NCC240309_FRO Submitted_20240205

Check if this project is ARPA-funded ❑
Attach a copy of the Letter of Intent to Fund
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 NCGO1 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 The Farms at Mill Spring Lot 37 Roy Drive Mill Spring NC 28756
*If this project involves American Rescue Plan Act(ARPA) funds, list the Project Name or Project
Number(e.g., SRP-D-ARP-0121) below under which you were approved for funding through the
Division of Water Infrastructure (DWI).
NA
2. Location of land-disturbing activity: County Polk City or Township Mill Spring
Highway/StreetRoy Price Drive Latitude(dec,maldegrees)35.3010 Longitude(decimaldegrees)-82-1340
3. Approximate date land-disturbing activity will commence:2/9/20
4. Purpose of development(residential, commercial, industrial, institutional, etc.): Residential
5. Total acreage disturbed or uncovered (including off-site borrow and waste areas): 3.30
6. Amount of fee enclosed: $400 . 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 0 Enclosed ❑ No ❑
8. Person to contact should erosion and sediment control issues arise during land-disturbing activity:
Name Michael Robertson E-mail Address [e-mail]
Phone: Office# 832-425-4279 Mobile# [phone]
9. Landowner(s)of Record (attach accompanied page to list additional owners):
Diane and Martin Dew 864-879-3035 864-879-3035
Name Phone: Office# Mobile#
571 East Main Street 571 East Main Street
Current Mailing Address Current Street Address
Spartanburg, SC 29302 Spartanburg, SC 29302
City State Zip City State Zip
10. Deed Book No. Page No. Provide a copy of the most current deed.

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:
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:
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:
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:
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.

Part B.
1. 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 landowner(s)is
an individual(s), the name(s)of the owner(s)may be listed as the financially responsible party(ies).
Gabriel Builders and Design, Inc. [e-mail]
Company Name E-mail Address
641 Garden Market Drive 641 Garden Market Drive
Current Mailing Address Current Street Address
Travelers Rest, SC 29690 Travelers Rest, SC 29690
City State Zip City State Zip
Phone: Office#832-425-4279 Mobile#[phone]
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.
2. (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:
CT Corporation
Name of Registered Agent E-mail Address
160 Mine Lake Court 160 Mine Lake Court
Current Mailing Address Current Street Address
Raleigh, NC 27615 Raleigh, NC 27615
City State Zip City State Zip
Phone: Office# 844-295-3630 Mobile# [phone]
Name of Individual to Contact(if Registered Agent is a company)
(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
Phone: Office# Mobile#
Name of Individual to Contact(if Registered Agent is a company)

Continued from Item 1 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.
Company 2 Name E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Phone: Office# Mobile#
Company 3 Name E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Phone: Office# Mobile#
Company 4 Name E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Phone: Office# Mobile#
Company 5 Name E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Phone: Office# Mobile#

