NCC242635_FRO Submitted_20240827

IMF-
-y rw^�r FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
�'�'�FIENDS` RM NEN�RS �
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 Henderson County Site Development Department. (Please type or print and, if the
question is not applicable or the e-mail and/or fax information unavailable, place NIA in the blank.)
Sign the original form in FLUE
Part A.
1. Project Name Evado at Tap Root
2. Location of land-disturbing activity: County Henderson City Unincorporated
Highway/Street Butler Bridge Road Latitude 35.40754728564.972 Longitude-82.52254475880714
Property Identification Number(s)PIN's 9652-01-5834, 9652-12-2330
3. Approximate date land-disturbing activity will commence:January 2024
4. Purpose of development(residential, commercial, industrial, institutional,etc.):Apartments
5. Total acreage disturbed or uncovered (including off-site borrow and waste areas): 15.1
6. Amount of fee enclosed: $5,000 The application fee of$300.00 per acre
(rounded up to the next acre)is assessed without a ceiling amount include a$200.00 plan review fee to
land disturbance fees. (Example: 8.10 ac=$2,900.00).
7. Has an erosion and sediment control plan been filed? Yes No Enclosed X
8. Person to contact should erosion and sediment control issues arise during land- disturbing activity:
Name W.McFaddin Blanding E-mail Address [e-mail]
Telephone [phone]
9. Landowner(s)of Record (attach accompanied page to list additional owners):
See attached
Name Telephone
Current Mailing Address Current Street Address
City State Zip City State Zip
10. Deed Book No.See attached 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 firm is a sole proprietorship,
the name of the owner or manager may be listed as the financially responsible party.
Orange Capital Advisors, LLC [e-mail]
Name E-mail Address
125 Regional Parkway, Suite 200 125 Regional Parkway, Suite 200
Current Mailing Address Current Street Address
Orangeburg SC 29118 Orangeburg SC 29118
City State Zip City State Zip
Telephone[phone] Fax Number

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
Cogency Global Inc.
Name E-mail Address
212 South Tryon Street, Suite 1000
Current Mailing Address Current Street Address
Charlotte NC
City State Zip City State Zip
Telephone[phone]
(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:
Orange Capital Advisors, LLC [e-mail]
Name of Registered Agent E-mail Address
125 Regional Parkway, Suite 200 125 Regional Parkway, Suite 200
Current Mailing Address Current Street Address
Orangeburg SC 2-„e Orangeburg - SC 29118
City State Zip City State Zip
Telephone[phone]
•
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.
W. McFaddin Blanding President
Type or rint name Title or Authority
it
Signature Date
I, hii,44 , a Notary Public of the County of S r(rC.11t,V eZ lsL
State of S C, , hereby certify that U) - mph a 414,-, gla.14ip
appeared personally before me this day and being duly sworn acknowledged that t above
form was executed by him.
Witness my hand and notarial seal, this °i day of U !t vv. - , 20 I
JOHN Mi RUNION
NOTARY PUBLIC,STATE OF SOUTH CAROLINA Notary
9$61JMMISSION EXPIRES APRIL 7,2032
My commission expires `-t 1 12o3 Z