NCC232843_FRO Submitted (4)_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.
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1. Project Name i`1 l \
1I r ,f,ct
2. Location of land-disturbingg activity: CountyvThZ ityor Township_ r1
I-h GL d Ait Lad 'vu s �Q v��i
Highway/Street \,Sv-Ni bc/PA ,-Latitu e(decimaldegrees)3590I LOngitude(decimaldegrees) 32-
"2.32
3. Approximate date land-disturbing activity will commence: likailigEnat 2-1 2 (7/ 2O2(
4. Purpose of development (residential, commercial, industrial, institutional, etc.): VAS
5. Total acreage disturbed or uncovered (including off-site borrow and waste areas): '6 i\c rzas
I f2G?G
6. Amount of fee enclosed: $ /0 o j" 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? YesX Enclosed E No ❑
8. Person to contact should erosion and sediment control issues arise during land-disturbing activity:
Name -� c- A� E-mail Address fY &--S 0 9✓VLai (. Co 0y1
Phone: Office# Mobile# 28 ' 7 7 S - f z-f
9. Landowner(s) of Record (attach accompanied page to list additional owners):
Name — t�, (� Phone: Office# Mobile#
Current Mailirfg Address NL ocb-)IL( Current Street Address
City State Zip City State Zip
10. Deed Book No. S5 4S Z. Page No. 3 3 9 Provide a copy of the most current deed.
RECEIVED
LAND CLII LC !ilt;TiOf'

(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
corrected info mation should there be any change in the information provided herein.
Ty e o mI Title or Authority
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c nature Date
-I ,_,� ` a NotaryPublic of the Countyof
� �a-n� �
State of North Carolina, hereby certify that Oar V G,c(I1L((t2U"d e a eared 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 e3 day of 20 21)7,3
�.�`.P KEFF
4C) 9 % of
ealoIPA}, �J !
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v My commission expires 1 //1!1 02
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RECEIVED
LAND CI MA l 1 a G i ie
e,cuafSril I c

Continued from Item 9 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#
RECEIVED
Company 5 Name E-mail Address
LAND( 10.11T EGiiC "
h;1",nl
Current Mailing Address Current Street Address
City State Zip City State Zip
Phone: Office# Mobile#

Addendum to FR/O form Part A, Item 9: Landowner of Record Letter of Consent
C N rc-I \<6--C/��- --4—
Landowner of Record Name: ��� .
Property Tax ID#/PIN: -T "1 (O ( _7)S)j Q 3, V U o
Property Address Line 1: R Lt 1 h Cc/ "�.`
lrsv\ ! ,�\�,L,6 3 V C.
Property Address Line 2: N IA-
City/State/Zip Code: ` J v1c� j.` , vC ;,L .
Applicant submitting plan - must match the financially responsible party named in Part B
Section 1 of the Financial Responsibility/Ownership (FR/0) Form:
651,-j ac id 1c c lei 61 ad! d
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.
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— 0 \.I3 r\c-V--,
Type or Pr. t Na e Title or Authority
, =1:/...A.)*
Sign. re Date
n� � %, 33i� �3� 9
Email .\�<< Telephone
r-Nr.
RECEIVED
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BK:CRP 879 . ,
PG: 58 60 2022001673
YANCEY COUNTY,NC
05n.1,07: SUSAN JOBE !
171736Phi err.c'reorrrrrt
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s of err CAr OLINA GENE':RAr.WARRANTY DEED
4 11 f.i. ib VI 0. oO
a r.u..I Iden i \. '':,UI "\v.00(1 Verified by_ —_ -- County on the day of -- __.`(l-- pi
1t. 1�
\Ltt1Urs :,, I\,ill:11 Her,sks.I's) Ro\ I57n.Burnsville,N(' ?87Ia _
' iI nstrumcn:'.ti.i.prep.Ired 's I)*WIlen.lei,I'i).Box_I?70flumsvd!c,N(_28714 -
linef de,..,rpt:'n t't:he hides-. _
I1 OI'la)m.,,ie;hi =adt day of May ,2022 ,by and between
GR A\I OR GRANTEE
a ;bra KJ •n Rem;:lird.llidoss GaryG Friedlander and wife Jacqueline I. Friedlander
s-S PIrmacic I)rnc P.O.Box 1633
10.64 liumsulk,\C 28714 Burnsville,NC 28714
MI
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r; rI r Tr...:e lock for each Grantor and Grantee: name,mailing address,and,if appropriate character of entity.e.g. 2
,.. r, f,.'. n r(•.niece lup. flit
The desicn..:i: r.(ir n:cr and Grantee as used herein shall include said parties.their heirs,successors,and assigns.and shall include singular.
mural,masculine.feminine or neuter as required by context. m;
WITNES SE:f H.that the Grantor,for a valuable consideration paid by the Grantee,the receipt of which is hereby acknowledged.has and by »+
:hese presents does gran:,bargain,sell and convey unto the Grantee in fee simple.all that certain lot,parcel of land or condominium un,t
1. siraated in the City of -__ Ilurnsol!c-- _,- Crabtree 'township, Yancey County,
North Carolina and more particularly described as follows: ���`
See e shihit"A"attached hereto and incorporated herein by n:ference This instrument prepared by k W tt�l r�leU -
a licensed NC attorney.Delinquent razes,it any,to oe paid `'
by the closing attorney to the County Tax Co!lector upon a.
disbursement at closing proceeds.
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The property hereinabove described was acquired by Grantor by instrument recorded in Book 833 page__ 4c_
All or a pun:on of the property herein conveyed in:ludes or X does not include the primary residence of a Grantor.
A m:.h shr)wink die above described property is recorded in Plat Book — page --
I'age l se:2 I
NC Ba:Assoconrurn 1 sent.No I:'1976,Revised R7 1977.20,12.:113 Ibis standard I 3�y`'I' IE r�
1^ts:cif t. Ag er r.rnr'WILK the NC his A%,ntiarion-1981 \,nit:Cmolina liar Asxsa'tl � ' '..,
Submitted electronically by "Dale W. Hensley, Attorney"
in compliance with North Carolina statutes governing recordable documents ,,s
and the terms of the submitter agreement with the Yancey County Register of Deeds. ._ ' i"r.
LANL uay(?.tIYS .CTIO1‘.
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