# Mobile#
Company 3 Name E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Phone: Office# Mobile#
Company 4 Name E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Phone: Office# Mobile#
Company 5 Name E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Phone: Office# Mobile# RECEIVED
LAND ? ;a Eel(C

Addendum to FR/O form Part A, Item 9: Landowner of Record Letter of Consent
Landowner of Record Name: n�F�'q �t;4 q, 1�,1 ,tcyk /4 .Jt
L_e4 r C�
Property Tax ID#/PIN: �' � c) Li 0Q)
Property Address Line 1: L T S I I O\1149`- w5
Property Address Line 2: /VIA
City/State/Zip Code: Z14-45 y lit W.- `" ) ) tt
Applicant submitting plan - must match the financially responsible party named in Part B
Section 1 of the Financial Responsibility/Ownership (FR/0) Form:
..74.1-1 Ur4- C. g a / "t t f!L. )OIL-4-ktty
Statement of Landowner Consent: In accordance with NCGS 113A-54.1(a), I hereby declare
that I am the owner or legally authorized representative of the owner of the property described
above and provide my consent for the applicant cited above and in Part B of the FR/O form to
submit a draft erosion control plan to the State of North Carolina and to conduct the planned
land-disturbing activities on the property listed above and in Part A of the FR/0 form.
3ZSti'4VA C. ?R✓ -lO •) Pone.fie L . etc
Type or Print Name Title or Authority
ir7 y -)3
Si ature / ate
JD514. ,zw e_ (Vlr�.1 .(� �q 713
Email Telephone
RPGSVED
LAW GOD I I, E.C:.i iO'

BK.CRP 882
PG:445-447 NC FEE 00
DEED 2022002301
STATE OF NC
RECORDED: YANCEY COUNTY, NC REAL ESTATE
07/21/2022 SUSAN JOBE
04:12:07 PM REGISTER OF DEEDS EXTX$190.00
Total Pages:3
TOTAL$216.00
*** TITLE NOT EXAMINED BY DRAFTSMAN***
PREPARED BY: Dale W.Hensley,a licensed North Carolina Attorney,P.O.Box 1570,Burnsville,NC 28714
Delinquent Tares, if any,to be paid by dosing attorney to the County Tax Collector upon disbursement of closing
proceeds.
The property herein conveyed does include the primary residence of a Grantor.
Parcel ID:a portion of 074901382785000 G DW 7/21/2022
Revenue Stamps:S190.00 Index:Lots 1-6 acres,Highland Meadow Ridge
Subdivision,Crabtree Twsp.
NORTH CAROLINA
YANCEY COUNTY GENERAL WARRANTY DEED
THIS DEED made this the CPday of , 2022,by ABRA REMILLARD,
Unmarried Widow, (57 Pinnacle Drive, Burnsville, NC 28714) Grantor, to, JOSHUA
CHRISTIAN BRUTON and wife, ANNETTE LEE BURCKLEY, (52 Trinity Chapel Road,
Asheville,NC 28805),Grantee. RECEIVED
WITNESSETH: LAND Uliitt Y SEGT
errs r r'
THAT the said Grantor,for the sum of TEN DOLLARS($10.00)and other good and valuable
consideration, the receipt of which is hereby acknowledged, has and by these presents does convey
to the said Grantee,as tenants by the entirety,his or her heirs and assigns,a certain tract or parcel of
land located in the Crabtree Township, Yancey County, North Carolina, and more particularly
described as follows:
DALE W.HENSLEY,ATTORNEY AT LAW,PO BOX 1570,BURNSVILLE,NC 28714
Submitted electronically by "John c Frue PA"
in compliance with North Carolina statutes governing recordable documents
and the terms of the submitter agreement with the Yancey county Register of Deeds.

instrizneritif LUZZUULSUi 13001E t!t$Z I'age 4.10 U//"Li/GUZZ U4:.L :U/ YM: Page z Or 3
See Exhibit A attached hereto and incorporated herein by reference.
TO HAVE AND TO HOLD the aforesaid tract or parcel of land and all privileges and
appurtenances thereto belonging to the said Grantee, as tenants by the entirety, his or her heirs and
assigns,in fee simple forever.
And the said Grantor covenants with said Grantee that Grantor is seized of said premises in
fee simple and has the right to convey in fee simple; that the same is free and clear from all
encumbrances, and that Grantor does hereby warrant and will forever defend the title to the same
against the claims of all persons whomsoever.
The designation Grantor and Grantee as used herein shall include said parties, their heirs,
successors,and assigns,and shall include singular,plural,masculine,feminine or neuter as required
by context.
IN WITNESS WHEREOF,the Grantor has hereunto set his hand and seal,the day and year
first above written.
r �
(SEAL)
L'ABRA REMILLARD
STATE OF NORTH CAROLINA
COUNTY OF YANCEY
I, cry r& . `i`i 4a n , a Notary Public in and for the State and County
aforesaid do hereby certify that, ABRA REMILLARD, Widow,personally appeared before me this
day and acknowledged the due execution of the foregoing instrument.
Witgem,wy hand and Notarial Seal,this the i 4'day of 1 ,2022.
Fes- o�AR y Notary Public-
�c:•. AUB4�G,;'_ My commission expires: I 0 I 1 (c= 0 acio
DALE W.HENSLEY,ATTORNEY AT LAW,PO BOX 1570,BURNSVI LLE,NC 28714

inerrumenty GULGUU'GSU1 BOOK BUG rage 44/ U//Gl/GULL U4:1G:U/ PM: rage S or S
LEGAL DESCRIPTION
EXHIBIT "A"
bruton&burkley from remillard
LYING AND BEING in Crabtree Township, Yancey County, North Carolina and being more
particularly described as follows:
BEING all of Lot 1 (0.995 acres), Lot 2 (0.974 acres), Lot 3 (1.304 acres), Lot 4 (0.862 acres),
Lot 5 (0.863 acres) and Lot 6 (0.960 acres) as shown on a map of survey entitled "Boundary and
Division Survey for Matt Remillard" dated October 12, 2020 and revised April 21, 2021 by
Mountaineer Land Surveying,P.A.,Marvin J.Nunley,PLS,L-44I 3,having Job No.20-1 I 1 REV
and being recorded in Plat Book 4, Page 418,Yancey County,NC Registry.
ALSO CONVEYED HEREWITH unto the GRANTEES, their heirs and assigns, and made
SUBJECT to the rights of others, is a perpetual, non-exclusive easement and right of way over
the roadways shown on the above referenced plat to be used as a means of ingress, egress and
regress to Cane Branch Road (NCSR 1146), together with the rights of ingress, egress and •
regress for the purposes of inspection, improvement, maintenance and repair of said right of way.
DEED REFERENCE: Being a portion of the property described and conveyed in instrument
dated December 30, 2020 from TERRY LEDFORD and wife. TONYA LEDFORD; and
MARTIN LEDFORD and wife. RHONDA LEDFORD, Grantors, to MATTHEW JOHN
REMILLARD and wife. ABRA KAREN REMILLARD, Grantees, and recorded in Deed Book
838,Page 549, Yancey County,NC Registry.
RECEIVED
LAND(AWkt.l!t SECT IC?`