NCC241355_FRO Submitted_20240502

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
foram 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.)
Part A. p 1. Project Name Biltmore Forest Stormwater System Improvements
2. Location of land-disturbing activity: County Buncombe City or Township Biltmore Forest
Highway/Street Vanderbilt Latitude 35.5392 Longitude-82.5370
3. Approximate date land-disturbing activity will commence:May 8, 2024
4. Purpose of development(residential, commercial, industrial, institutional, etc.):Municipal
5. Total acreage disturbed or uncovered(including off-site borrow and waste areas): 3.0
6. Amount of fee enclosed: $ 300 . 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 X No Enclosed X
8. Person to contact should erosion and sediment control issues arise during land-disturbing activity:
Name Harry Buckner E-mail Address hbuckner©biltmoreforest.org
Telephone [phone] Cell# N/A Fax# N/A
9. Landowner(s)of Record (attach accompanied page to list additional owners):
Town of Biltmore Forest 828-274-0824 N/A
Name Telephone Fax Number
355 Vanderbilt Road 355 Vanderbilt Road
Current Mailing Address Current Street Address
Biltmore Forest, NC 28803 Biltmore Forest, NC 28803
City State Zip City State Zip
10. Deed Book No. Page No. 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 fin,is a sole proprietorship,
the name of the owner or manager may be listed as the financially responsible party.
Town of Biltmore Forest [e-mail]
Name E-mail Address
355 Vanderbilt Road 355 Vanderbilt Road
Current Mailing Address Current Street Address
Biltmore Forest, NC 28803 Biltmore Forest, NC 28803
City State Zip City State Zip
Telephone [phone] Fax Number N/A

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:
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:
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.
Jonathan Kanipe Town Manager
T •- or print name Title or Authority
1arillqawe*. 5- I - Z'4
Sigre Date
I, le SS it Ca- 4 Q.(k,-C , a Notary Public of the County of - •Vor x r o
State of North Carolina, hereby certify that Jov1/411‘.4c� � ��-►"--�L' appeared
personally before me this day and being duly sworn acknowledged that the above form was
executed by him. , I
Witness my hand and notarial seal, this I day of Ma, , 20 24
JESSICA HEDRICK
Notareublic-North Carolina I
Ierson County I
My Commission Expires Feb 1,2029 I commission expires 2 t 1 12-41

Continued from Items 9 & 10 in Part A of the Financial Responsibility/Ownership Form for multiple
owners. Attach copies of this page as needed to list all landowners.
Landowner 2 of Record:
Eugenia Barry
Name Phone: Office# Mobile#
11 Lone Pine Road 11 Lone Pine Road
Current Mailing Address Current Street Address
Biltmore Forest, NC 28803 Biltmore Forest, NC 28803
City State Zip City State Zip
0Deed Book No.2685 Page No. 130 Provide a copy of the most current deed.
Landowner 3 of Record:
Cresterly, LLC
Name Phone: Office# Mobile#
P.O. Box 1905 2 Stuyvesant Road
Current Mailing Address Current Street Address
Jackson, WY 83001 Biltmore Forest, NC 28803
City State Zip City State Zip
Deed Book No. 5842 Page No. 0249 Provide a copy of the most current deed.
Landowner 4 of Record:
Blair and Gabriel Holl
Name Phone: Office# Mobile#
1 Stuyvesant Road 1 Stuyvesant Road
Current Mailing Address Current Street Address
Biltmore Forest, NC 28803 Biltmore Forest, NC 28803
City State Zip City State Zip
Deed Book No.4981 Page No. 0786 Provide a copy of the most current deed.
Landowner 5 of Record:
Thomas and Nancy Maher
Name Phone: Office# Mobile#
1 Park Road 1 Park Road
Current Mailing Address Current Street Address
Biltmore Forest, NC 28803 Biltmore Forest, NC 28803
City State Zip City State Zip
Deed Book No.4776 Page No. 1434 Provide a copy of the most current deed.