NCC221770_FRO Submitted_20220509

W-W WAKE COUNTY FINANCIAL RESPONSIBILITYIOWNERSHIP 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
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
„tI,, l ARMINA Environmental Services, Water Quality Division. (Please type or print and, if the question is not
applicable, place NIA in the biank.)
Part A.
1. Project Name 38 Prescott Manor
2. Location of land-disturbingactivity; Jurisdiction Wake County
Y (Wake Co. or Municipality)
Highway/Street Harrison Ridge Rd. Latitude 36.009280 Longitude-78.006950
3. Approximate date land -disturbing activity will commence: March 1, 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): 0.767
6. Person to contact should erosion and sediment control issues arise during land -disturbing activity:
Name Christopher Davis
E-mail [e-mail]
Telephone Cell # 919-868-4720 Fax #
7. Landowner(s) of Record (attach accompanied
page to list additional owners):
Stephen Swihura, Karen Marie Handy
919-426-8809 [e-mail]
Name(s)
Telephone Fax or E-mail address
5301 Harrington Grove Dr.
SAME
Current Mailing Address
Current Street Address
Raleigh NC 27613
SAME
City State Zip
City State Zip
8. Deed Book No. 018661 Page No.
02116 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):
Grande Manor Homes, LLC.
[e-mail]
Name
E-mail Address
1151 Tarboro Rd
SAME
Current Mailing Address
Current Street Address
Youngsville NC 27596
SAME
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:
Trevor D. Brandt, Attorney [e-mail]
Name
PO Box 2108
Current Mailing Address
Wake Forest NC 27588
City State Zip
Telephone 919-55£-3008
E-mail Address
417 S. Main Street
Current Street Address
Wake Forest NC 27587
City State Zip
Fax Number 919-249-5130
(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:
Name of Registered Agent
Current Mailing Address
City
Telephone.
E-mail Address
Current Street Address
State Zip City
_- 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.
Christopher Don Davis
Member/Manager
Type or; in ame Title or Authority
1�1(-a--0? C�L
Signature Date
U Y Ql V a {n a Notary Public of the County of vy
State of North Carolina, hereby certify that U `VIs tD YTS 4- PgyA 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 J,,
day of l VK01 ✓L , 20 �y
Amy LWarren Notary
NO9ARY PUBLIG
Wake County, NC My commission expires ��
My Commission Expires February 2, 2023