NCC216844_FRO Submitted_20211210

WAKE COUNTY 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 Wake
WAKICounty 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
n,c„�,14 C A R0LINA Environmental Services, Water Quality Division. (Please type or print and, if the question is not
applicable, place N/A in the blank.)
Part A.
The Point - Phases 3,4,5,7&10-CD Package 2
'1. Project Name
2. Location of land -disturbing activity: Jurisdiction Rolesville (Wake Co. or Municipality)
Highway/Street East Young Street Latitude 35.905 Longitude 78.451
3. Approximate date land -disturbing activity will commence: March 2022
4. Type of development (residential, commercial, industrial, institutional, etc.): Residential
5. Total acreage disturbed or uncovered (including off -site utilities and borrow/waste
areas): 68.18
3
r6
Person to contact should erosion and sediment control issues arise during land -disturbing activity:
NameRaymond Rinker E-mail Address [e-mail]
Telephone [phone] Cell #
Fax #
Landowner(s) of Record (attach accompanied page to list additional owners):
Ashton Raleigh Residential LLC
Name(s)
4025 Lake Boone Trail ste 200
Current Mailing Address
Raleigh NC 27607
City State Zip
Telephone
Current Street Address
City
State
Fax or E-mail address
Zip
8. Deed Book No. 017720 Page No. 01506-01514 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):
Ashton Raleigh Residential LLC [e-mail]
Name E-mail Address
4025 Lake Boone Trail ste 200
Current Mailing Address Current Street Address
Raleigh NC 27607
City State Zip City State Zip
Telephone [phone] Fax Number

2. (a) If the Finnaa,npially Responsible Party is not a resident of Wake County, identify a designated agent in
Wake Cdtuntyito receive any notice, process, pleading in any action or legal plroceeding arising out of any
matter relating to the Wake County Erosion and Sedimentation Contr�l Ordinance and/or Land
Disturbances Permit: I
Name
Current Mailing Address
City State Zip
Telephone
E-mail Address
Current Street Address
City I State Zip
Fax Number
(b) If the Financially Responsible Party is a Partnership or other person eng� ging in business under an
assumed name, attach a copy of the Certificate of Assumed Name. if he Financially Responsible
Party is a Corporation, give name and street address of the Registered Agent:
Name of Registered Agent E-mail Address
Current Mailing Address Current Street Address
City State Zip City
Telephone _ Fax Number
The above information is true and correct to the best of my knowledge and
by me under oath (This form must be signed by the Financially Responsib
or his attorney -in -fact, or if not an individual, by an officer, director, partner
the authority to execute instruments for the Financially Responsible Pery
corrected information should there be any change in the information provid(
Raymond Rinker
Type or print name'.,�
Sign u e
State Zip
belief and was provided
Person if an individual
or registered agent with
)n). I agree to provide
d herein.
Vice President # Land Development
Title or Authority
Date
a Notary Rublic of
State of North = Carolina, hereby certify that
personally before; me this day and being duly sworn ac
Witness my hand; and notarial seal, this __'___day of
I
MARY HILL HEROLD
NOTARY PUBLIC
WADI COUNTY, N.C.
My Commission Expires 9-24-2026.
I
County of�'
appeared
that the above f rm was executed by him.
My commission expires�� I °'