NCC220421_FRO Submitted_20220121

13�w WAKE COUNTY FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
P=7 SEDIMENTATION POLLUTION CONTROL ACT
No person may initiate any land -disturbing activity on one or more acres as covered by the Wake
WACounty 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 rH cn ROI 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
Lot 22 Treelight - Wendell Falls
2. Location of land -disturbing activity: Jurisdiction _ Town of Wendell (Wake Co. or Municipality)
HighwaylStree• 2200 Treelight Way Latitude 35.7749 Longitude-78.4331
3. Approximate date land -disturbing activity will commence
January 31, 2022
4. Type of development (residential, commercial, industrial, institutional, etc.)
Commercial
5. Total acreage rlictiirhed or uncovered (including off -site utilities and borrow/waste
areas): 0.81 acre _
Person to contact should erosion and sediment control issues arise during land -disturbing activity:
Na ne David Miller E-mail Address [e-mail]
Telephone [phone] Cell # ! oq —q0 q- q ! 40 Fax # 704 - 32!— / 00/
7 Landowner(s) of Record (attach accompanied page to list additional owners)
RMP-ZIG Wendell, LLC 704 321 1000
[e-mail]
Name(s)
Telephone Fax or E-mail address
10815 Sikes Place Suite 300
Same
Current Mailing Address
Current Street Address
Charlotte, NC 28277
City State Zip
City State Zip
8. Deed Book No. 18765 Page No.
1622-1634 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):
RMP-ZIG Wendell, LLC
[e-mail]
Name
E-mail Address
10815 Sikes Place Suite 300
Same
Current Mailing Address
Current Street Address
Charlotte, NC 28277
City State Zip
City State Zip
704 321 1000
Telephone
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:
William Weatherspoon Jr
Name
3700 Glenwood Avenue, Suite 250
Current Mailing Address
Raleigh, NC 27612
City
Telephone
[e-mail]
E-mail Address
3700 Glenwood Avenue, Suite 250
Current Street Address
Raleigh, NC 27612
State Zip City State Zip
[phone] Fax Number [phone]
(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:
William Weatherspoon, Jr
Name of Registered Agent
3700 Glenwood Avenue, Suite 250
Current Mailing Address
Raleigh NC 27612
City
Telephone.
[e-mail]
E-mail Address
3700 Glenwood Avenue, Suite 250
Current Street Address
Raleigh NC 27612
State Zip City State Zip
919-459-2390 Fax Number 919-459-2392
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.
David S. Miller
Type or print name
�') �
1
Signature
Manager
Title or Authority
January 5, 2022
Date
I, cr � r A , a Notary'
Public of the County of 11 Y\.(- M
State of North Carolina, hereby certify that '✓GNU } S. �l'�ti� ��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 day of v 20 Z �—
N y �� Notary
Seal
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