NCC233125_FRO Submitted_20231108

EWI 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
Nl)I(TII(:,\Il()1IN,\ 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 Jones Dairy Lots
2. Location of land-disturbing activity: Jurisdiction Wake Co. (Wake Co. or Municipality)
Highway/Street Winter Spring Dr. Latitude 35.955983 Longitude -78.462062
3. Approximate date land-disturbing activity will commence: September 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):4.974 AC
6. Person to contact should erosion and sediment control issues arise during land-disturbing activity:
Name Bryan Stanley E-mail Address [e-mail]
Telephone Cell# 919-861-6380 Fax#
7. Landowner(s)of Record (attach accompanied page to list additional owners):
HHHunt Lot Acquisition, LLC. 919-614-7673
Name(s) Telephone Fax or E-mail address
800 Heathwood Blvd.
Current Mailing Address Current Street Address
Balcksburg, Va 24060
City State Zip City State Zip
8. Deed Book No.019389 Page No.01263 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):
HH Hunt Homes Raleigh/Durham, LLC
Name E-mail Address
1 Fenton Main Street Ste.280 [e-mail]
Current Mailing Address Current Street Address
Cary, NC 27511
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:
5\r �n SA-ok,r\l-c, S S . c 6Y�
Name of Registered Agent E-mail Address
T,V IkO'1 Man S v Pig --o fl' a,'I w s+
Current Mailing Address Current Street Address
,� c o�1Sll C I �N C a� s)
City J State Zip City State Zip
Telephone "( - l,Q �`^ 3 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.
William Sutphin Division Manager
T p pri a e Title or Authority
(ti 9)11w3
Signature Date
I,5 QC.QJ r: . J4)1,-16,00 , a Notary Public of the County of ,Uri 6C
State of North Carolina, hereby certify that l,1 J lam appeared
personally before me this day and being duly sworn acknowledged that the above form was executed by him.
t�� C
Witness my hand and notarial seal, this day of iot"y- , 20 7
rotary
Seal
My commission expires
"111 t /-/-1
tacy E.Johnson
Notary Public
North Carolina
My Commission Ex sires 5/11/2027