(c) If the Financially Responsible Party 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.
Company DBA Name
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(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.
Michael Robertson Project Manager
Type or print name Title or Authority
—� -_ 2/2/24
Signature Date
I, t'tO:610A) l o.> nS , a Notary Public of the County of G-rejtelvAle .SG
State of North Carolina, hereby certify that ;GM A.t PI oLnr 4s ,, appeared personally
before me this day and being duly sworn acknowledged that the above form was executed by him/her.
Witness my hand and notarial seal, this 2 day of r ab r to'y , 20 2
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IIIlllt VIII IllIllIllhllIll 1111 IIIII11111IIIII11 I1111111
Doc ID: 004898950004 Type: CRP
Recorded: 04/04/2022 at 05:04:54 PM
Fee Amt: $2,826.00 Page 1 of 4
Revenue Tax: $2,800.00
Polk NC
Sheila Whitmire Register of Deeds
BK468 PG2359-2362
NORTH CAROLINA GENERAL WARRANTY DEED Coll
Anri Use
Excise Tax: $2,800.00
Parcel Identifier No.P82-70,P82-71,P82-72,P82-73,P82-74,P82-75 Verified by ounty on the day of ,20
By:
Mail/Box toHovendon Law,455 S.Trade Street,Tryon,NC 28782
This instrument was prepared by: Goosmann Rose Colvard&Cramer,P.A.,77 Central Ave.Suite H,Asheville,NC 28801 (22-0686
JRRmh)
Brief description for the Index: Lots 33-38,Tryon Equestrian Farms
THIS DEED made this 9 day of April,2022, by and between
GRANTOR GRANTEE
Molly Oates Sherrill,LLC,a North Carolina limited liability Diane Dew and Martin Dew,married to each other
company,a 50%undivided interest and 571 East Main St
C.Lemuel and Sandra T.Oates,LLC,a North Carolina limited Spartanburg,SC 29302
liability company,a 50%undivided interest
3737 Howard Gap Road
Hendersonville,NC 28792
Enter in appropriate block for each Grantor and Grantee:name,mailing 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.
WITNESSETH, 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, parcel of land or
condominium unit situated in the City of Mill Spring,Polk County,North Carolina and more particularly described as follows:
See Exhibit A attached hereto and incorporated herein by reference. This instrument was prepared by the Law Office of
Goosmann Rose Colvard& Cramer,P.A. without review or examination of the herein described property and no opinions or
representations are being made,either expressed or implied,by said law firm or any of its attorneys. This instrument was prepared
by John R.Rose,a licensed NC attorney. Delinquent taxes,if any,to be paid by the closing attorney to the county tax collector
upon disbursement of closing proceeds.
The property hereinabove described was acquired by Grantor by instrument recorded in Book page
All or a portion of the property herein conveyed includes or XXX does not include the primary residence of a Grantor.
A map showing the above described property is recorded itt Plat Book page
NC Bar Association Form No. 3©Revised 7/2013 North Carolina Bar Association-NC Bar Form No 3
Printed by Agreement with the NC Bar Association North Carolina Association of Realtors,Inc -Standard Form 3

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 warrant and defend the title against the
lawful claims of all persons whomsoever, other than the following exceptions: Those matters set forth in the description for the
property;easements and rights of way of record or in place;restrictive covenants of record;the use provisions of any governmental
ordinance affecting the property and taxes for the current year.
IN WITNESS WHEREOF,the Grantor has duly executed the foregoing as of the day and year first above written.
Molly Oates Sherrill,LLC (SEAL)
6)&-A
Print/Type Name:By: M o 1...1.2{ (} Ti LL SEAL
Molly Oates Sherril , ember Manager Print/Type Name: (SEAL)
C.Lemuel and Sandra T.Oates,LLC
(SEAL)Print/Type Name:
By. 0 l-l. l L C�
C.Lemuel Oates,Member Manager /}-1-t-5 (SEAL)
Print/Type Name:
By:
Print/Type Name&Title:
State of North Ca'rolipa-County of Her SCK\
.,.'1,011iLlilaygiitd.Notary Public of the County and State aforesaid,certify that Molly Oates Sherrill
persunaI y,apVeared bt{$ e'me this day and acknowledged that he is the Member Manager of Molly Oates
Shen fi•LLC,,T�(�North. r6iina n/limited liabilitycompany/general partnership/li itea pagership(s•rik tr r.t�
+f ttablej� Yitlythat by'.authority duly given and as the act of such entity,she signed the foregoing instrument in its name on its
behalf its its act and deed. Witness my hand and Notarial stamp or seal,this 30 day of March,2022.
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Notary Public
The foregoing Certificate(s)of
is/are certified to be correct. This instrument and this certificate are duly registered at the date and time and in the Book and Page
shown on the first page hereof.
Register of Deeds for County
By: Deputy/Assistant-Register of Deeds
State of North Carolina-County of {-e."th(so'�
I,the undersigned Notary Public of the County and State aforesaid,certify that C.Lemuel Oates
personay'h`p�c jl before me this day and acknowledged that he is the Member Manager of C. Lemuel and Sandra T.Oates,
LLC. a 1131 t f`ii,ja,eFeefferatien/limited liability companyigelier-aliwt+tershipAl-imited-paftmership-fstfike-thFeugh4he
4154E6414),and that authority duly given and as the act of such entity, he signed the foregoing instrument in its name on
its.:baiaff as gr,fwand deed. Witness my hand and Notarial stamp or seal,this 30 day of March,2022.
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NC Bar Association Form No. 3 m 1976,Revised®1/1/2010,2013 This standard form has been approved by
Printed by Agreement with the NC Bar Association North Carolina Bar Association-NC Bar Form No 3

