NCC232437_FRO Submitted_20230811

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
WAKECounty 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 C AROt N� 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 Fifth Third Bank- Wendall Falls
2. Location of land-disturbing activity: Jurisdiction Wendall (Wake Co. or Municipality)
Highway/Street Treelight Way Latitude -78.433784 Longitude 35.775873
3. Approximate date land-disturbing activity will commence:
4. Type of development(residential, commercial, industrial, institutional, etc.): Commercial
5. Total acreage disturbed or uncovered (including off-site utilities and borrow/waste
areas): 1.003
6. Person to contact should erosion and sediment control issues arise during land-disturbing activity:
Wendy Hall @ BDG Architects LLP [e-mail]
Name E-mail Address
Telephone [phone] ext 110 Cell# Fax#
7. Landowner(s)of Record (attach accompanied page to list additional owners):
Nash Wendall Falls, LLC 704-981-8951 Ext. 110 [e-mail]
Name(s) Telephone Fax or E-mail address
13777 Ballantyne Corporate Place Suite 250
Current Mailing Address Current Street Address
Charlotte NC 28277
City State Zip City State Zip
8. Deed Book No, 015478 Page No. 01623-01629 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):
Fifth Third Bank-Tammala Brooks [e-mail]
Name E-mail Address
38 Fountain Square Plaza I MD 10903k 38 Fountain Square Plaza I MD 10903k
Current Mailing Address Current Street Address
Cincinnati OH 45202 Cincinnati OH 45202
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:
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.
Tammala Brooks Vice President/EWS Senior Project Group Manager
Type or print nab, Title or Authority
Signature Date
I, 1(sl/1e�se. 1►'�t�1 , a Notary Public of the County of_}lU,F'hi 111U1A
Utilo
State of fdv —Gefetiaa, hereby certify that Tammalct 13�'bo S 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 1 day of kri -L.J , 20 ZS
,„.0;;I"4"i' \j/01,844:14
4 Vanessa Thiel Notary
alNotary Public,State of Ohio
. - My Commission Expires: My commission expires I Z /Z7/2-7
12/27/2027
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