NCC230505_FRO Submitted_20230309

FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
SEDIMENTATION POLLUTION CONTROL ACT
No person may initiate any land -disturbing activity on one ormore acres as covered bythe Act before this
form and an acceptable erosion and sedimentation oonbn| plan have been completed and approved by
the Lend Quality SooUon, N.C. Department of Environmental Quality. Submit the completed form to the
appropriate Regional Office. (Please h/po or print and, if the question ionot applicable nrthe e-mail and/
or fax information unavailable, place N/A in the blank.)
Part A.1 . Project Name South Parking Area _Phase 1 - Clearing
2. Location ofland-disturbing activity: CountyBuncombe City orTownohi Asheville
Highway/Street61Terminal Drive Latitude35 26'1815N Longitude82 32"1391W
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5. Appnoxma�date |and-di�urbing activity will commenoe�^^° ^^^^ ' °-""-"-
4. Purpose of development (residential, commercial, industrial, institutional, etc.): Airport
5. Total acreage disturbed or uncovered (including off -site borrow and waste areas): 11.07 Acres
1�08
0� Amo��#� application fee of $10010per acre
(rounded up to the next acre) is assessed without a ceiling amount (Example: 8.10 ac = $900.00).
7. Has anerosion and sediment control plan been filed? Yes NoEnclosed X
O. Person to contact should erosion and sediment control issues arise during land -disturbing activity:
Nam |a0OesMoose`RE E-mail Address
'moo0e@aveoO'nc'com
Telephone 784_908
CoU ^ # °-`~"=�O-���M
° `^"`~° Fam#
0. ofRecord (attach accompanied page tnlist additional owners):
Greater Asheville Regional Airport Authority 828-209-3660
Name
61 Terminal Drive, Suite 1
Telephone
�� ��M�
~�~ ~~. ~.°_,Fax Number
Current Mailing Address Current Street Address
Fletcher NC 28732
city State Zip City State Zip
10. Deed Book No. ~''" ���� PoqeNo. =°° �M�
Provide ocopy ofthe most current deed.
Part B.
1. Cnmpony(ieo) or Mnn(n) who are financially responsible for the land -disturbing oodvih/ (Provide o
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.
Greater Asheville Regional Airport Authority |b|e'Vye's@fl\/aV|_cQm
Name E-mail Address
61 Terminal Drive, Suite 1 8E300f3
Current Mailing Address Current Street Address
Fletcher NC 28732
city State Zip City State Zip
���_�8�_���O 82��-684-��D�
|�ep,mn ~—��~~ �~~~ �mNumbe[�°�,�~ =�"�

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:
N/A
Name
Current Mailing Address
City
Telephone
E-mail Address
Current Street Address
State Zip 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:
N/A
Name of Registered Agent
Current Mailing Address
City
Telephone
E-mail Address
Current Street Address
State Zip City State Zip
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.
Lew Bleiweis
Type or print name
Signature
President and CEO
Title or Authority
Date
I, j f � ':;, � � a Notary Public of the County of
1
State of North Carolina, hereby certify that Lf, V.i e I e lv^j al appeared
personally before me this day and being duly sworn acknowledged that the above form was
executed by him.
Witness my hand and notarial seal, this
EVEN M HEYWOOD
Seal NOTARY PUBLIC
HENDERSON COUNTY, NC
W Carr *Ww Expires 5-10-2024
day of �� E` ," � �i f 201. ,
Notary
My commission expires�l