NCC240828_FRO Submitted_20240322

BUNCOMBE COUNTY FINANCIAL RESPONSIBILITY/
PLANNING & DEVELOPMENT OWNERSHIP FORM FOR AN
i, r [phone]-Planninglnfo 8uncombeCounty.org
www.buncombecounty.org/planning EROSION CONTROL PERMIT
INSTRUCTIONS:All sections must be completed.Section E must be CASE NUMBER;
completed in the presence of a Notary Public.
A. I:cistiny i'raperty information
PIN(Numbers):9752-25-2483;9752-25-5201;9752-24-3887;9752-24-6901 Project Nnttte: Encore at Recast Creek
Latitude:35.689993 Longitude: -82.529734 Amount of fee enclosed:$9450
Project Location-Highway/Street: !teems Creek Rd(SRXI003)
Proposed Use: a Single Family Residence ®h4tdti-Family o Vacation Rental a Commercial/Industrial/Other a Other
Proposed Disturbed Area(include°Jfsite borrow and waste areas): 18 acre(s)
B. Landowner(s)of Record*
Name of Landowner(s)of Record: Ricky Ponder,Dennis Ponder
Mailing Address: 149 Ponder Rd,Weavcrville,NC 28787
Recorded in Deed Book No: o1IE Page: 785
*Note:Attach accompanied page to list additional owners
C. Contact Information—Financially Responsible Person**
Section 26-228(b)of the Buncombe County Soil Erosion and Sedimentation Control Ordinance: "Erosion control plans shall be
accompanied by a notarized statement of financial responsibility and ownership".This statement shall be signed by the person
financially responsible for the land disturbing activity or his attorney in fact.The undersigned states that he/she is the person financially
responsible for land disturbing activity described in this application and acknowledges receipt of a copy of the County of Buncombe
Soil Erosion and Sedimentation Control Ordinance and that he/she has thereby been advised of the requirements therein as well as the
penalties and resources available to the County in the event of violation of the Ordinance,including revocation of the Land Disturbing
Permit and all building permits issued in connection with the project covered by the application.
Name of Applicant: Seth Peterson
Mailing Address: P.O.Box 17437,Greenville,SC 29606
Street address: 200 East Bread Street,Suite 220
Greenville SC 29601
City State Zip
E-mail address: speterson'n4�graycliffcapital.com —
Telephone: [phone] Cell: Fax:
**Note:lithe Financially Responsible Party Is not the owner of the land to be disturbed,Include with this form a copy(s)of the Soil
Erosion and Sedimentation Control Agent or Landowner Authorization Form signed and dated with written consent for the applicant
to submit an erosion control plan and to conduct the proposed land disturbing activities.
D. Contact Information—Financially Responsible Company
Company(ies)who are financially responsible for the land disturbing activity(Provide a comprehensive list of all responsible parties on
accompanied page)If the company is a sole proprietorship or if the landowner(s)is an individual(s),the name(s)of the owner(s)may
be listed as the financially responsible party(les).
Company Name: Encore at Rums Creek Tow»homes.LLC
Mailing Address: P.O.Box 17437,Greenville,SC 29606
Street Address 200 East Broad Street,Suite 220
Greenville
SC 29601
City State Zip
E-mail address: spctersanengrayclilrcapiiat.com
Telephone: (864)679'4799 Cell: Fax:
E. Contact Information—North Carolina Agent(Registered) `I
if the Financially Responsible Party is a domestic company registered on the North Carolina Secretary of State business registry,please
provide information below of the Registered Agent:
Name of Registered Name:
Mailing Address:
Street Address
E-mail address:
City State Zip
Telephone: Cell: Fax: _
Rev Nov-23

