NCC230135_FRO Submitted_20230118

IMF WAKE COUNTY FINANCIAL RE$RONSISILrrYM rINERSHIP FORM
5EDIMEN7A71ON PCLLUTICH CONTROL AC'F
No pen rsomamayinitinls ory land-disiurblng activol on ane or mom 6CM& � oouered by Wake
W�
u►4y Vilfed Development Ord'uionce beiue this farm and an occeptab?e enasi-on and
COUNTY cedlmenlatlorn owfroJ plain li aw-e bean oorrpleted aryl approved ll�y Woke County 06Dpanment Of
MKI1, U•,..ArNA Ellll1i0nrAento $enAccs. Wator Qualms ❑iuislon. (Please tWe or ^t and- it the gafisDon is rnt
appW.9ble, Place NIA in the blank.I
Pan A.
1. PH48aNarre 8101 Holly Springs Rd
2. UMation of land.disturbinrg actiuity-- JurjadlrVgn Wake fflakc Co. or Muniripality)
Miglvy,rVr lreel HallySprings rd Latitude. 35.7DS92 ._Lor-gRud¢-78.76255
a, pTexlmare OiaM IOhd-dla;urbing ELeWILyyra camrnerge_ 111
10/2-022 --- --
& Type of eveWrnent [realideratial, corrinar&d. industrial, JMERUIJ011101,ere_); Res,identlai
S. Total ecns2ga rKaturbod or wacorered (Irichtding cE-sitn utililics and hQrrgrdwaate
areas), 0.36
G. Flemap Io rontact should eroslon anri sadi-ncnt ;,o-ilrai isvuos oris$ during lend.disbudiing sr4lhr .
Name SaMUel St. Clair JJ E-mailAddmssstclairconstrueMongroupciDg -a-a l.corn
Telephone 919-559- U7] Call FW 4
7. Landow") of Recard (228th a=ompan iod page do list oddlional cwriengk
Christopher and Laura Flythe 919-455-3807 chrlsOgfengineerg.com
Na"s) - -- Telephone Fax or E-nta a4drew
7334 Chapel HIII Fed Suite 200 7334 Chtiapel Hill Rd Sulte 2
Cui rflnt Marling ,addrase R ++ Current Slrcot Address
Raleigh NC 27647 _ RaJetgh Nc 271133Q7
City 3131e Pip Cqg sleds Zip
9_ Deed BDak No. Page td0..- 967 PrRide a Copy of Me rnoSL e&7tn1 dead.
Part a,
Persanis) or firm(s) who are fhoncially respximble for the lard-dlsturbhg advJty {Provida
comprchcrisivc list 43,4311 respan sibla p<arthm on an aMcherd shell_ Ind ude requez" Irro;tnjllonj'
St. Clair Cans#ruction Group [e-mail]
Rome Email Adore
1619Obethri Rd 1619 Oberlin Rd
Gmanl hinilfi-9 Address Current Street Address
Ralei& NC 275DB Raleigh NC 27508
pity Stale Zip Cky Skate Zip
Teleptiona 919-5.59-2471 Fak NWMDef___,_,_W--

(a) If the FnancUly Ra! por6ibLe Party Is rrat a residM of 4fi as Courity, identily a designWed $gen I Irt
akd CODUL ro rer aim any noise, proms, pleadiN Lq ony+ action or legai pnaceedir� VrbhR out of 3n yr
maffar Yelutrn9 to th-o Wakv County Eroslon and ScrimardaGan Car#rflE 07d;noiice andfor Lavd
01slurbaroe pem)IL
Name E-anall Adrf=a
Ceirrort Madinp Address Current Strtat Addmis
CiE� State .7Jp Mj S1910 211p
Telaphwm Fax PU mbar
(b) If Eie Fnencialry RespanslMv Party is a t}arlmmhip or other parson engaorxg in buelnass under an
-Omsurnod nmm$, attach a copy of the Carllfln,ake of A;saumad Name, U the Etenamly Respong-re
Partin is a Cargoral"r give name mad istreel addms of the Regislared Agent
Narnc of Ragieered Age at
E-nial Address
isurrant Mailrag Address Current StreeE Milmss - -- -
Ciry 'stala 7Jp CWy Rate zrp
itldphorfm - _ Few Nurrrbar
The abcnvw� Jnfimrnawon is irue and carract to Lhe best of my knowledge and beNef and was provided
by me under oath (ThIS l09m must be signed by the flinandally Respcmlbl a Pees rT Ilan individual
or Ws attorneir-Irnrfact, 4019 not an indivEdual, by an officer, difectot, PMrLer. Orregilsiered agentwI14
I" aulhuity to exemAe jnsirufr eMs for tree FInamUly Rasp�onsibia Permnl I agree to peol+fde
corn-ected infcernaiion should there be any -change in die lnbnrratlon prould ed herein.
kv` 4,1 - — - - Manager
Type or pirto -naw Tine or Auftfliy
Slignalure Date
1, f � A # 2�___ _, a Nolafy Pubric of the County of "
S aie 0 North Carolina, rrereby carllfy Ehal :} ' e f f Ir appeared
.)emanagyh re ma this dayand being dLAy sworn ackrtu + edged Mott eabcnrc dorm wrsa oxe utcd by mini -
Witness myhand and aatarW seal. thts Lday of .20,2
,vyl� Nhlhhr r'
+ff
01 011
Notary
4
z
Seal _ :{� -rA A
a rp' Any CL1 UTlSSIsm e