NCC233571_FRO Submitted_20231205

WAKE COUNTY FINANCIAL RESPONSIBIUTY'OWNERSHIP FORM
SEDIMENTATION POLLUTION CONTROL ACT
WAKENo person may rebate any oand.disturling.chitty on one a more acres as covered by time wane
Caurty Unified Dsr.loprnens Droiteric.o before this form aid an acceptable eruslurr old
COUNTY sedimentasor control plan have been compmeted and approved by Wake County Department d
Emnron manta Servces. Water Duality Division (Please type de print and rf the gumboil ins not
appbcabte place NJA in the bank I
Part AL
pr, i Name The reserve at falls lake ph 4
2 Locaton of andaastuibng acsvrrf Junsdcbon Wake (Wake Co or lsuniclpalty)
SUMMEF TANAGER TRL 35.9830' 78.683e'7
►tignwaySt-cet LaWWe Langrtude__
3 Arprrxlnate date IaM-dlstutvmg artrvty vile cdnrnenre 11/1/2023
4. Type 7r develOpmer6(resioenna( commetcia,industrial. institutional.etc.). residential
5 Tonal acreage dettabed or unouvered la>cludng off•eite Willies and borrowhveste
areas) 0,7
6 Person to contact shout]Boson and sediment control ditties mesa during land-disturbing activity.
Nam Samuel St.Clair t1 e4nadAdda [e-mail]
Telephone [phone] Cell a Fax a
7 Landowneris)of Record(attach accompanied page to kW additional omen)
Ryan and Lindsay Kelly 424-327-3267
Names) Telephone Fax or E-mail address
908 MERE OAK DR 908 MERE OAK DR
Current Maatnq Addrasu Current Street Address
Raleigh,NC 27615 Raleigh, NC 27615
Cell State Zip car State Zip
8 Deed Book No 19412 page No_2162 Provroe a copy of the most current deed
Part B.
I Person(s) or firm(*) who are fvian iaty r.sponante for tuir tanddieturbng activity (Pravda a
comprehensive fist of aC responsible parties on an attached sheet Include requested nto rtabortr
St.Clair construction group [e-mail]
Name E•rnari Maws
1619 Oberlin road 1619 Oberlin road
Currant Mains Address Current Street Address
Raleigh,NC 27608 Raleigh,NC 27608
Cry State Zip City Sete Zip
Tdeo,one 919-559-2071 Fax Number

ill.1 I I.1 a Vs Fw•.R.ry r. Pan,•ram a ra..lere d is GR.., awry•e•apresA•pese w
Wad.Cmrwly le r...r.a w ratim plum p....o an.air•c1••wr—/maserso mono eel d awe
mow Wow, .• w• as.. Csr•r Cr.non one Swessimmiero Cow Ceilleawrw anew laaA
Oacaaa do Poem
Mime [ever Masai -——
Craw MOO.A.famw lama AAArne
car cs' -hoe Zia
Tame !•s Numb.
rNI r Po f•,•ncnay Ibapa,wOr.Porn,is•Par.op.r.p or aver Vme.w .+O.eegaa viol. an
...leer mows OM*a copy.f M CareMtes of AawosH lemma a ow ~waft iM•oorsta•
Pent,.a Carpar.lEr• ono name and is .daima d O+.R.piarwsw Apra
Samuel St. Clair II stclairconstructiongroup@ mail.com
..a,-o d i opriir:i Ana - too.Aoe�... _� _
1619 Oberlin Road 1619 Oberlin Road
Cum.Wang __ _—
Raleigh, NC 27608 'Raleigh, NC 27608
c.•y ow. = re Ca, Oils 114$
t••ran,an. F.fasnnOn
The above Odorrnalion•lyre and caned to Ps toed d my ernbdadge And bead and ems prowled
by me wow oath(The torn mim b.signed by ala Financially Milapproble person II an ndladlnl
or he aponryrn-lact, or I not an rnSadlW by an dear.deader.penny or rained agent with
Is auttatly b aneousa msP miaeb b Ina Financially Reeponeibh Paforl) I agree to provide
oon.ded mono bon Maid Psis be arty claps in Ilse Infirmion prodded tweet ..
Samuel St Gab b Owner
type not nano Tile or Aallaaa
Signalise ONO
,LA. Di�4M__KJ a Pen d She Canty Of W4k1i
'Jet d Moots cob.+. hereby awl', alai SI,e kt14 ke S t-d r ...... _
perform',before win I1r Ayr and berm duly maws IMIUM Odpse Lae tee abe•e ion,ma..menial by leas
tamale my hen"and notanal sere the 2S_day d 10 2
•
P.••ts$OyF!. Mowryo T A R i P: keyeoaellrnloa OWNZ.31p
°LJ L1C :rr�'