HomeMy WebLinkAboutNCC230560_FRO Submitted_20230302IWW. WAKE COUNTY FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
P::7 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
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 Willow Landing Lot 9
2. Location of land -disturbing activity: Jurisdiction Wake County (Wake Co. or Municipality)
Highway/Street 7501 Frasier Fir Pl. Latitude -78.694 Longitude 35.579
3. Approximate date land -disturbing activity will commence: 2/10/2023
4. Type of development (residential, commercial, industrial, institutional, etc.): Residential
5. Total acreage disturbed or uncovered (including off -site utilities and borrow/waste
areas): 1.076
6. Person to contact should erosion and sediment control issues arise during land -disturbing activity:
Name Thurm Bowen E-mail Address rtbowen@kbhome.com
Telephone 919-768-7972 Cell # 919-427-3775 Fax # N/A
7
Landowner(s) of Record (attach accompanied page to list additional owners):
Willow Landing- Willow Spring LP 847-809-5159
Names) Telephone
23975 Park Sorento, Ste 220 Same
Current Mailing Address Current Street Address
Calabasas CA 91302
City State Zip City
8. Deed Book No. 01948 Page No. 01959
State
N/A
Fax or E-mail address
Zip
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):
KB Home Raleigh -Durham, Inc. rtbowen@kbhome.com
Name
4506 S. Miami Blvd., Ste. 100
Current Mailing Address
Durham NC
City State
Telephone 919-768-7972
E-mail Address
Same
Current Street Address
27703
Zip City State
Fax Number N/A
Zip
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:
Doug Schwartz dschwartz@kbhome.com
Name E-mail Address
1405 Willow Landing Way Same
Current Mailing Address Current Street Address
Willow Spring NC 27592
City State Zip City State Zip
Telephone 919-768-7972 Fax Number N/A
(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
City State Zip
Telepho
Current Street Address
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.
Doug Schwartz
Type or print name
Signatur
Division President, KB Home Raleigh -Durham, Inc.
Title or Authority
Date
`1OVao _ a Notary Public of the County of
State of North Carolina, hereby certify that �)L') a S3'WCXAZ appeared
personally before me this day and being duly sworn ackno wn edged that the above form was executed by him.
Witness my hand and notarial seal, this .�� day of 20D �,
ERIN N POLLOCK L—, � Qt
NOTARY PUBLIC Notary
Seal Johnston County
North Carolina \ ^ �1
My Commission Expires June 17, 2024 My commission expires i1�2 V1