NCC230096_FRO Submitted_20230112

WAKE COUNTY FINANCIAL RESPONSIBILITY/OWNERSHIP 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
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 Grand Highland Estates Lot 7
2. Location of land -disturbing activity: Jurisdiction Wake Co. (Wake Co. or Municipality)
Highway/Street 1604 Legacy Ridge Ln Latitude 36.02917900087423 Longitude -78-59079344369077
3. Approximate date land -disturbing activity will commence: 111812023
4. Type of development (residential, commercial, industrial, institutional, etc.): residential
5. Total acreage disturbed or uncovered (including off -site utilities and borrow/waste
areas): 0.73
1.1
Person to contact should erosion and sediment control issues arise during land -disturbing activity. -
Name Sarah Heenan E-mail Address [e-mail]
Telephone
Cell # 703-965-6917 Fax #
7. Landowner(s) of Record (attach accompanied page to list additional owners):
BIG SKY ESTATES LLC 919418-1608 wilI6c bellavistaraleigh.com
Name(s) Telephone Fax or E-mail address
8310 BANDFORD WAY
Current Mailing Address
RALEIGH NC 27615-2752
same
Current Street Address
City State Zip City State Zip
8. Deed Book No, 018713 Page No. 01748 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):
Hearthstone Luxury Homes
Name
PO Box 97816
Current Mailing Address
_ Raleigh, NC 27624
City State Zip
Telephone [phone]
[e-mail]
E-mail Address
1C04 Manor Glen Way
Current Street Address
Raleigh, NC 27615
City State Zip
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:
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. -
Name of Registered Agent
E-mail Address
Current Mailing Address
Current Street Address
City State
Zip City State Zip
Telephone
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.
Jeff Logsdon
Type or print nam
Signature
President 1 Owner
Title or Authority
j�JR-3
Date
1, 1r �rrla� L�Q a Notary Public of t11_ he County of Wae.
State of North Carolina, hereby certify that sle I msdon appeared
personally before me this day and being duly sworn acknowledged th e above form was executed by him.
Witness my hand and notarial seal, this day of 20a3
TRINA M LOGSDON
NOTARY PUBLIC
Wake County Notary
t Carolin
My Commission Expires z SO My commission expires