The foregoing Certificate(s)of
is/are certified to be correct. This instrument and this certificate are duly registered at the date and time and in the Book and Page
shown on the first page hereof.
Register of Deeds for County
By: Deputy/Assistant—Register of Deeds
3
NC Bar Association Form No 3 0 1976,Revised©1/1/2010,2013 This standard form has been approved by
Printed by Agreement with the NC Bar Association North Carolina Bar Association-NC Bar Form No 3

EXHIBIT "A"
Being all of Lots Numbered 33 through 38 inclusive,Phase 3,Section 1,as shown and delineated upon a plat entitled,"The Farms at
Mill Spring,Phase 3,Section 1,a Major Subdivision,"Located Near Mill Spring,White Oak Township,Polk County,North Carolina,
dated August 29,2008,and prepared by Huskey&Huskey,Inc.,Professional Land Surveyor Timothy E.Huskey,Spartanburg,South
Carolina,which plat is duly recorded in Card File E,Page 2312,in the office of the Register of Deeds for Polk County,North
Carolina;reference being made to said recorded plat for a full and complete metes and bounds description of said lot,pursuant to
North Carolina General Statute Section 47-30(g).
The above described property is also conveyed SUBJECT TO a right of way to the North Carolina Department of Transportation
recorded in Book 275,Page 14,Polk County Registry.
The above described property is also conveyed SUBJECT TO the ten(10')foot by twenty(20')foot"site triangle,"along with twenty
(20')foot trail easements inside"all"property lines,and ten(10')foot drainage and utility easements along all rear and side lot lines,
as shown upon the above referenced plat.
The above described property is conveyed SUBJECT TO the Restrictive&Protective Covenants for The Farms at Mill Spring and any
covenants hereto,recorded in Book 378,Page 120,Book 412,Page 1810,and Book 415,Page 1013,Polk County Registry.
The above described property is a portion of the property conveyed by C.Lemuel Oates and Sandra T. Oates,husband and wife,a
one-half(1/2)undivided interest and Molly Oates Sherrill,LLC,a one-half(1/2)undivided interest,as Tenants in Common,to C.
Lemuel and Sandra T.Oates,LLC,a one-half(1/2)undivided interest and Molly Oates Sherrill,LLC,a one-half(1/2)undivided
interest,as Tenants in Common by deed dated December 1,2009,and recorded in Book 378,Page 118,Polk County Registry.
irs
4
NC Bar Association Form No 3 C 1976,Revised m 1/1/2010,2013 This standard form has been approved by
Printed by Agreement with the NC Bar Association North Carolina Bar Association-NC Bar Form No 3

Addendum to FR/O form Part A, Item 9: Landowner of Record Letter of Consent
Landowner of Record Name Diane and Martin Dew
Property Tax ID#/PIN: _P82-74_
Property Address Line 1: Lot 37, Roy Price Drive
City/State/Zip Code:Mill Spring, NC 28756
Applicant submitting plan- must match the financially responsible party named in Part B
Section 1 of the Financial Responsibility/Ownership (FR/0) Form: Gabriel Builders Mike
Robertson Project Manager
Statement of Landowner Consent: In accordance with NCGS 113A-54.1(a), I hereby declare
that I am the owner or legally authorized representative of the owner of the property described
above and provide my consent for the applicant cited above and in Part B of the FR/O form to
submit a draft erosion control plan to the State of North Carolina and to conduct the planned
land-disturbing activities on the property listed above and in Part A of the FR/0 form.
Diane Dew Martin Dew Owner
Type or Print Name Title or Authority
A4A,A
//k /14/13
Signature Date
[e-mail] 864-879-3035
Email Telephone