NCC233395_FRO Submitted_20231205

C,*.RY
A
NORTH CAROLINA
Stormwater Division
FINANCIAL RESPONSIBILITY - OWNERSHIP FORM
No person may initiate any land-disturbing activity covered by Cary's Sedimentation and Erosion Control
Ordinance before completing and filing this form with the Cary Stormwater Division. Indicate N/A if a
question is not applicable.
Section 1
PROJECT NAME: Millstone Subdivision
PROJECT DEVELOPMENT PLAN #: 22-DP-7419
PROJECT LOCATION:
0724-71-6063 &0724-70-6260
Property Tax ID#/PIN
0 Mills Road and 7824 Emery Gayle Lane
Street Address
APPROXIMATE DATE OF PROJECT INITIATION: October 2, 2023
ACREAGE OF LAND TO BE DISTURBED: 23.8 acres
APPLICANT SUBMITTING PLAN: (must match the financially responsible party named in Section 2
of the Financial Responsibility/Ownership (FR/O) Form.)
Toll Bros. Inc. - Edward B. Pease
Name(Person or Firm)
Section 2
PERSON(S) OR FIRM(S) FINANCIALLY RESPONSIBLE FOR THIS LAND-DISTURBING ACTIVITY:
(If out of state, a registered agent in North Carolina must be used.)
Toll Bros. Inc. - Edward B. Pease
Name(Person or Firm)
900 Perimeter Park Drive, Suite B3
Street Address(No PO Box)
Morrisville, NC 27560
City State Zip
Cary
316 North Academy Street, Cary, NC 27513 PO Box 8005, Cary, NC 27512-8005
Tel: 311 or 919-469-4000 outside Cary limits www.carync.gov
updated:04/2023

[phone]
Telephone Number
N/A
Fax Number
[e-mail]
E-Mail Address
REGISTERED AGENT FOR THE PERSON OR FIRM WHO IS FINANCIALLY RESPONSIBLE:
(If out of state, a registered agent in North Carolina must be used.)
Name
Street Address(No PO Box)
City State Zip
Telephone Number
Fax Number
E-Mail Address
The Town reserves the right to contact either the financially responsible person or registered agent listed
below in case of violation. Please indicate your preference below.
Toll Bros. Inc. - Edward B. Pease OR
Financially Responsible Person Registered Agent
Section 3
LANDOWNER OF RECORD:
Toll Southeast LP Company, Inc.
Name(Person or Firm)
0724-71-6063 & 0724-70-6260
Property Tax ID#/PIN
1140 Virginia Drive
Street Address(No PO Box)
Fort Washington, PA 19034
City State Zip
Cary
316 North Academy Street, Cary, NC 27513 PO Box 8005, Cary, NC 27512-8005
Tel: 311 or 919-469-4000 outside Cary limits www.carync.gov
Page 2 of 3 updated:04/2023

STATEMENT OF LANDOWNER CONSENT:
In accordance with NCGS 113A-54.1(a), I hereby declare that I am the owner or legally authorized
representative of the owner of the property described above and provide my consent for the applicant
cited in Section 1 above to submit an erosion control plan to the Town of Cary Stormwater Division and to
conduct the planned land-disturbing activities on the property listed in Section 1 above.
Edward B. Pease Division President
Name Title or Authority
6'2 9J41J2
Signature Date
[e-mail] [phone]
Email Telephone Number
THE ABOVE INFORMATION is true and correct to the best of my knowledge and belief and as provided
by me while under oath. (This form must be signed by the financially responsible person, if an
individual or by an officer, director, partner, attorney-in-fact, or other person with authority to
execute instruments for the financially responsible person if not an individual.)
Type or Print Name Title or Authority
Signature Date
, N jaiti - 8w0-he_r , a Notary Public of the County of 36k115f off)
State of North Carolina, hereby certifies that E0t.40.rd e. f&.S•e
personally appeared before me this day and under oath acknowledged that the above form was
executed by him/her.
Witness my hand and notarial seal,this day of a
"• '161Ad
NOTAliy -
fA/•• _ ary/ ublic
l
PUBLIC .' My commission expires 51 417
Cary
316 North Academy Street, Cary, NC 27513 PO Box 8005, Cary, NC 27512-8005
Tel: 311 or 919-469-4000 outside Cary limits www.carync.gov
Page 3 of 3 updated:04/2023