HomeMy WebLinkAboutNCC222811_FRO Submitted_20220805=�W_ WAKE COUNTY FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
P=l SEDIMENTATION POLLUTION CONTROL ACT
A■� No person may initiate any land -disturbing activity on one or more acres as covered by the Wake
County Unified Development Ordinance before this form and an acceptable erosion and
COUNTY sedimentation control plan have been completed and approved by Wake County Department of
NOR Ili CAROLINA Environmental Services, Water Quality Division. (Please type or print and, if the question is not
applicable, place N/A in the blank.)
Part A.
1 . Project Name WATERFIELD RIDGE APARTMENTS
2. Location of land -disturbing activity: Jurisdiction GARNER (Wake Co. or Municipality)
101 WATERFIELD
Highway/Street RInr;F PI ACF o Latitude 35.6864 Longitude-78.5606
3. Approximate date land -disturbing activity will commence: 9/1i2n22
4. Type of development (residential, commercial, industrial, institutional, etc.): NON RESIDENTIAL
5. Total acreage disturbed or uncovered (including off -site utilities and borrow/waste
areas): 12 AC
6 Person to contact should erosion and sediment control issues arise during land -disturbing activity:
Telephone ..(919) 828.4428 Cell #
Fax # (919) 828-4711
7. Landowner(s) of Record (attach accompanied page to list additional owners).
DD Garn r-W terfi Id LLC (770) 474-4345 (hazel@davisdevelopfrent.com
Name(s) Telephone Fax or E-mail address
403 CORPORATE EN] ER DR. SUITE 201 SAMF
Current Mailing Address Current Street Address
STOCKBRIDGE GA 30281
City State Zip City State Zip
8. Deed Book No. 01g,955 Page No. 02648 h 02654 Provide a copy of the most current deed
Part B.
1
Person(s) or firm(s) who are financially responsible for the land -disturbing activity (Provide a
comprehensive list of all responsible parties on an attached sheet. Include requested information):
DID Garner-Waterfield, LLC fhazel@davisdevelopment.com
Name E-mail Address
403 Corporate Center Drive, Suite 201
Current Mailing Address Current Street Address
Stockbridge Georgia 30281
City State Zip City State Zip
Telephone (770) 474-4345 Fax Number
2. (a) If the Financially Responsible Party is not a resident of Wake County, identify a designated agent in
Wake County to receive any notice, process, pleading in any action or legal proceeding arising out of any
matter relating to the Wake County Erosion and Sedimentation Control Ordinance and/or Land
Disturbance Permit:
Corporation Service Company
Name
2626 Glenwood Ave., Suite 550
Current Mailing Address
Raleigh NC 27608
City
Telephone
State Zip
E-mail Address
Current Street Address
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:
Same as above.
Name of Registered Agent
Current Mailing Address
City
Telephone
State Zip
E-mail Address
Current Street Address
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.
Vice President of Davis Development, Inc.,
Fred S. Hazel - n er of DD Garner-Waterfield, LLC
Type or print
'pame . Title or Authority
Signature
--------------
ZO Z Z
Date
1, "E- , a Notary Public of the County of Henry
State of Georgia, hereby certify that Fred S. Hazel, Vice President of Davis Development, Inc., Manager of
DD Garner-Waterlield, LLC, 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 day of August, 2022.
Megan M Lanz
NOTARY PUBLIC
C.Oweta County, Georgia
My Commission Expires June 13, 2025
No ry
My commission expires 7wv+r 5