NCC241187_FRO Submitted_20240417

"WI WAKE COUNTY FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
SEDIMENTATION POLLUTION CONTROL ACT
WAKE No person may initiate any land-disturbing activity on one or more acres as covered by the Wake
n Development c be icb
COUNTY sedimentationCountyU ified controlv planlopmen haveOrdinan been completedeefor
and th s approvedform byand an Wakeac Countyepta le Departmenterosion ofand
NOUN<:AROI.INA 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 Meadow at Jones Dairy-Lots 22-40,53-62,93-110
2. Location of land-disturbing activity: Jurisdiction Rolesville (Wake Co. or Municipality)
Highway/Street Averette Road Latitude 35.954922 ,Longitude -78.460716
3. Approximate date land-disturbing activity will commence: Spring 2024
4. Type of development(residential, commercial, industrial, institutional, etc.): Residential
5. Total acreage disturbed or uncovered (including off-site utilities and borrow/waste
areas): 8.49 ac
6. Person to contact should erosion and sediment control issues arise during land-disturbing activity:
Name Teri Trefftzs E-mail Address [e-mail]
Telephone Cell# 919-256-5478 Fax#
7. Landowner(s)of Record (attach accompanied page to list additional owners):
The Drees Homes Company _
Name(s) Telephone Fax or E-mail address
8521 Six Forks Road,Suite 500
Current Mailing Address Current Street Address
Raleigh NC 27615
City State Zip City State Zip
8. Deed Book No. 018255 Page No. 01872-01874 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):
The Drees Homes Company [e-mail]
Name E-mail Address
8521 Six Forks Road,Suite 500
Current Mailing Address Current Street Address
Raleigh NC 27615
City State Zip City State Zip
Telephone [phone] _ 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:
N/A N/A
Name E-mail Address
N/A N/A
Current Mailing Address Current Street Address
N/A N/A
City State Zip City State Zip
Telephone N/A 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:
Reginald B. Gillespie Jr. N/A
Name of Registered Agent E-mail Address
4600 Marriott Dr,Suite 400 N/A
Current Mailing Address Current Street Address
Raleigh NC 27612 N/A
City State Zip City State Zip
Telephone [phone] Fax Number N/A
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.
Jerry Dean Division President
Type or print name Title or Authority
y//,
Sjg� Date
I, 111120 SQ _ �reP 'Z . , a Notary Public of the County of WO-'
State of North Carolina, hereby certify that j 4 b_e_o_ ►' 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 f , 20)-L/
.\ N: Notary
II
1 '%OLIC = My commission expires/OA.gq
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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:
Preserve at Jones Dairy, LLC
Name Phone: Office# Mobile#
10534 Arnold Palmer Dr
Current Mailing Address Current Street Address
Raleigh, NC 27617
City State Zip City State Zip
Deed Book No.018255 Page No.01 872 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.

Project: Meadows at Jones Dairy
Lot Number PIN Address
22 1850824583 244 Murray Grey Ln
23 1850825533 248 Murray Grey Ln
24 1850825583 252 Murray Grey Ln
25 1850826533 256 Murray Grey Ln
26 1850826584 264 Murray Grey Ln
27 1850827543 268 Murray Grey Ln
28 1850827592 272 Murray Grey Ln
29 1850828542 276 Murray Grey Ln
30 1850828592 300 Murray Grey Ln
31 1850829541 304 Murray Grey In
32 1850829591 308 Murray Grey Ln
33 1850920541 312 Murray Grey Ln
34 1850920591 316 Murray Grey Ln
35 1850921540 320 Murray Grey Ln
36 1850921590 324 Murray Grey Ln
37 1850922540 328 Murray Grey Ln
38 1850922590 332 Murray Grey Ln
39 1850923540 336 Murray Grey Ln
40 1850923590 340 Murray Grey Ln
53 1850923697 341 Murray Grey Ln
54 1850923647 337 Murray Grey Ln
55 1850922697 333 Murray Grey Ln
56 1850922647 329 Murray Grey Ln
57 1850921697 325 Murray Grey Ln
58 1850921648 321 Murray Grey Ln
59 1850920698 317 Murray Grey Ln
60 1850920648 313 Murray Grey Ln
61 1850829698 309 Murray Grey Ln
62 1850829639 301 Murray Grey Ln
93 1850836051 413 Marthas View Way
94 1850835093 409 Marthas View Way
95 1850835003 405 Marthas View Way
96 1850824946 401 Marthas View Way
97 _1850824865 400 Marthas View Way
98 1850825852 404 Marthas View Way
99 1850826824 408 Marthas View Way
100 1850826874 412 Marthas View Way
101 1850827823 416 Marthas View Way
102 1850827882 420 Marthas View Way
103 1850828629 273 Murray Grey Ln
104 1850827761 269 Murray Grey Ln
105 1850827711 265 Murray Grey In
106 1850826762 261 Murray Grey Ln
107 1850826711 257 Murray Grey Ln
108 1850825761 253 Murray Grey In
109 1850825710 249 Murray Grey Ln
110 1850824750 245 Murray Grey Ln