NCC221460_FRO Submitted_20220419

WAKE COUNTY FINANCIAL RESPONSIBILITYIOWNERSHIP FORM
SEDIMENTATION POLLUTION CONTROL ACT
WAKENo 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]-11 ( -, R01 E,%A Environmental Services, Water Quality Division. (Please type or print and, if the question is not
applicable, place NIA in the blank.)
Part A.
1. Project Name Legacy Oaks Commercial
2. Location of land -disturbing activity: Jurisdiction Knightdale (Wake Co. or Municipality)
Highway/Street Hodge Rd Latitude 35.796560 Longitude-78.519885
3. Approximate date land -disturbing activity will commence: July 2022_
4. Type of development (residential, commercial, industrial, institutional, etc.): Commercial
5. Total acreage disturbed or uncovered (including off -site utilities and borrow/waste
areas): 8.65
6. Person to contact should erosion and sediment control issues arise during land -disturbing activity:
Name Curtis Gautier E-mail Address [e-mail]
Telephone [phone]
Cell # Fax #
7. Landowner(s) of Record (attach accompanied page to list additional owners):
STC Cap Prop EAT LLC
910-230-8177
Name(s)
Telephone Fax or E-mail address
3724 National Dr., Suite 215
Current Mailing Address
Current Street Address
Raleigh NC
27612
City State
Zip City State zip
8. Deed Book No. 017440
Page No. 01286 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):
STC Cap Prop EAT LLC
Name
E-mail Address
3724 National Dr., Suite 215
Current Mailing Address
Current Street Address
Raleigh NC
27612
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:
NA NA
Name
NA
Current Mailing Address
NA NA NA
City
State Zip
E-mail Address
Current Street Address
NA
city
Telephone NA Fax Number NA
NA NA
State Zip
(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:
David Stallings
Name of Registered Agent
_3724 National Dr., Suite 215
Current Mailing Address
_Raleigh NC 27612
City State Zip
david@shenandoahhomesms
E-mail Address
Current Street Address
City
Telephone[phone] Fax Number
State Zip
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.
L 'Cf �I l iLKIj,c�ewA"
int name Title or Authority
Date
1, L (}�,S r,� 1 �r� R>f —. -S+u S a Notary Public of the County of Y AVIC"
State of North Carolina, hereby certify that D'Id+GL appeared
personally before me this day and being duly sworn acknowledged that he above form was executed by hire.
Witness my hand and notarial seal, this f i!day of IM.11r11� , 2fl 2 Z
Notary
My commission expires ��' 25
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