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HomeMy WebLinkAboutNCC233607_FRO Submitted_20231208 "WI 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 i Development c be io COUNTY sedimentationCountyUnif ed controlv planlopmen haveOrdinan been completedeefor and th s approvedform byand an Wake Countyacceptable Departmenter sion ofand NORTH (.AROI 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 Sidney Creek Phase 3 2. Location of land-disturbing activity: Jurisdiction Zebulon (Wake Co. or Municipality) Highway/Street NC HWY 39 Latitude 35 . 811478 Longitude —7 8 . 2 6 8 7 9 9 3. Approximate date land-disturbing activity will commence: Fall 2022 4. Type of development(residential, commercial, industrial, institutional, etc.): Residential 5. Total acreage disturbed or uncovered (including off-site utilities and borrow/waste areas): 56 . 15 6. Person to contact should erosion and sediment control issues arise during land-disturbing activity: Name Fred Morin E-mail Address fmorin@drbgroup. com Telephone 1 . 919 . 4 3 7 . 0 2 2 5 Cell# Fax# 7. Landowner(s) of Record (attach accompanied page to list additional owners): DRB Group North Carolina, LLC Name(s) Telephone Fax or E-mail address 3000 RDU Center Dr. Suite 202 Current Mailing Address Current Street Address Morrisville NC 27560 City State Zip City State Zip 8. Deed Book No. 17 910 Page No. 548 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): DRB Group North Carolina, LLC fmorin@drbgroup . com Name E-mail Address 3000 RDU Center Dr . Suite 202 Current Mailing Address Current Street Address Morrisville NC 27560 City State Zip City State Zip Telephone 1 . 919 . 4 3 7 . 0 2 2 5 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. er4 et<< frill rw+ .1)ivVo VP 01 ika,>`.e,e- . Type orri name Title or Authority /�79/ 3 S6(' Date 11-0.1V, � Lc nnq n , a Notary Public of the County ofCrionU 6I. State of North Carolina, hereby certify that C,roa t 'I (n1 an appeared personally before me this day and being duly sworn acknowledged th the above form was executed by him. 11 Witness my hand and notarial seal, this L day of , 20 O �,�a •, '• % No ry • NARY �'U ll,Sl o�lC • My commission expires . i G PUBLIC c. 4,•'�<<E COV 0..•.