NCC217031_FRO Submitted_20220107

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FU 0 JAY -VAR. ! NA
north coroirna
Financial Responsibility/Ownership Form SPCA
See TOFV LDO, Section §9-1407 SOIL EROSION & SEDIMENTATION CONTROL and Town Standards and Specifications for
additional details.
Part A.
1. Project Name Hidden Valley - Section E
2. Location of land -disturbing activity: Highway/Street Purfoy Road
3. Approximate date land -disturbing activity will commence: Spring 2020
4. Type of development (residential, commercial, industrial, institutional, etc.): Residential
5. Total acreage disturbed or uncovered (including off -site utilities and borrow/waste areas): 22.0
6. Person to contact should erosion and sediment control issues arise during land -disturbing activity. -
Name Chris Raughley E-mail Address [e-mail]
Telephone [phone]
Cell #
7. Landowner(s) of Record (attach accompanied page to list additional owners):
Pulte Home Company, LLC [e-mail]
Name E-mail Address
1225 Crescent Green Drive
Current Mailing Address
1225 Crescent Green Drive
Current Street Address
Cary, NC 27518 Carv, NC 27518
City State Zip City State Zip
8. Deed Book No. 016985 Page No. 00008 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):
Pulte Home Company, LLC chris.raughley(c-b_pultegroup.com
Name E-mail Address
1225 Crescent Green Drive
Current Mailing Address
1225 Crescent Green Drive
Current Street Address
Cary, NC 27518 _ Cary, NC 27518
City State Zip City State Zip
Telephone [phone]
Town of Fuquay-Varina - 401 Old Honeycutt Road, Fuquay-Varina, NC 27526 HE
[phone] = fuquay-varina.org

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 Town of
Fuquay-Varina Land Development Ordinance and/or Land Disturbance Permit:
Name
Current Mailing Address
City State Zip
E-mail Address
Current Street Address
City State Zip
Telephone
(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:
Pulte Home Company, LLC - Chris Raughley [e-mail]
Name E-mail Address
1225 Crescent Green Drive 1225 Crescent Green Drive
Current Mailing Address Current Street Address
Cary, NC 27518 Cary, NC 27518
City State Zip City State Zip
Telephone [phone]
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.
Type or print name Title Auth rity
CA,: C"" " 2 ,• .Z o
Signature 1VU Date
I, ':; V�, a., r, 0 , Q - E i Ck2-cC�, C,-. a Notary Public of the County of Ljrk �4—
State of North Carolina, hereby certify that C—�- , S �z �' e- Y 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 1 \thr
day of I~ y , 20 Q_y
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Seal ���G%E D4 4*
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My commission expires

APPLICATION FOR MAJOR SUBDIVISION
CONSTRUCTION PLANS
This application shall be submitted for all major subdivision construction drawings as defined by the Town of
Fuquay-Varina Code of Ordinances. For each submittal after the second review, there is a $450
construction review fee, and a $75 erosion & sedimentation control review fee.
SUBDIVISION NAME: Hidden Valley - Section E _
SUBDIVISION ADDRESS: Purfoy Road
WAKE COUNTY PIN: 0665-96-8722, 0665-98-2183, 0666-70-5143, 0675,-17-2458, 0675-27-1608, 0675-27-5371
LAT/LONG: 35.545578 /-78.759335
DISTURBED ACREAGE: 22.0
PRIMARY CONTACT: Chris Raughley
EMAIL ADDRESS: [e-mail] PHONE: [phone]
DATE OF PRE -SUBMITTAL MEETING WITH TOWN:
PROPERTY OWNER/DEVELOPER: Pulte Home Company, LLC
ADDRESS: 1225 Crescent Green Drive
CITY: Cary STATE: NC zip: 27518
EMAIL ADDRESS: [e-mail] PHONE: [phone]
SITE DESIGNER: Jim Chandler, PE
DESIGN FIRM: Timmons Group
ADDRESS: 5410 Trinity Road, Suite 102
CITY: Raleigh STATE: NC zip:27607
EMAIL ADDRESS: [e-mail] PHONE: [phone]
The Undersigned agrees that all plans created by the undersigned or the undersigned agents or assigns shall be bound
to and comply with the Town of Fuquay-Varina's Code of Ordinances and Standard Specifications & Construction
Details. The Undersigned further agrees any approvals issued by the Town shall not constitute a waiver of compliance
with the Town of Fuquay-Varina's Code of Ordinances and Standard Specifications & Construction Details. The
Undersigned hereby acknowledges the requirement to fully research and understand the Town's Code of Ordinances
and the Standard Specifications & Construction Details and to create plans in full accordance with such, and to be
responsible for investigating the need, and obtaining all permits or approvals that may be required. The Undersigned
hereby agrees to prominently note any applicable exceptions to the Town's Code of Ordinances and Standard
Specifications & Construction Details on the drawings and to call said proposed deviations to the Town's attention if such
deviations are to be implemented.
OWNER SIGNATURE:
DATE:
Z - I %—?,:)-
DEVELOPER SIGNATURE:
DATE:
SITE DESIGNER SIGNATURE:
Revised 09IM20I S
Page 2 of 2
DATE:
TOWN USE ONLY:
Tracking #
Date Rec'd

E
!IrPutteGroup-
TOWN OF FUQUAY-VARINA
Vendor Number 42PER2100
Check Number 0071747114
Check Date 01 / 2 8 / 2 0
Invoice
Date
Cc
Lot
Lot Address
apt
Cat
Cat
Acct Cat Description
Amount
100702845991320
01/27/20
6634
99939
00001
10232
Municipai Fee Hidden Valley
5,500.00+
TOTAL
5,504.04
Bank of America
Customer Connection
Atlanta, Dekalb County,GA
TO THE TOWN OF FUQUAY-VARINA
134 N MAIN STREET
ORDER OF FUQUAY-VARINA, NC 27526
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