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Home My WebLink AboutNCC241300_FRO Submitted_20240426 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 MITI Run *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). 2. Location of land-disturbing activity: CountyAlamanCe City or Township Mebane 4677 Mrs. White Lane 36.128335 LOn Rude decimal degrees) -79.272552 Highway/StreetLatitude(decimal degrees) g ( 3. Approximate date land-disturbing activity will commence: 5/1/24 4. Purpose of development(residential, commercial, industrial, institutional, etc.): Residential 5. Total acreage disturbed or uncovered (including off-site borrow and waste areas): 8.74 6. Amount of fee enclosed: $900.00 . 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 17 No El 8. Person to contact should erosion and sediment control issues arise during land-disturbing activity: Name Ryan Tanner, Tanner Built Homes, LLC E-mail Address Ryan@TannerBuiltHomes.com Phone: Office# 336-637-4094 Mobile# 9. Landowner(s)of Record (attach accompanied page to list additional owners): Tanner Built Homes, LLC 336-637-4094 Name Phone: Office# Mobile# 3122 Battleground Ave, Suite B 3122 Battleground Ave, Suite B Current Mailing Address Current Street Address Greensboro, NC 27408 Greensboro, NC 27408 City State Zip City State Zip 10. Deed Book No.4172 Page No. 0029 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). Tanner Built Homes, LLC Ryan@TannerBuiltHomes.com Company Name E-mail Address 3122 Battlegound Ave, Suite B 3122 Battleground Ave, Suite B Current Mailing Address Current Street Address Greensboro, NC 27408 Greensboro, NC 27408 City State Zip City State Zip Phone: Office# 336-637-4094 Mobile# 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: Ryan Tanner Ryan@TannerBuiltHomes.com Name of Registered Agent E-mail Address 3122 Battleground Ave, Suite B 3122 Battleground Ave, Suite B Current Mailing Address Current Street Address Greensboro, NC 27408 Greensboro, NC 27408 City State Zip City State Zip Phone: Office# 336-637-4094 Mobile# Ryan Tanner 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) 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 (d) If 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: EarthCentric Engineering Inc. Phil.Koch@EarthCentric.com Engineering firm or other consultant E-mail Address Charles P. Koch 919-563-9041 Individual contact person (type or print) Phone: Office# Mobile# 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. Ryan Tanner Manager, Tanner Built Homes, LLC Type or print ame Title or Authority �S %gin 5' 27/7-23 Sigi4ature Date tt _ Co-ry k , a Notary Public of the County of k`tro Cc State of North Carolina, hereby certify that Ryan Tanner 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 a.'1 day of CPC , 20 23 KATHY A CAMPBELL `-A,• C-0`4--`-‘ NOTARY PUBLIC Notary Guilford County S:. North Carolina My commission expiresa0.Y\- 1o10a.�- ny Commission Expires Jan.30,2024 BK 4172 PG 0029 FILED ELECTRONICALLY ALAMANCE COUNTY NC DAVID BARBER FILED May 28, 2021 AT 09:14:42 AM BOOK 04172 START PAGE 0029 END PAGE 0030 INSTRUMENT # 12443 EXCISE TAX $380.00 NORTH CAROLINA GENERAL WARRANTY DEED Excise Tax: $380.00 Recording Time, Book and Page Tax Map No. 166697 Parcel Identifier No. Mail after recording to: GRANTEE: 3122-B BATTLEGROUND AVENUE,GREENSBORO,NC 27408 Property Address:4677 Mrs. White Lane, Mebane, NC 27302 This instrument prepared by:MICHAEL R.CHANDLER,A LICENSED NORTH CAROLINA ATTORNEY,DELINQUENT TAXES.IF ANY,TO BE PAID BY THE CLOSING ATTORNEY TO THE COUNTY TAX COLLECTOR UPON DISBURSEMENT OF CLOSING PROCEEDS THIS DEED made this 20th day of April , 2021 by and between GRANTOR Jacob Andrew Lohr and wife, Lura Galloway Lohr 3599 Mossy Creek Lane,Tallahassee,FL 323 l I GRANTEE Tanner Built Homes, LLC 3122_B BATTLEGROUND AVENUE,GREENSBORO, NC 27408 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 or parcel of land and more particularly described as follows: BEING ALL OF LOT NUMBER ONE (1) OF RUTLEDGE RUN SUBDIVISION AS SHOWN ON FINAL PLAT RUTLEDGE RUN SUBDIVISION, PLAT OF WHICH IS RECORDED IN PLAT BOOK 48 AT PAGES 91 AND 92 OF THE ALAMANCE COUNTY REGISTRY, NORTH CAROLINA. Submitted electronically by "chandler & Schiffman, P.A." in compliance with North Carolina statutes governing recordable documents and the terms of the submitter agreement with the Alamance County Register of Deeds. BK 4172 PG 0030 Ail or a portion of the property hereinabove described was acquired by Grantor by instrument recorded In Book 3158 Page 984 , Alamance County Registry. A map showing the above described property is recorded in Plat Book 48 Page 91-92 and referenced within this instrument. The above described property ❑does ®does not include the primary residence of the Grantor. 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 except for the exceptions hereinafter stated. Title to the property hereinabove described is subject to the following exceptions: ALL EASEMENTS,RESTRICTIONS,AND RIGHTS OF WAY OF RECORD,IF ANY,AND AD VALOREM TAXES FORTH E CURRENT YEAR. 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 officer(s),the day and year first above written. C (SEAL) Jacob Andrew Lohr Cv0 o■-, �' -� (SEAL) Lura Galloway Lohr STATE OF: NC- COUNTY OF: \M E I certify that the following person(s)personally appeared before me this day,each acknowledging to me that he or she signed the foregoing document: Jacob Andrew Lohr and wife, Lura Galloway Lohr Witness my hand and official stamp or seal, this the 20 day of APRIL.2021 . My Commission Expires: 6)-2.EF Notary blic HOUSTON BARNES Notary Public, North Carolina Print Notary Name: '0. Wake County My Commission Expires June 25. 2022