HomeMy WebLinkAboutNCC222566_FRO Submitted_20220725FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
SEDIMENTATION POLLUTION CONTROL ACT
EXPRESS PERMITTING OPTION 08012007
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 and/or
fax information unavailable, place N/A in the blank.)
Par+ 4
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Project Name WAYNESVILLE INN & GOLF CLUB
Location of land -disturbing activity: County HAYWOOD City or Township WAYNESVILLE
Highway/Street Country Club Drive Latitude 35.471 Longitude-82.999
Approximate date land -disturbing activity will commence: 10-16-21
Purpose of development (residential, commercial, industrial, institutional, etc.): Commercial
Total acreage disturbed or uncovered (including off -site borrow and waste areas): 53
6. Amount of fee enclosed: $ 3,445 . The Express Permitting application fee is a dual charge.
The normal fee of $65.00 per acre is assessed without a ceiling amount. In addition, the Express
Permitting supplement is $250.00 per acre up to eight acres, after which the Express Permitting
supplemental fee is a fixed $2,000.00 (Example: 9 acres total is $2,585). NOTE: Both fees are
rounded up to the next whole acre and need to be paid by separate checks to NCDENR.
7. Has an erosion and sediment control plan been filed? Yes No X Enclosed X
8. Person to contact should erosion and sediment control issues arise during land -disturbing activity:
Name Brandon Graham E-mail Address brandon.graham@rainesco.com
Telephone cell # 864.444.7216 Fax #
9. Landowner(s) of Record (attach accompanied page to list additional owners):
WGC Hospitality LLC 843-799-2306
Name Telephone Fax Number
1943 Hoffmeyer Rd, Ste C
Current Mailing Address Current Street Address
Florence SC 29501
City State Zip City State Zip
10. Deed Book No. 1027/1027 Page No. 2044/2048 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.
WGC Hospitality LLC david.tart@rainesco.com
Name E-mail Address
51 South Market Street
Current Mailing Address Current Street Address
Asheville NC 28801
City
State Zip City
State
Zip
Telephone 843-799-2306 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:
Encore -Asheville, LLC david.tart@ rainesco.com
Name
411 West Pope Street
Current Mailing Address
Dunn NC 28334
City State Zip
Telephone 843-799-2306
E-mail Address
Current Street Address
City State Zip
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:
Encore -Asheville, LLC
Name of Registered Agent
411 West Pope Street
Current Mailing Address
Dunn NC
City
david.tart@ rainesco.com
E-mail Address
Current Street Address
28334
State Zip
Telephone 843-799-2306
City
Fax Number
State Zip
(c) In order to facilitate Express Permitting, it is necessary to be able to contact the Engineer or other
consultant who can assist in providing any necessary information regarding the plan and its preparation:
Civil Design Concepts, PA dbraun@ cdcgo.com
Engineering Firm or other consultant E-mail Address
David Braun 828.252.5388
Individual contact person (type or print)
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.
David Tart
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Manager
Title or Authority
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Date
I, 1-� (, I'J ' l� c� fit✓✓ c , a Notary Public of the County of -
State of North Carolina, hereby certify that ` /c 1 appeared personally
before me this day and being duly swom acknowledged that the above form was executed by him.
Witness my hand and notarial seal, this day of � 11LA_k&20or
Notary
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Q,. NOTARY My commission expires J
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