NCC221511_FRO Submitted_20220420

• MAR 0 3 2L122
FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
SEDIMENTATION POLLUTION CONTROL ACT Raleigh Regional Offico
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.)
Part A. Whispering Pines Phases 4-5
1. Project Name p g
9
3
4.
Location of land -disturbing activity: County Franklin City or Township Franklinton
Highway/Street Cedar Creek Rd Latitude 36.080702 Longitude-78.446036
Approximate date land -disturbing activity will commence: Summer 2021
Purpose of development (residential, commercial, industrial, institutional, etc.): Residential
5. Total acreage disturbed or uncovered (including off -site borrow and waste areas): 46.1
6. Amount of fee enclosed: $4,700 . The application fee of $65,00 per acre (rounded
up to the next acre) is assessed without a ceiling amount (Example: a 9-acre application fee is $585).
7. Has an erosion and sediment control plan been filed? Yes No Enclosed X
8. Person to contact should erosion and sediment control issues arise during land -disturbing activity:
Name Ben Areno E-mail Address [e-mail]
Telephone [phone] cell # 919-717-0794 Fax # NIA
9. Landowner(s) of Record (attach accompanied page to list additional owners):
Whispering Pines of Franklin County NIA NIA
Name
3129 Heritage Trade Drive
Current Mailing Address
Wake Forest, NC 27587
City
10. Deed Book No. 1807
Telephone Fax Number
3129 Heritage Trade Drive
Current Street Address
Wake Forest, NC 27587
State Zip City
Page No. 235
State
Zip
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 orfirm is a sole proprietorship,
the name of the owner or manager may be listed as the financially responsible party.
Dan Ryan Builders North Carolina LLC [e-mail]
Name
3000 RDU Center Drive
Current Mailing Address
Morrisville, NC 27560
City
State Zip
Telephone [phone]
E-mail Address
3000 RDU Center Drive
Current Street Address
Morrisville, NC 27560
City State Zip
Fax Number NIA

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:
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Name E-mail Address
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Current Mailing Address
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City
Telephone n/a
State Zip
Current Street Address
n/a
City State Zip
Fax Number n/a
(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:
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Name of Registered Agent
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Current Mailing Address
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City
Telephone n/a
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E-mail Address
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Current Street Address
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State Zip City
Fax Number n/a
State Zip
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.
_Ditl t S ion . r --
Type br print name Title or Authority
ure Date
I. Avyla ncjg_ L . Mcur-i-�'1'e , a Notary Public of the County of k'e
State of North Carolina, hereby certify that ��... C- L-�-L.-� tS 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 Z ay of rVar , 20
AMANDA L MARTINEZ Notary
Notary PubliFF, North Carolina
b County
My Commission Expires My commission expires
August 13, 2024