NCC240209_FRO Submitted_20240123

For TOWF Use Only Application #:
Project Name:
Date Received: Acres:
Date Approved: Fees Paid:
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4
vowWAKE FOREST
LAND DISTURBING (E&SC)
PERMIT APPLICATION, PLAN CHECKLIST, &
FINANCIALLY RESPONSIBLE OWNER (FRO) FORM
NO PERSON MAY INITIATE ANY LAND-DISTURBING ACTIVITY ON 1/2 ACRE OR MORE BEFORE THESE FORMS, FEES,AND AN
EROSION AND SEDIMENTATION CONTROL PLAN SEALED BY A NORTH CAROLINA REGISTERED PROFESSIONAL ENGINEER OR
LANDSCAPE ARCHITECT HAVE BEEN COMPLETED AND APPROVED BY THE TOWN OF WAKE FOREST. MULTIPLE SINGLE
FAMILY LOTS THAT DISTURB MORE THAN 1/2 ACRE ALSO REQUIRE A PERMIT AND SHALL FOLLOW THE STANDARD
PROCEDURES OUTLINED BELOW. SEE THE UNIFIED DEVELOPMENT ORDINANCE FOR ADDITIONAL INFORMATION AND FULL
ORDINANCE REGULATIONS.
NOTE: THE APPLICATION FEE OF$500.00 PER ACRE(ROUNDED UP TO THE NEXT ACRE I.E.:1.1 ACRES = 2 ACRES*
$500=$1,000)IS DUE AT TIME OF SUBMITTAL. IF FEES ARE NOT SUBMITTED THE PLAN WILL AUTOMATICALLY BE
DISAPPROVED.
DISCLAIMER:TOWN OF WAKE FOREST FEES AND CHARGES ARE SUBJECT TO CHANGE WITHOUT NOTICE.
PLEASE CALL 919-435-9443 TO CONFIRM CURRENT FEES AND CHARGES.
PART A: PROJECT INFORMATION
PROJECT NAME Reserved Bennett Park, Phase 1
1. TAX PIN NUMBER 1830-98-0861
2. ZONING GR5
3. LOCATION/ADDRESS OF TRACT 729, 733, and 737 Bennett Ridge Court

729, 733,
4. SUBDIVISION Bennett Ridge LOT# and 737
5. DEED BOOK 018793 PAGE 01219-01221
*PLEASE PROVIDE A COPY OF THE MOST CURRENT DEED
6. PURPOSE OF DEVELOPMENT Single Family Residential
7. TOTAL NUMBER OF UNITS 3
8. PERCENT IMPERVIOUS SURFACE
9. TOTAL TRACT ACREAGE: 1.42 Acres
10. TOTAL ACREAGE DISTURBED (INCLUDING OFF-SITE UTILITIES AND ROADWORK): 1.0 Acres
11. AMOUNT OF FEE ENCLOSED:
ROUNDED UP ACREAGE 1.0 Acres * $500/ACRE = $ $500.00
CHECK NUMBER PAID ON-LINE
DATE PAID 12/18/23
DISCLAIMER:Town of Wake Forest fees and charges are subject to change without notice. Please call 919-435-
9443 to confirm current fees and charges.
12. PROPERTY OWNER(S) (PROVIDE LIST OF ADDITIONAL PROPERTY OWNERS ON AN ATTACHED SHEET):
(Duane Williams)
NAME Williams General Contractors E-MAIL [e-mail]
ADDRESS 4487 Sunset Avenue, Rocky Mount NC 27804
PHONE CELL [phone]
13. PERSON TO CONTACT SHOULD EROSION AND SEDIMENT CONTROL ISSUES ARISE DURING LAND-DISTURBING ACTIVITY:
(Duane Williams)
NAME Williams General Contractors E-MAIL [e-mail]
ADDRESS 4487 Sunset Avenue, Rocky Mount NC 27804
PHONE CELL [phone]

14. PLANS PREPARED BY NV5 Engineers and Consultants (Michael Allen, Project Manager)
ADDRESS 3300 Regency Parkway,Suite 100, Cary NC 27518
EMAIL [e-mail]
PHONE [phone] CELL [phone]
15. DOCUMENTS SUBMITTED (SUBMITTER TO PLACE A CHECK MARK IN THE BOX):
FEES ($500per acre rounded u due upon 1st review) Developer
p� p to Provide
FINANCIAL RESPONSIBILITY OWNER FORM x
COMPLETED PLAN CHECKLIST X
PLANS (to be submitted with construction set) x
E&SC CALCULATIONS (1 copy) N/A
STORM WATER CALCULATIONS (1 copy) N/A
MAINTENANCE AND OPERATION AGREEMENT N/A
NCDOT Encroachment/Driveway Permit N/A
DWQ 401 Permit N/A
USACOE 404 Permit N/A
NCG010000 Permit COC ToonceTowF
Perbemit hasprovided been issued.
EROSION & SEDIMENT CONTROL SURETY oePeavde
APPROXIMATE DATE LAND-DISTURBING ACTIVITY WILL COMMENCE: March 2024
THE SOIL EROSION AND SEDIMENTATION CONTROL PLAN, supporting documents, maps and
computations submitted for the above tract conform to the requirements of all applicable
sections of the Town of Wake Forest Erosion & Sedimentation Control Ordinance outlined in
the UDO.
Project Manager 12/18/2023
SIGNATURE TITLE DATE

PART B. FINANCIALLY RESPONSIBLE OWNER(FRO)/PERSONS INFORMATION
1. PERSON(S)OR FIRMS WHO ARE FINANCIALLY RESPONSIBLE FOR THE LAND-DISTURBING ACTIVITY(PROVIDE A
COMPREHENSIVE LIST OF ALL RESPONSIBLE PARTIES ON AN ATTACHED SHEET):
Williams General Contractors 7,./AZ'`7' YY1,c'e:z 66/71' 1L, . 6/(fili
NAME EMAIL
ADDRESS
. oay /920 -1-TlYi. 0-21-0 (./
CITY STATE ZIP CODE
ZC2 2-6‘ /717 2,3--^2 2 77"1?
PHONE CELL
2. IF THE FINANCIALLY RESPONSIBLE PARTY IS NOT A RESIDENT OF NORTH CAROLINA,GIVE NAME AND STREET ADDRESS OF
THE DESIGNATED NORTH CAROLINA AGENT:
NAME EMAIL
ADDRESS
CITY STATE ZIP CODE
PHONE CELL
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
ADDRESS
CITY STATE ZIP

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PHONE FAX
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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.
^~— TITLE ORAUTHOR
�A/TE
SIGNATURE
|, 0OP-TFe- 5-, , a Notary Public of the County of
WAKC , State of North Carolina, hereby certify that
P' DL�AdC kV/LLlHM-C appeared personally before nne this day and being
duly sworn acknowledged that the above form was executed byhim.
Witness nny hand and notarial seal, this /6 day of DEC 61"8M , 30 2-3
. , Carter S.H8[Rell
Notary NOTARY PUBLIC
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/ /_ Franklin
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