F. Contact Information—North Carolina Agent(Non-Resident)
Section 26-228(b)of the Buncombe County Soil Erosion and Sedimentation Control Ordinance:"If the person financially responsible is
not a resident of North Carolina,a North Carolina agent must be designated in the statement for the purpose of receiving notice of
compliance or non-compliance with the plan,the Act,this ordinance,or rules or orders adopted or issued pursuant to this ordinance."
The person noted below is the designated North Carolina agent who is registered on the North Carolina Secretary of State business
registry and is duly authorized by the financially responsible person to accept and convey correspondence regarding the aforementioned
project.
Name of Agent: CAPITOL CORPORATE SERVICES,INC.
Mailing Address: 176 MINE LAKE CT STE 100 RALEIGH NC 27615
Street Address 176 MINE LAKE CT STE 100 RALEIGH NC 27615
E-mail address: [e-mail]
Telephone:800 345 7 } Cell: Fax: [phone]
Signature: ...11C.1-7 Jody Roberts,Vice President Date: 3/I$/Deo1
1,the undersigned,attest that I am the financially responsible party or an authorized representative with signatory authority for the
financially responsible party,responsible for the construction activities and maintenance of the site until ownership is completed for the
above referenced project.I acknowledge receipt of a copy of the County of Buncombe Soil Erosion and Sedimentation Control
Ordinance and have thereby been advised of the requirements therein as well as the penalties and resources available to the County in
the event of violation of the Ordinance.The above information is true and correct to the best of my knowledge and belief and was
provided by me while under oat
Name: h r Title: � �r'�
•
Signature: � /_ _. Date: 3 /(S/,�o
I, ILL It t 1-I. �)r 4 w5,&tecl k a Notary Public for
the
County of �9JGIU A-1 arso 1/� -(;ealtA))L
State of Satti CAP)b I.IA' ,hereby certify that ��T^ PP f'S 0 ^ personally
appeared before me this day and under oath acknowledged that the above form was executed by hint and is cornet to the best of his
knowledge and belief. �/
Witness my hand and seal,this / / 'day of t A C ,20 J-1
Nota 'oa7' I000 JCu c
�lcr?i/t f -2 2 20 2 e
My�Commission Expires_
OFFICE Review Fec:S Permit No.: Check No:
USE Date Paid:" Received by: Date Issued:
The County of Buncombe does not discriminate on the basis of disability in the admission or access to.or treatment or employment in. —
its programs or activities.Requests for appropriate auxiliary aids and services,when necessary,to offer a person with a disability an
equal opportunity to participate in or enjoy the benefits of County services,programs, or activities,Wray be made by contacting
Buncombe County Erosion Control,[phone]. Buncombe CowNy's TDD number is(828)250-4001,
`e 0111114�
FOR OFFICE USE ONLY s ` $T.�'USe 9/%i'
Reciev Per .
•
sNOTAR•�' �1 •
Permit No4 y G
i 0
— mi..ca !_
n,re Issued. • S :
S
Due Paid. ' ..• PUBLIC '
Check Nu: ' •
I O••••��.....• �• �`
Reed ay. //,/H C Mk°0 NN
Rev Nov-23

Continued from Section B of the Financial Responsibility/Ownership Form for multiple owners.
Attach copies of this page as needed to list all landowners.
•
Landowner 2 of Record:
Ricky Ponder,Dennis Ponder
Name Phone# E-mail Address
149 Ponder Rd 149 Ponder Rd
Current Mailing Address Current Street Address
Wc,rvervillr NC 28787 Wencer itle NC 28787
City State Zip City Slate Zip
Deed Book No. 2820 Page No. 754 Provide a copy of the most current deed.
Landowner 3 of Record:
Kathy flullman
Name Phone# E-mail Address
492 Krems Creek Rd 492 Rrrnx rr'ek Rd
Current Mailing Address Current Street Address
\Vcavcrsillc NC 28787
1Vcarcnille NC 28787 '.
City State Zip City State Zip
Deed Book No.1937 Page No. 2s3 Provide a copy of the most current deed.
Landowner 4 of Record:
Name Phone# E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Deed Book No. Page No. Provide a copy of the most current deed.
Continued from item ?in Part B of the Financial Responsibility/Ownership Form for multiple companies.
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 Stale Zip
Phone: Office# Mobile#
Company 3 Name E-mail Address
Current Mailing Address Current Street Address
City Slate 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#
Rev Nov-23