NCC230792_FRO Submitted_20230328

Check if this project is ARPA-funded
FINANCIAL RESPONSIBILITYIOWNERSHIP FORM
SEDIMENTATION POLLUTION CONTROL ACT
No person may initiate any land -disturbing activity on one or more acres as covered by the Act, including any
activity under a common plan of development of this size as covered by the NCO01 permit, 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 address or phone
number is unavailable, place N/A in the blank.)
Part A.
1. Project Name N UA Wed\ff
'if this project involves American Rescue Plan Act (ARPA) funds, fist the Project dame below
under which you applied for funding through the division of Water irlfr'astructure (DWI).
2. Location of land -disturbing activity: County [7U+C c City or Township C40a ll,�_4 s�Tcard
Highway/Street 0= W. Pdfdkt Latitude(declmaldegrees) 35.177 Long ltUde(decimaldegrees) * $1."5
MUrbOf Pf1Ue
3. Approximate date land -disturbing activity will commence:OLI 108 i �09"3
4. Purpose of development residential commercial, industrial, institutional, etc.):
5. Total acreage disturbed or uncovered (including off -site borrow and waste areas): a -13
6. Amount of fee enclosed: IOd. 06 . The application fee of $100.00 per acre (rounded
up to the next acre) is assessed without a ceiling amount (Example: 8.10-acre application fee is $900).
Checks should be addressed to NCDEQ.
7. Has an erosion and sediment control plan been filed? Yes ❑ Enclosed No ❑
8. Person to contact should erosion and sediment control issues arise during land -disturbing activity:
Name 060a W eaw E-mail Address dllnrcGitP�r� G1l�OUP CbS . (nm
Phone: office # 744 - 51 to - t4 e,1 p a Mobile # a i a - 477- 09 71
9. Landowner(s) of Record (attach accompanied page to list additional owners):
Dave w RAw 70"ll - sau - 4 aria, 9 )0 - ` 77- dazt
Name J Phone: Office # Mobile #
VV Lbw ROA Rygrx M aaoa w P_O(Ad13t Paebdr ])give
Current Mailing Address Current Street Address
concord NG AbQa5 000611 50rin�.5 Nc j,8t.(l g,
City State Zip City J I J State Zip
10. Deed Book No.,5 rq--� Page No.�'" U14 Provide a copy of the most current deed.

Check if this project is ARPA-funded ❑
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, including any
activity under a common plan of development of this size as covered by the N0001 permit, before this farm
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 address or phone
number is unavailable, place NIA in the blank.)
Part A. 1. Project Name D o m w PQ m
*if this project involves American Rescue Plan Act (APPA) funds, list the Project tVeme below
under which you applied for funding through the Division of Water Infrastructure (DWI).
2. Location of land -disturbing activity: County_ 6U(Kt City or Township��).T,-ar'd
Highway/Street a%l W. A fAdi5 Latitude(dec(maldegrees) 3S.171 Longitude(decimaldegrees) VV1 1(g5
Arb6r pnvt
3. Approximate date land -disturbing activity will commence:04 % 09 f a090
4. Purpose of development residential commercial, industrial, institutional, etc.):
5. Total acreage disturbed or uncovered (including off -site borrow and waste areas): 0.13
6. Amount of fee enclosed: $ (06.00 _ The application fee of $100.00 per acre (rounded
up to the next acre) is assessed without a ceiling amount (Example: 8.10-acre application fee is $900).
Checks should be addressed to NCDEQ_
7. Has an erosion and sediment control plan been filed? Yes ❑ Enclosed Cl No ❑
8. Person to contact should erosion and sediment control issues arise during land -disturbing activity:
Name D80a pip tV»y E-mail Address C�It�rcaltew��OV�A G��
Phones: Office 9 704 - 'J 1 Li - m l `z Mobile # q l o -
9. Landowner(s) of Record (attach accompanied page to list additional owners):
Dove W e(AW 76"1-5%-9 q4% 9)0- `i1?- Qa-7l
Name \J Phone: dice # Mobile #
D-A0 Naebor D)ive_
Current Mailing Address Current Street Address
Gncofd+ NC a pas �o�l a�llui Slorin� 5 tic r).,a� I a
City State Zip City J J state Zip
10. Deed Book No. 25_iJ_ Page No.- (1 r t -.. Provide a copy of the most current deed.

