NCC222437_FRO Submitted_20220707

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
W 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
NORTH CAROLINA 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 0 Slater Road Apartments
2. Location of land -disturbing activity: Jurisdiction Morrisville (Wake Co. or Municipality)
Highway/Street Slater/SR1641 Latitude 35.865075 Longitude 78.826382
3. Approximate date land -disturbing activity will commence: April 2022
4. Type of development (residential, commercial, industrial, institutional, etc.): Multifamily Residential
5. Total acreage disturbed or uncovered (including off -site utilities and borrow/waste
areas): 13.0
6. Person to contact should erosion and sediment control issues arise during land -disturbing activity:
Joseph Murray, Vice President Construction [e-mail]
Name Dominion Realty Partners, LLC
E-mail Address
Telephone [phone] Cell # 919-369-6766 Fax #
*Current owner is listed. However,
7. Landowner(s) of Record (attach accompanied page to list additional owners): title will change to DRP, LLC prior
Thompson, Earl Ryan
to construction.
Names)
Telephone Fax or E-mail address
73 Cheney Rd
0 Slater Road
Current Mailing Address
Current Street Address
Marlborough CT 06447
Morrisville NC
City State Zip
City State Zip
8. Deed Book No. 015559 page No
00488 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):
Chris Carlino, Chief Operating Officer
[e-mail]
Dominion Realty Partners, LLC
Name
E-mail Address
501 Fayetteville St., Suite 100
501 Fayetteville St., Suite 100
Current Mailing Address
Current Street Address
Raleigh NC 27608
Raleigh NC 27608
City State Zip
City State Zip
919-845-3306
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:
N/A
Name E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Telephone Fax Number
(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:
Alexander Andrews, IV [e-mail]
Name of Registered Agent E-mail Address
501 Fayetteville St. Suite 100
Current Mailing Address Current Street Address
Raleigh NC 27608
City State Zip City State Zip
Telephone [phone] Fax Number
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.
Chris Carlino Chief Operating Officer, Dominion Realty Partners, LLC
Type or print name
Signature
Title or Authority
a r4 lz-z-
Date
I, �.S�cve��0., C ,S�**-o , a Notary Public of the County of W 0—VC _
State of North Carolina, hereby certify that C_,tj S C��\i*, o _ 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 1A day of r , 20
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