NCC233362_FRO Submitted_20231113

Ir WAKE COUNTY FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
SEDIMENTATION POLLUTION CONTROL ACT
WAKE No person may initiate any land-disturbing activity on one or more acres as covered by the Wake
Do ter O bb
COUNTY sedimentationCountyUnified control planevelopmen have beenrdinance completedefore and this approved
form byand an Wake Countyaccepta le Department erosion ofand
NOR 1�:,��W.IN,', 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 Camberly 40, 44, 50, 58
2. Location of land-disturbing activity: Jurisdiction Wake County (Wake Co. or Municipality)
40`35.987130, -78.572640
Highway/Street Camber Dr.&Dover Hills Dr. Latitude as 3s.ses720, Longitude -78.570560
50`35.986390, -78.572980
58*35.983160, -78.570420
3. Approximate date land-disturbing activity will commence: 10/31/2023
4. Type of development(residential, commercial, industrial, institutional, etc.): Residential
5. Total acreage disturbed or uncovered (including off-site utilities and borrow/waste
areas): 3.48
6. Person to contact should erosion and sediment control issues arise during land-disturbing activity:
Name Robert Russotti E-mail Address [e-mail]
Telephone N/A Cell# 919-360-6099 Fax# N/A
7. Landowner(s)of Record (attach accompanied page to list additional owners):
Exeter Building Company LLC N/A N/A
Name(s) Telephone Fax or E-mail address
900 Ridgefield Drive STE 50 900 Ridgefield Drive STE 50
Current Mailing Address Current Street Address
Raleigh NC 27609 Raleigh NC 27609
City State Zip City State Zip
8. Deed Book No. 019449 Page No. 01433 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):
Exeter Building Company LLC [e-mail]
Name E-mail Address
900 Ridgefield Drive, STE 50 900 Ridgefield Drive, STE 50
Current Mailing Address Current Street Address
Raleigh NC 27609 Raleigh NC 27609
City State Zip City State Zip
Telephone [phone] Fax Number N/A

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:
N/A N/A
Name E-mail Address
N/A N/A
Current Mailing Address Current Street Address
N/A N/A
City State Zip City State Zip
Telephone N/A 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:
John Finan [e-mail]
Name of Registered Agent E-mail Address
900 Ridgefield Drive, STE 50 900 Ridgefield Drive, STE 50
Current Mailing Address Current Street Address
Raleigh NC 27609 Raleigh NC 27609
City State Zip City State Zip
Telephone [phone] Fax Number N/A
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.
John Finan Managing Member
Tyt- o print na Title or Authority
10/30/2023
Sig .ture Date
'S.t,r-ew..) 61 A- , a Notary Public of the County of Wake
State of North Carolina, hereby certify that John Finan appeared
personally before me this day and being duly sworn acknowledged that the above form was exec ed by him.
Witness my hand and notarial seal, this 30th day of October , 20 23
JEREMY GAGE
1 Notary Public- North Carolina I Notary
sedtke County
My Commission Expires Apr 3, 2024 ( My mmission expires N/s/2402`i