r
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 landowners) is
an individual(s), the names) of the owners) may be listed as the financially responsible padfy(ies),
Dow Vicam view r'a ajzb5, cam
Compan Name E-mail Address
�3a6 1AW .Nkv IZ RA 2aba ParadiX NUbdr j9nve
Current Mailing Address r� Current Street Address
Nod tic WS WI`Ifllu 506na5 6c, 9sb/a
City State Zip City j 1-11 State Zip
Phone: Office # 70q 5q G . � a � g, Mobile # q 10 - q? 7' Q a-j I
Note, If the Financially Responsible Party is not the owner of the land to be disturbed, include with this form
the landowner's signed and dated written consent for the applicant to submit a draft erosion and sedimentation
control plan and to conduct the anticipated land disturbing activity.
(a) If the Financially Responsible Party is a domestic company registered on the NC Secretary of State
business registry, give name and street address of the Registered Agent:
NSA
Name of Registered Agent
Current Mailing Address
City State Zip
Phone: Office #
E-mail Address
Current Street Address
City
Mobile #
Name of Individual to Contact (if Registered Agent is a company)
State Zip
(b) if the Financially Responsible Party is not a resident of North Carolina, give name and street address
of the designated North Carolina agent who is registered on the NC Secretary of State business registry:
Name of Registered Agent E-mail Address -
Current Mailing Address Current Street Address
city State Zip City State Zip
Phnnp• Office # Mobile #

(c) If the Financially Responsible Parry is engaging in business under an assumed name, give name under
which the company is Doing Business As. If the Financially Responsible Party is an individual, General
Partnership, or other company not registered and doing business under an assumed name, attach a copy
of the Certificate of Assumed Name.
_.- N r A
Company DBA Name
The above information is true and correct to the best of my knovdedge and belief and was provided
by me under oath. (This form must be signed by the Financially Responsible Person if an individual(s)
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 Party). i agree to provide
corrected information should there be any change in the information provided herein.
Do(Lg 1AIrLIW
Typ- or pfint name ,
dwaef
Title or Autho720
/ 2
Date
1, W 1 dfi �&s , a Notary Public of the County of (Aa S
State of North Carolina, hereby certify that UU mj I g r— appeared personally
before me this day and being duly sworn acknowle ed that theabove for was executed by him/her.
s� � ,
Witness my hand and notarial seal, this ��day of 201,a
My commission expires

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:
N Ih
Name Phone: Office # Mobile #
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.
Landowner 3 of Record:
i0.�
Name Phone: Office # Mobile #
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.
Landowner 4 of Record:
MIA
Name Phone: Office # Mobile #
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.
Landowner 5 of Record:
``1 A
Name Phone: Office # Mobile #
Na
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 9 in Part B of the Financial Responsibility/Ownership Form for multiple parties,
Attach copies of this page as needed to list all financially responsible parties.
NIA
Company 2 Name E-mail Address
Current Mailing Address Current Street Address
city State Zip
Phone: Office #
City State Zip
Mobile #
_Ni(A
Company 3 Name E-mail Address
Current Mailing Address Current Street Address
city
Phone: Office #
State Zip City State
Mobile #
NIA
Company 4 Name E-mail Address
Current Mailing Address Current Street Address
City State Zip
Phone: Office #
Zip
City State Zip
Mobile #
WA
Company 5 Name E-mail Address
Current Mailing Address Current Street Address
City state Zip City sto-te Zip
Phone: Office # Mobile #

BK 2579 PG 612 - 614 (3) DOC# 2021012860
This Document eRecorded: 10/25/2021 01:54:05 PM
Fee: $26.00 Tax: $238.00
Burke County, North Carolina
Stephanie A. Norman, Register of Deeds
This instrument prepared by, Fleischer Law Office, PLLC, a licensed North
Carolina attorney. Delinquent taxes, if any, to be paid by the closing
attorney to the Burke County, NC Tax Collector
upon disbursement of closing proceedings.
Excise Tax $238.00
Parcel Identification Number: 2764277131, REID: 58051
Mail after recording to: Hamby & Hamby, P.A., P.Q. Drawer A, Granite Falls, NC 28630
This instrument was prepared by Dale L. Haml a, without title search, eloainu or proration of taxes
Brief Description for the index 2252 W. Paradise Harbor Drive
made
NORTH CAROLINA GENERAL WARRANTY DEED
GRANTOR
andbetween
DA'VID A. CRUMP, by and through his Attorney in Fact,
Sharon L. Crump; and wife, SHARON L. CRUMP
5704 Silver Bell Lane
Granite Falls, NC 28630
GRANTEE
DOUGLAS P. WEAVER
Enter in appropriate block for each party: name, address, and, if appropriate, character of entity, e.g., corporation or partnership.
The designation Grantor and Grantee as used herein shall include said parties, their heirs, successors, and assigns, and shall include
singular, plural, masculine, feminine or neuter as required by context.
WITNE99M- I, that the Grantor, for a valuable consideration paid by the Grantee, the receipt of which is hereby acknowledged, has
and by these presents does grant, bargain, sell and convey unto the Grantee in fee simple, all that certain lot or parcel of land situated
in the Town of Connelly Springs, Icard Township, Burke County, North Carolina and more particularly described as follows:
Being aR of Lot 7 of Paradise Harbor, Phase 1, as described in Plat Book 25, Pages 190-214, Burke County
Registry, said plats being referred to for a more complete and detailed description of the property conveyed.
Subject to Restrictions recorded in Book 1378, Page 991, Burke County Registry. Subject to Homeowner's
Association Covenants, Condifions and Restrictions recorded in Book 1379, Page 1, Burke County Registry. Also
subject to Restrictions recorded in Book 1327, Page 864; Book 351, Page 236; and in Book 832 Page 1126, Burke
County Registry.
Submitted electronically by "Fleischer Law office, PLLC'
in compliance with North caroling statutes governing recordable documents
and the terms of the submitter agreement with the Burke county Register of Deeds.

BK 2579 PG 613 DUG# 2021012860
The draftsman of this instrument did not perform a tithe search, makes no representations as to title, did not
perform a closing and did not prorate taxes.
The property hereinabove described was acquired by Grantor by instrument recorded in Book 2385, Page 883.
A map showing the above descnbed property is recorded in Book 25, Pages 1"-214
TO HAVE AND TO HOLD the aforesaid lot or parcel of land and all privileges and appurtenances thereto belonging to the Grantee
in fee simple.
And the Grantor covenants with the Grantee, that Grantor is seized of the premises in fee simple, has the right to convey the same in
fee simple, that title is marketable and free and clear of all encumbrances, and that Grantor will wanraot and defend the title against the
lawful claims of all persons whomsoever except for the exceptions hereinafter stated.
"Title to the property hereinabove described is subject to the following exceptions:
The above described property does not contain the principal residence of a Grantor. The draftsman of this instrument did
not perform a title search, makes no representations as to title, did not perform a closing and did not prorate taxes.
IN WITNESS WHEREOF, the Grantor has hereunto set his hand and seal, or if corporate, has caused this instrument to be signed in
its corporate name by its duly authorized officers and its seal to be hereunto affixed by authority of its Board of Directors, the day
and year first above written.
(SEAL)
DAVITS A. CR'1 M P, by and tfirough his Attorney in
Fact, Sharon L Crump